QuestionQUESTION: My husband and I are trying for our 3rd child. It took me two years to get pregnant with my first daughter and then my second was a surprise 18 months later. I have never been "regular" my entire life. My periods have been better since I had my daughters. We have been trying for 15 months now. I have been using ovulations kits since Sept. and every month I have been getting an LH surge. The surges are not the same day every cycle though. My cycles are usually between 29 and 39 days. I always start my period 14 days after I get a LH surge. I had my dr. run a progesterone test a few months ago. It was 5 days after my LH surge and it came back at 8.9 (he said it was a little low, 10 being normal.) He put me on Prometrium starting on day 15 of my cycle. Last cycle I started taking it on day 15, but did not get and LH surge. I have NEVER gotten a surge that early before. Could the Prometrium be blocking ovulation? My dr. said to try again this cycle and if I don't ovulate he could put me on Clomid. Which I do NOT want to have to do, I've taken it in the past and all I got from it was huge cysts on my ovaries! Should I hold off on the Prometrium until I get a LH surge? Or do I need to take it before the surge? Help, I'm so confused! And should I really just suck it up and take Clomid?
Thanks for taking the time to read this, I know it's long!
ANSWER: Hello,
You have an ovulatory dysfunction. The best treatment would be to use Clomid or Femara to induce ovulation and regulate your cycles, however, you need to be monitored closely with ultrasounds to make sure that you don't produce ovarian cysts. As your doctor if he/she uses ultrasound to monitor the follicular development and time ovulation, and give HCG. If he/she doesn't, then you need see a different doctor, preferably a fertility specialist.
Prometrium should not be started until after ovulation. So, if you are going to continue trying on your own, you should use the prometrium after your LH surge, not before. However, you should know that the prometrium is not treating anything. The decreased progesterone level is because you probably did not ovulate, and not because the progesterone is low. Progesterone is created after ovulation occurs. If you use clomid or femara to induce ovulation, that should take care of the progesterone as well. I do supplement with progesterone in all my fertility treatments, however.
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.
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QUESTION: Thanks for the answers. My question is: How come I am getting an LH surge every month if I'm not ovulating? Can you get a surge and not actually release an egg? And I've already had ovarian cysts (a few have actually ruptured and I lost one of my tubes because of it), what can be done so that they don't get really large on Clomid and cause problems?
Thank you for taking the time to answer these questions!
AnswerHello Again,
If you have showing positive on an ovulation prediction kit (LH surge), then you are probably ovulating. I assumed that because your doctor recommended Clomid, that you were not.
In your case, the doctor is using Clomid to "enhance" your ovulation by getting you to ovulate more than one egg at a time. That statistically increases the chances of pregnancy by increasing the number of eggs available to find the tube. But that may not be the issue with you. You brought up the fact that you have had surgery in the past and that one tube was removed. That changes things completely. First of all, now you only have one tube to catch the egg after ovulation. Secondly, any pelvic surgery can cause scar tissue formation in the pelvis, which will block the egg from getting to the tube. If that is the case, no amount of Clomid or fertility drug will get you pregnant. You might want to consider IVF instead.
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.
