Question of the Day: Follicle Reduction

So as I was wasting precious time by goofing around on my blog I came across this post on another internet bulletin board. At the risk of getting flamed by posting on a patient board I have elected to reply here in the relative safety of my own blog/Facebook page! So here is the post.....

I was diagnosed with PCOS and am prone to overstimulating. Two of my IUI cycles were canceled due to too many follicles. I was googling and found Dr. Gordon's facebook page on follicle reduction. Just cautious whether someone here been through a follicle reduction procedure and what it is like. When I spoke to a nurse at my clinic, she told me they don't do follicle reduction. Instead I can choose selective reduction in the event of multiples or covert the cycle to IVF. Wonder why my clinic doesn't provide this procedure?

So first of all, a follicle reduction is performed the same day as an IUI (or coitus) and timing in terms of HCG is the same as for an IVF egg collection. Essentially, a follicle reduction is an egg collection but with 2 big differences. First of all, the eggs are discarded and not fertilized and secondly we leave 1-3 follicles untouched so that a pregnancy can occur once those eggs ovulate.

On this bulletin board some other individual opined "why not do IVF if you are going to do an egg collection anyway?" Yes, that is an option but usually I recommend follicle reduction in cases where the patient has maybe 6-8 follicles as opposed to the usual 10-15 that we like for IVF. Remember this is an IUI or coitus cycle that has resulted in an over-response. Usually the patient is not doing IVF for a reason......economic, religious, philosophic etc. In general, I have charged about $1000 for a follicle reduction on top of the charges for the whole cycle so it is not that expensive compared with converting to a full IVF which is $10-12,000 in most clinics.

I will say that the advice given by the nurse concerning selective reduction is a bit cavalier...Yes, fetal reductions (selective abortion) can be done but it is a Sophie's Choice situation and I really hate to ever put a patient into that difficult position. Better to cancel and walk away in my mind. When patients see 3-4 fetuses with cardiac activity it is really tough for them to undergo a selective reduction, although many do make that difficult choice.

Why don't all clinics offer this option. Beats me.