Dear Dr Sher,

I’m 37.5 years old and have a long history of unsuccessful IVF rounds albeit with one successful cycle four years ago. My case has been classed as quite challenging. I’ve undergone 13 IVF cycles under the care of a leading UK physician and have good ovarian reserve for my age notwithstanding PCOS. Throughout the past 13 cycles, I’ve consistently had between 19-35 eggs retrieved all being immature. I did have one successful cycle which was a rescue IVF as 8 of the eggs matured overnight in the lab and ICSI was successful. I’ve just finished completed another disappointing cycle in which 19 immature eggs were collected on day 19 of my cycle. The usual protocol applied for me has been to use Letrozole throughout treatment starting on day 2 or 3 of my cycle along with GONAL-F. Fyremadel is then administered once the lead follicle reaches 14mm. Due to concerns of ohss (which I’ve never had with all 13 cycles), a trigger of 0.5 buselin and 7-8 clicks of Ovitrelle is administered typically any day between day 14 – day 17 of my cycle with an EC 36 hours later. I’m frustrated and would appreciate your thoughts on what other protocol to try. I would like to give my child a sibling but cannot continue to do the same thing and same results!

Your thoughts would be gratefully received.