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From me to Nurse:


Good Morning Nancy ,

I’ve spent my weekend Googling different things concerning IVF after having another phone consultation with a doctor based in Las Vegas . He suggested that Micro-Flare Protocol was the worst protocol that a patient with Endometriosis could be on. This is what triggered my endless internet searching this weekend.

However, I couldn’t find anything to support his comment but I did find the suggested dosage for those on Micro-Flare protocol:

This is from dfwivf.com - the Micro-Dose Lupron 0.2 cc (40 μg), every 12 hours, and
continue daily, until time of hCG. Please Note: Micro-Dose Lupron is a special diluted
Lupron prepared by mixing 0.4 cc (2 mg) of standard Lupron with 10 cc of normal saline.
This will be prepared by our office or your pharmacy.

This is from ivf.ca/flare - Start Lupron on the third pill free day. We use a 50ug dose of Lupron twice daily -AM and PM- for these flare cycles. 50ug is a very small dose as compared to the usual Long Lupron protocol dose of 0.5mg (500ug). The Lupron needs to be diluted by the pharmacy or the doctor's office in order to be able to inject such a low dose.

This is from centerforhumanreprod.com –
F.Y.I. Lupron Dose Equivalents:
0.25 mg = 5 units (Ta) = .05cc
0.5 mg – 10 units (IU) = .1cc
1.0 mg = 20 units (IU) = .2cc
If you are on a “micro-dose” Lupron, stimulation, most likely it will come pre-mixed, if not we will dilute the Lupron for you.

You may be wondering why this is important. After reading the dosages above, I go to my refrigerator and pull out my box of Lupron. It is the regular Leuprolide Acetate Injection 1mg/0.2mL and not the diluted Lupron that should be used for Micro-Flare. So all this time I’ve thought I was on the Micro-Flare Protocol I have actually been injecting 20 units of regular full strength Lupron. This explains why I wasn’t getting a response to Follistim and also explains why it was taking a full 7 days of stims before getting any response from the stimulation drugs.

I am having a hard time understanding how this could happen two cycles in a row without it being caught by anyone. I was under the impression the Lupron that I picked up from Concord Pharmacy that was ordered for me was the Micro-Flare Lupron I needed for my cycle and all I needed to do was follow my instructions given to me. I feel that this is a huge oops by someone and it explains a lot. Injecting that much of a dose at the beginning of a stim cycle would definitely shut down the ovaries and possibly damage the eggs trying to grow which could explain the back to back chemicals since all my other testing are proving to be normal.
As I’m having a hard time trying to figure out how this happened, I’m hoping that you can explain to me what happened.

Thanks,
Tash!d@

From Nurse to Me:

Hi Tash!d@ – I don’t know where you got the idea you were on a micro-dose flare protocol. You were on a modified flare. Micro-dose flare is usually used on low responders – which has not been your problem. I am happy to pass on this information to Dr. Mitchell, but if you have questions about your protocol, you may want to gather all your information and come in to talk to her again – just so she can explain what she has prescribed for you and why she chose this protocol. Just give Stephanie a call if you want to set something up. Thanks. Nancy .

From Me to Nurse:

Hi Nancy,

I got it from Dr. ML as in all her consults with me she said Micro-Dose Flare which she said she was using after my Nov 1, 07 cycle for a better response. Not one time have I heard modified flare in any of my consults with her. I was told I was on Micro-Dose for Feb and Sept. Even in the follow-up I just had with her MDF was mentioned again.

From Nurse to Me:

Tash!d@ – I had Dr. Mitchell read your letter, and in 7 years of working for her, I have never done a micro-dose flare protocol – and she just doesn’t do them, so I’m not sure where the confusion came in, but I think it might be good for you to come talk to Dr. Mitchell so we can clear all of this up. Nancy.

So right now, I don't know what to think, what to feel, and still don't know what to do!