QuestionI started clomid at the beginning of last year following secondary infertility diagnosis. I was found not to be ovulating, and that I have one permanently blocked tube on the left. On my first cycle of clomid I had 2 strong folicles on the left and a small one on the right. I had the HCG trigger and did not get pregnant. On the second cycle I had 2 strong folicles on the right (the side where the tube is clear) and I got pregnant that month. I miscarried at 8 weeks. I am now on clomid again. I went for my ultrasound on day 10 of cycle and I had one large 20mm folicle on the left, and 2 small (12mm) folicles on the right. They wanted to give me the trigger, saying that a left folicle egg can travel down the opposite tube, but I have heard this is very rare - and instead opted to wait 3 more days for the trigger, so that the folicles on the right can mature. I have been having intercourse in between just in case I ovulate naturallty. Have I done the right thing? I can't seem to get a straight answer from my doctor as to whether an egg can cross over to the other side, and how likely this is...
Answer
Dr. R
Hello Joanna from the U.K.,
Unfortunately, there is a general misconception that the egg goes into the tube on the side that it ovulates from. That is not correct. Women with only one tube, on the opposite side of the ovary that ovulated still get pregnant. In actuality, what is happening is that the tube hangs down about 2 cms from the ovary, in its normal position. This is into an area behind the uterus called the culdesac. When you ovulate, and it can occur from any surface of the ovary - the ovary is a three dimensional structure, the egg goes out of the ovary with the fluid that it is in. Imagine a object in a tub of water. When you pull the drain, all the water rushes out through the drain and the object goes with it (if it is small enough). In the same way, the egg exits the ovary and all the fluid and egg fill up the culdesac, which is like a bowl. The egg then bobs along within that fluid until it contacts the fimbria (fingers of the tube) on one side or the other. Of course if it contacts the side that is blocked, you won't become pregnant, but it has the same chances of contacting the good side. So, you doctor is correct.
The only problem with waiting, is despite the fact that you want the right follicles to grow and ovulate, in a natural cycle (like with Clomid#, the body will trigger ovulation once the dominant follicle reaches ovulatory size #18-24 mms), so your best intentions may not come to pass anyway. It is good that you decided to begin having intercourse.
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 and twitter with me at @montereybayivf.
