QuestionQUESTION: Hello my name is Amanda and I am 25 y/o from the US (cali). I have a 6 y/o daughter and a 4 y/o son both pregnancy occured the same month I got off my birth control pills. However I decided to get on Nuva ring after my son and stayed on it for 2.5 years. In May of 2009 I thought I had a miscarriage and ever since they I have had pain in my left ovary. My general pract. said an ultrasound said that I had a large amount of folicles & fluid in the "culdasac". the OB said the follicles were normal & I might have just been ovulating that day. after endless migranes & ovarian pain I decided to get off nuvaring since my husband & I were ready for another baby. I got off in October 2009 had my period in Nov. (one week after removing nuvaring). The next period was Dec. @ 32 days (normally 28 exactly). Then Jan. 2010 I had a period after 44 days, skipped Feb. and @ 46 days had a period in March. After that period I had nothing else until June when I started spotting brown, that lasted two weeks. Finally a new OB gave me provera, which stopped my spotting. On day 9 of my 10 day dosage of provera I finally began a period. But it was not heavy & still had a lot of brown coloring. Insurance changes landed me with a new OB who told me that all my & my husbands labs came back ok but that it was showing I no longer ovulate. He then perscribed me clomid 50mg for days 3-7 of my period. I bought a clear blue ovulation pack & July 4th it showed a happy face indicating that I was ovulating; but it only showed the happy face for one day. I dont understand why it was only there for one day? Also, the night before and that entire day I was having horrible, horrible cramps from my fight ovary.It is now 6 days past ovulation and I have pains again but this time they are back in my left ovary (like for the last year). Do you think I ovulated or was it most likely a false reading? Why am I having these pains still with no one trying to figure out what it could be? Could I have a blod clott? The OB said no cyst when he did my pap June 15th. He did say my pap came back that my cells were inflamed but he believes it is from the amount of intercourse my husband and I have been having. I'm sorry this is so long, but I am racking my brain trying to understand why I have sudden infertility, I truely believe it was the nuva ring; why I have these pains? One last thing, when would a pregnancy be accurate if the OPK says I ovulated on JULY 4th!? Thank you in advance, Amanda
ANSWER: Hello Amanda from the U.S.,
Let me start with your last question. Wait 14 days from July 4th to check for pregnancy.
It sounds like some type of ovulatory or ovarian dysfunction is going on that is manifest by irregular menstrual cycles. Did any of your doctors bother to evaluate that? Were blood tests done to look for FSH, LH, TSH, Prolactin? Any of these tests would reveal the cause of the irregular cycles and the reason the ovaries are not functioning correctly. I hate it when general Ob docs go straight to Clomid without any evaluation, and without following the patient for a response. I refer you to my blog for the correct way to do ovulation induction so that you will understand what I am referring to. Basically there are five dosage levels of Clomid and each person will respond differently, so different dosages may be required. The ultrasound is done starting on cycle day #10 to see if (1) you are responding to that dose, (2) how many follicles are growing (you don't want too many# and #3)when to give HCG to trigger ovulation and tell you when to have intercourse. If you doc did not do this, then they did not perform the treatment correctly.
In addition, an ultrasound can reveal if there is anything going on with the ovaries to cause your pain. A baseline ultrasound should always be done at the beginning of the cycle, before starting the Clomid, to make sure that a cyst is not present. If there is, this needs to be treated first (usually with the birth control pill or surgery). Clomid should NOT be taken if there is a cyst because it can cause the cyst to become larger leading to pain, or hemorrhage or emergency surgery.
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 follow me on Facebook at http://bit.ly/9Iw9oV
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QUESTION: Thanks for answering my questions... it really helped! The last time they did an ultrasound was in November(and that was ordered by my general prac.), but since I saw this new OB he did nothing. Before I saw the OB I have now, I saw an OB who ordered labs for myself and my husband. But he did not tell me what he was looking for. He was also the doctor who had prescribed me the Provera. By the time my labs were back in, my insurance changed and that is when I went to see my new OB. When I went in to see him I told him that my initial concern was that I was no longer having a period and that I wanted to know the results of mine and my husbands labs. He told me that my husbands were fine and that mine did not suggest that I was "early menopausal," which I did not know they were looking into in the first place. He noticed I was due for a pap and told me that he wanted to do one. I had already started spotting at this point and so he told me basically that I was no longer ovulating, with no explanation as to why that was so. He then said that if pregnancy was not something I wanted right away he would just continue to give me provera every two months, but that if I did want to get pregnant he was going to give me clomid. He told me to start taking it day 3 and continue the 5 day cycle and monitor my temp. in the mornings. A week later a girl from his office called back to say that my labs came back clear of any STD but that I had "abnormal" cells. She said not to worry it could be that they were "inflamed" from a lot of intercourse and that the OB wanted to do another pap in 4 months. I got an at home OPK, but like I said it only showed I ovulated for one day. Is this normal? Was it likely it was a fluke? Also, the lab did not make me feel at ease since I am still having pains in my ovary and sex has become pretty painful. Do you know if painful sex is a side affect of clomid? I am going to tell my OB that I want him to check my follicles and give me the HCG trigger, thank you for telling me that is what he should be doing! One last thing, when he did my pap, he said that I did not have cyst. Can they really feel cyst through a pap? How accurate would he be with saying this?
AnswerHello Again,
I answered most of your questions with the last letter, but in terms of feeling cysts at the time of the pelvic exam/pap, unless the cysts are large they cannot be felt.
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 follow me on Facebook at http://bit.ly/9Iw9oV
