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Esther Eleboh: When a Dominant Follicle Appears Early in an Antagonist IVF Cycle

Esther Eleboh/LinkedIn

Aug 16, 2026, 17:24

Esther Eleboh: When a Dominant Follicle Appears Early in an Antagonist IVF Cycle

Esther Eleboh, Reproductive Health Nurse (Head of Nursing Department) at Viva Fertility Clinic, shared on LinkedIn:

“When a Dominant Follicle Appears Early in an Antagonist IVF Cycle

A recent case reminded me of an important consideration during controlled ovarian stimulation (COS): not every follicle starts at the same pace.

The patient presented on cycle Day 3 in the evening. Baseline ultrasound showed multiple small follicles in both ovaries, with some measuring as small as 3 × 4 mm.

However, the right ovary already had a leading follicle measuring approximately 10 × 9 mm.

We commenced stimulation with exogenous FSH using an antagonist protocol.

By Day 3 of COS, the leading follicle had progressed to approximately 12 × 13 mm. At this point, Cetrotide (cetrorelix) was introduced to help prevent a premature LH surge and further premature luteinization.

With careful monitoring and appropriate intervention, we were ultimately able to achieve good suppression/downregulation by the end of stimulation.

The key lesson?

Baseline follicular synchrony matters, but seeing a leading follicle early does not automatically mean the cycle is lost.

Close ultrasound monitoring, timely antagonist initiation, and individualized stimulation management can make a significant difference.

Every IVF cycle has its own dynamics, and sometimes the scan tells us when we need to adjust the plan.

I am Nurse Esther, a fertility nurse passionate about helping couples overcome infertility and achieve pregnancy. I am also actively involved in fertility research and reproductive health education.”

Esther Eleboh: When a Dominant Follicle Appears Early in an Antagonist IVF Cycle