Microgynon Downregulation for IVF: Bleeding & Timing - Patient Question

Question
Hello,

I am due to start my fourth cycle of IVF during August and for this cycle they want me to down regulate with Microgynon 50.

I normally have a 28 day cycle and have never used a contraceptive before so I am a little curious to know what the timing of my bleed will be and when would be best to start the pill.

I have my down regulation scan booked for the 20th August and they want me to take it for at least 14 days by the appointment.

My next periods are due on the 6th July and the 4th of August, which would mean that I would be on Microgynon for either 46 days (the longest recommended is 42 days but my consultant is ok with it) or for 17 days.

I am worried that if I only take it for 17 days that the resulting bleed will be minimal and hard to pin point but the 46 days bleed might be intense and persistent.

Which duration would you recommend?

Does it matter if I am still bleeding when I start stims?

Also, I have read that spotting is common for people taking Microgynon for the first time. How would I identify my cd 1 (starting stims on cd 2) if I am also spotting?

How many days after stopping the Microgynon would you expect bleeding to occur?

I have tried to ask my consultant these questions but English is not their first language as I've had to travel abroad for AOA. I live in the UK.

Thanks

Answer
Hello Louise from the U.K.,

In terms of the start and end time for the OCP, you'll have to ask your doctor.  I cannot answer that one because it is a protocol question and protocols can vary wildly.  I might add that a 50 mcg pill is a pretty high dose pill these days.  The newer pills are 20-30 mcgs.  You might also want to ask why they are using such a high dose pill.

In terms of identifying your period, again, that is a question you'll have to ask your doctor.  Most IVF protocols are based on scheduled dates, and not necessarily when you start your period like you would do in a natural treatment cycle.  The designated day is usually called cycle day #2 and this is arbitrary in terms of when your bleeding actually starts.  It is the day that is designated for you to start your stimulation medications.

There are two major risks to traveling abroad for IVF: (1) communication and (2)quality of care.  In many foreign countries, there is no oversight or regulations with IVF centers.  As the saying goes, "you get what you pay for."  I hope that will not be the case with your cycle.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf