QuestionHello Doctor,
I am new to this site & some of the answers you have provided on this site answered some of the basic questions I had about cyst. I am ttc for 6 months now. Both me & my husband have some complications... I am having hypothyroidism and consuming 100mcg of thyroxin. My husband has excellent sperm count but his progressive motility count was zero percent 8 months back. He has been on MGAM tablets since then & in his recent test, his progressive motility percent has increased to 10%. So far we have been trying for baby in natural means. Now we are getting a bit nervous and anxious as time is flying by & I am 31. This cycle my gynaec put me through ovulation monitoring cycle. My Left ovary had a dominant follicle & grew about 2+ mm each day. Day 10 it was at 26, Day 11- 28 & Day 12- 31. My doc told me that this cycle it is likely that the follicle will not rupture and is a cyst...which is common to ladies and will mostly go off on its own. Having removed any hopes of conceivnig this month & awaiting my next cycle, I observed brown discharge last friday which was CD24. It is 3 days now.. and still it is only occasional spotting when I wipe off after using rest room. Not enough flow to stain a sanitory pad. I normally have regular periods with my cycles of 32-36 days. This is the second subsequent time that I am observing this kind of spotting about 1 week before my regular periods kicks in. Is this something I should be worried? I told this to my gynaec... she didn;t seem to be alarmed by it & asked me to visit her with the next ovulation monitoring report in the next cycle. Knowing my body... this spotting/brown discharge phenomenon is something new I am observing. Especially this month, I am feeling a little dizzy/light headed. I am not sure if I am reading too much into it due to lack of experience. At the same time I don't want to be negligent if my body is sending some signs/symptoms be it related to pregnancy or not. Can you clarify & help put my mind at ease?
Some stats for your reference:
Last cycle:-
32 days. Spotting observed for 3 days from CD25 through 27.
This cycle:-
CD1= 13Jul. CD11- 25/Jul- Follicle size 31mm & did not rupture.CD24- Aug 5th to 8th Aug(today) spotting.
Is there anything else I need to monitor, should I be worried?
Thanks for your help in advance.
AnswerHello Meena from India,
Your ovulatory follicle went cystic. That means that it did not ovulate/rupture. It sounds like your doctor was just watching a natural cycle and did not intervene at all. You probably should have been given an HCG injection once the follicle reached 20 mms to trigger ovulation. Now that you have a cyst present, it will prevent you from having a period until it resolves. The usual treatment for this is either to wait or to use the birth control pill to suppress the cyst. This type of cyst is called a "physiologic cyst." It will resolve either way and then you will be able to proceed into another cycle.
Based on the limited information that you have given me, I see that the sperm abnormality is a serious issue. A motility of 10% is severely abnormal and will prevent most natural pregnancies from occurring. To explain, only 10% of your husband's sperm are alive and able to swim toward the egg. This is an insufficient number. IUI (intrauterine insemination) where the sperm are injected into the uterus and tubes is a better alternative but still not very good with this number. The ideal treatment is IVF and ICSI where the sperm are injected directly into each available egg. The reason is that often when the sperm are abnormal like this, they are also functionally abnormal, meaning they do not fertilize well or don't have the capability to fertilize.
In light of this problem, I think your current doctor is leading you astray and not the proper doctor for you to see. You need to see an infertility specialist, which is a doctor that does ALL levels of treatment, including IVF. Only they will be able to provide you with all your options and lead you toward success. If you don't want to go in that direction because it is not natural or too invasive, then the alternative would be for your husband to do a trial of Clomid 50mg per day treatment plus a supplement like Proxeed or Fertility Blend (both ordered via the internet) for at least three months, then recheck to see if it has helped at all. In the meantime, I would not waste any money on infertility treatments if you are taking this path. Then if there is no change, go to IVF. If there is some increase, try IUI.
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
