QuestionI am doing my first round of FSH injections (Puregon). I have PCOS, so my doctor had me take 50 UI of Puregon on day 3, 5, and 7 of my cycle.
By day 8, my I had one follicle measuring 19m. My natural LH surge started on day 8, so my doctor had me do an HCG trigger that evening.
I am concerned because my cycle was so short, and as a result my lining only had a chance to grow to 7.3mm.
My questions are:
1) My doctor would like to see more than one follicle mature in a future cycle, and mentioned increasing my Puregon dose to 75 UI every other day next cycle. Is there anything I can do in a future cycle to lengthen the cycle so that the lining has more time to grow?
2) I was previously on Clomid, where I never had any lining issues. I got pregnant and had an early miscarriage my third month of using Clomid, and did not achieve pregnancy after a further 3 months of using Clomid so my doctor recommended moving to injectibles.
I am wondering if I should go back to using Clomid, if I am going to have a thinner lining on injectibles (since I had such a short cycle using the injectibles)?
Thank you,
Stephanie
AnswerHello Stephanie from the U.K.,
I am concerned by the protocol that your doctor is using. It tells me that he is not an infertility specialist. Taking the Puregon in a everyother day method is not proper because the blood stream does not see a steady dose of the hormone. That being said, considering that you failed three subsequent cycles of Clomid after your miscarriage, it would be appropriate to move to injectables, if you had used the maximum dose of the Clomid. Clomid can be given up to 250 mg per day. Is that the dose that you used? If not, then you certainly have the option to try Clomid again at that increased dose. Most non-infertility specialists will only go up to 100 or 150 mg per day.
Certainly having a follicle ready at CD#8 is pretty fast. I would recommend that you doctor do a steady puregon dose (at the same dosage), on a daily basis, and consider adding supplemental estrogen in the form of vaginal suppositories, Estrace tablets used vaginally or Estrogen patches. This will help to accelerate the endometrial lining growth. In terms of the stimulation, he might want to consider a low-slow protocol, where he starts with a low dose then increases the dosage every three days. The estradiol level will need to be monitored so that you don't develop too many follicles. In other words, when you have three developing (medium sized) follicles, the dosage is held at that level.
I hope this helps.
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
