QuestionHi -
I am 38 and have been trying to get pregnant with my third child for almost a year. This last cycle I took femara cd 3 -7. I had an ultrasound on cd 12 and they found one follie that was 26 mm and what could be a dermoid cycst. My questions are -
1. Is the follie they found too big? I've read mixed things about either the egg being over-mature or this being a cyst. I had already detected my LH surge the night before so I was getting close to ovulation.
2. Given the size of the follicle, should I continue to try femara or does it appear I've over stimulated from the drug? I've never ovulated early before (usually cd 14-17) so this was a surprise.
3. Should I be concerned about the dermoid cyst and can this be contributing to me not getting pregnant?
Thank you so much for your response!
AnswerHello Holly from the U.S.,
Let me answer your questions in order:
1. Yes, the follicle is too big. Usually ovulation will occur when the follicle reaches 24 mms. If it is allowed to grow bigger, and ovulation is not triggered before then, the egg within it will over-mature and will not be viable. The next cycle they should see you by cycle day#10 at the latest to begin the ultrasound surveillance.
2. You can continue to try Femara. The size is not considered "overstimulation" only that ovulation was not triggered on time. That was because you were not seen until you were cycle day #12. Actually, I'm not too sure that the Femara, at your current dose, did much for you. In a normal cycle, a woman will only create on follicle to ovulate (just as you did). The goal with fertility medications is to stimulate two to three ovulatory sized follicles. That is what increases the pregnancy rate. I would recommend increasing the dosage in the next cycle.
3. Dermoids are considered to be benign ovarian tumors. It needs to be removed. It does not interfere with getting pregnant, but in rare cases, the Dermoid can be hiding or be a malignant tumor. I would get this taken care of as soon as you can. 99% of Dermoids are bening so don't be too worried.
Sincerely,
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 facebook and twitter with me at @montereybayivf
