QuestionWe've been TTC over a year and I have never fallen pregnant. I ovulate regularly, so we are currently undergoing a set of IUI for unexplained infertility.
I have just completed my 2nd IUI with Puregon 75 daily from day 4 + Ovidrel as trigger (so the Dr can control the timing). Both times my estrogen and other hormones were exemplary, IUI occurred on day 12 and 7dpo progesterone levels looked very promising - it appears that I ovulated 2 follicles both times. Unfortunately they both ended in menses - earlier than usual?!
Even if an egg had fertilised this time, having my period come early is definitely not going to help us get pregnant!
I have a reliable 13/14 day luteal phase on natural cycles- but my period arrived 3 days early for IUI#1 and 2 days early following IUI#2. This time I also charted my basal temps this time and they were jumped around a lot (on natural cycles my post ovulation temps constantly increase or hold steady until day 12). This time my temperature started to drop 2-3 days after my progesterone blood test (dpo 10).
Have you heard of puregon/ovidrel causing a period to come early?
Or can you suggest something else that may be causing this?
We'd like to try IUI again - but not if it shortens my luteal phase - could taking additional medications (eg:progesterone) or an alternative medication help?
AnswerHello Lou from Australia,
A shortened luteal phase is called a luteal phase defect. It is not usually caused by the medication you are using for follicular recruitment and stimulation, nor the ovidrel, but it is seen in Clomid cycles. Your doctor should be using progesterone supplementation for the luteal phase, regardless. It is the standard protocol. There are many different kinds of natural progesterones that can be used (Crinone, Endometrin, Prometrium) and they are generally started the day after the IUI and continued until the pregnancy blood test. You have to have the pregnancy test because you will not get a period while on the progesterone and should not stop it until you know you are not pregnancy. If you are pregnant then we recommend you continue it until 10 weeks gestational age.
You state that your infertility is unexplained. Have you had a laparoscopy already? In most of the cases in my experience where the basic tests are negative, the patient will often have endometriosis. some of this can be treated so that natural pregnancy occurs, but some will require moving to IVF.
Good Luck,
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
