QuestionQUESTION: I am writing from Maine and have been TTC for 12 months now. When i went off the pill, i didn't not get a period and an OBGYN and a Reproductive endocrinologist diagnosed me with hypothalamic amenorrhea. I have tried three rounds of clomid and failed to ovulate and now im on gonadotropins (Menopur) I had an ultrasound this morning after 9 days of injections, and i have nothing over 10mm for follicles. Will the RE cancel my cycle.. is it bad that im not responding?
ANSWER: Hello Lori from the U.S.,
First, Clomid would not work with hypothalamic amenorrhea, which means that the hypothalamus is not producing GnRH (gonoadotropin releasing hormone), which would stimulate the pituitary to produce FSH and LH, which in turn, would stimulate the ovary to ovulate.
Menopur is the appropriate medication because it has FSH and LH in it to stimulate the ovaries. 9 days after starting the medication would not necessarily be long enough to have mid-sized follicles. In this case, he would check your estradiol level to see for response and probably incrase the Menopur dose. He may also just want to wait as day or two more and redo the ultrasound. In any case, the proper protocol with Menopur is to continue the medication and the same or increased dosage until an ovulatory follicle or two form. Then you would be triggered with HCG to induce ovulation. I would be very surprised if the cycle were cancelled.
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
---------- FOLLOW-UP ----------
QUESTION: I just wanted to write back and tell you that my estradiol level for day 5 was 40, on day 7 it was 148, and then today it was 419.. Do you think thats weird that my estradiol is raising but my follies aren't growing yet (Day 9 of menopur) Im hoping that maybe since it is rising, my follicles will kick into gear on the growth department.
AnswerHello Again,
The increasing estradiol level shows that either 1 follicle is growing or several smaller follicles are growing. You just need to wait and be patient. Something is definitely happening because it is the follicles that produce the estradiol (unless you are taking estrogen supplementation), and so as long as it is increasing, it signifies that the follicles are growing and the medication is working.
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
