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How do you know I won’t ovulate before my retrieval? if I don’t take lupron, how can this be controlled?

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During the middle of a woman’s menstrual cycle, when the lead follicle reaches 16-18 mm in diameter, the estrogen level reaches its peak. This estrogen peak triggers the estrogen sensor – the receptors in the brain – through so-called “positive feedback,” and tells the highest hormone-producing command center (the hypothalamus) to produce gonadotropin releasing hormone (GnRH), which in turn tells the intermediate command center (the anterior pituitary) to produce leutenizing hormone (LH). The surge of LH triggers the final maturation of the egg. In conventional IVF, lupron (GnRH analogue) is used to down regulate (disable) the hypothalamus from producing GnRH in order to prevent a sharp increase in LH. Clomid, an estrogen antagonist, blocks the estrogen sensor, which then blocks the positive feedback loop so the hypothalamus does not receive the signal to release a larger amount of GnRH. Clomid works as efficiently as Lupron in preventing premature LH surge.

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