QuestionQUESTION: Dear Doctor,
I am Chitra(Age 26) writing from Coimbatore, India
I have been married since 2 years and i was diagonised with PCO Oct 2010. I have irregular periods, my periods lasts for 10 days every month. I started taking treatment from october 2010 and took tablets Fesovit, folic acid and metformin 850 mg twice a day and doctor told to try to conceive naturally for 4 months.
Till April 2011, my periods was irregular which lasts for 10-15 days. On 19-Mar-2011, I got my periods which lasted for only 4 days. From Day3 to Day7 I took Clomid 100mg(Siphene) as per doctors advice and went for follicular study from Day10. From Day10 -Day16, the follicular study report shows that 'No Dominant Follicles' and doctor told me to stop going to follicular study and told me to meet her once i get the next periods. In case if i am not getting periods till 05-May-2011 she told to take the pregnancy test and if it comes as -ive i was asked to take meprate 10mg for 5 days.
I took HPT on 05-May-2011 and it came positive and took a early pregnancy scan on 26-May-2011 and it showed the gestational period of the foetus is 7 weeks 2 days. Doctor told it is normal and i was told to take a NT scan on 30-June-2011 in Mediscan, Chennai.
In this NT scan, the report said that the foetus is suggestive of EXCENCEPHALY and the survival of the foetus is 100%fatal and I was told to terminate the pregnancy.
I terminated the prenancy and had done D&C and sent the foetus and placenta to autopsy. I will get the autopsy report by november 2011.
After this, my periods was very irregular. On july 24 2011 i got my periods and it extended for about 20 days and doctor told to take meprate 10mg for 21 days. I got the next periods on 12-sep-2011 with normal flow for 5 days and very mild flow for 4 days. Then the periods got stopped completely for 4days and after 4 days again i got my periods. Doctor told to take meprate 10mg for 10 days and asked me to meet her day2/day3 of my next period. I got my period on 10-Oct-2011 and i am going to meet the doctor tomorrow.
I am frustrated of my condition and Can you please tell me whether i am on the right track?
Please tell me what may be the reason for the exencephaly condition? Please guide me.
Thanks In Advance
Chitra
ANSWER: Hello Chitra from India,
Since you were able to get pregnant by using Clomid, and it is clear that your doctor is doing the cycles correctly by using ultrasound surveillance, I think that this is right course of action and you just need to try again. You have shown that Clomid can correct your ovulatory dysfunction and you can get pregnant. I don't think you need any more intervention.
The cause of the fetal abnormality is not explainable. It has been related to some inherited genetic abnormalities and medications. A lack of Folic acid has also been found to be a possible cause and therefore it is recommended that all women attempting pregnancy take extra folic acid of at least 1 mg. This disorder, also known in the broader category of neural tubes defects, is due to the non-closure of the neural tube in the formation of the embryo. It is a developmental defect. I would recommend that you undergo genetic counseling and testing prior to another pregnancy, and you begin taking Folic acid prior to beginning attempts. If the genetic testing for yourself and husband return normal, then hopefully this was a one time abnormality and won't recur.
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
---------- FOLLOW-UP ----------
QUESTION: Dear Doctor
Thank you so much for your reply.
I got my last periods on 10-Oct-2011 and from Day 12 doctor asked me to take meprate 10mg from Day12 - Day26. i.e. Till 04-Nov-2011 i have to take meprate 10mg. i am taking meprate as per doctor advice but today(02-Nov-2011) i got brown discharge and i have a very light pain in my abdomen. Usually i get periods 3-4 days after stopping meprate. But this time, before stopping meprate i got a brownish discharge. Does it indicate something? or is this normal. Could you please clarify?
Thanks in advance
chitra
AnswerHello Again,
This is a question you should be asking your doctor. His office nurse or the doctor himself should be available to you to answer questions or concerns. Don't let him get away with not providing adequate or good care.
The brownish discharge is not significant and does not mean anything. There is no need to worry.
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
