QuestionHello Dr. Ramirez,
I hope you can advise me: I have had 3 IVF cycles, 2nd one cancelled due to
OHSS, the rest to the pregnancy test. However, each time I came on my
period about 2-3 days prior to the pregnancy test.
The 3rd cycle, they gave me 'double progesterone' (I injected myself with the
maximum dose/2 injections-worth of PIO), yet still came on my period
early/before the pregnancy test.
My question is this: They have said they have no 'protocol' for giving me any
higher dosage PIO than what they already do, but have no explanation for
why I bleed early. Please can you shed some light as to why the progesterone
is not working, or why I am bleeding early?
On this 4th cycle about to commence, they have prescribed the 'double
gestone' injections and advised me to take baby aspirin (I have found only
75mg Aspirin here in the UK).
I am a good responder, but get loads of follicles, so they changed my
previous from Menopur to Puregon, as it is purer/more gentle on me.
I have never been able to have eggs/embryos frozen. I have never been
pregnant. I have just turned 38. I had PID at 23 (couldn't put their finger on
what it was, so gave it the umbrella term of PID), which the emergency
operation to save my life itself caused tubal damage at 23 years old. I'd gone
to my GP (doctor) for almost a year complaining of abdominal pains, but he
didn't believe me... until one day I collapsed from the pain.
Sometimes, looking back over the years, I had 'felt' pregnant, but only to
come on my period weeks late. I have PCOS without hirtuism, so was hard to
diagnose until very recently. As I say, I have never been pregnant, to my
knowledge - sorry for rambling on, that was to give you some of my history.
Before they would try any IVF they told me I had to have my tubes removed,
as it improves the chances - so I have had a bilateral salpingectomy.
This 4th protocol (last one as we are unable to afford anymore) and I am still
intrigued as to why I bleed before the pregnancy test, when the progesterone
is supposed to stop one bleeding at all?
I really appreciate your help in advance.
Best wishes,
Angelique
AnswerHello,
I am a little stumped as to why you would have bleeding prior to your pregnancy test. The double progesterone (I presume 100 mg per day) should be enough to keep the lining intact, unless there was not adequate estrogen stimulation. I presume your estrogen level was high since you are a PCO and prone to hyperstimulation. I add additional estrogen to my patients after retrieval just to be sure. I use an estrogen patch called Climara 0.1 mg, two patches per week. You might want to consider that. Also, I use double progesterone but as a 50mg injection and a progesterone vaginal cream called Crinone 8%. The vaginal form has been shown to go directly to the endometrial lining. Your doc might want to check the progesterone level in the luteal phase and increase the progesterone as needed (this would be before the pregnancy test). At this point, with the information that you gave, that is the only explanations I can give.
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.
