QuestionIam 40 years old .. I had 2 miscarriages last year.. No heart beats detected.. I have been trying for a year now after the last miscarriage .. uterus clesr - tubes clear .. Progesterone after miscarriage was 18 .. I ovulate every month (follow at the doctor's) and no good .. the last two months I have been having 2 mature follicles a cycle.. but the last cycle I had two follicles 23 and 19 but NO Rupture .. I asked doc to give me HCG injection but she said it can only be used in induced ovulation .. This happened to me once before in one of the cycles .. My question is : 1- Can we use Pregnyl injection in natural cycles ?
2- If this Unrupture problem happen in non consecutive random cycles does that require a treatment ?? IS there a treatment?
3- Why am I ovulationg 2 follicles a month?
AnswerHello Omneya from the U.A.E.
Yes you can use HCG in a natural cycle. There is absolutely no reason not to. Your doctor is wrong in this account and this is an indication that your doctor is probably not an infertility specialist. At your age, you should be seeing an infertility specialist.
I don't know how a conclusion of "unruptured" follicle could be made in a natural cycle. When a follicle does not ovulate it will lead to the formation of a persistent physiologic cyst and you will not have a period. Is that what occurred? Considering that you have been regular, I would doubt that you had an unruptured follicle. More that likely, the ultrasound were done close enough in sequence to detect ovulation. Keep in mind that an ovulatory follicle will refill with fluid and become the corpus luteum.
You should not be ovulating 2 follicles are month unless you are taking fertility medications. However, ovulating more than one egg a month is what leads to natural fraternal twinning so it can happen sometimes.
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
