QuestionQUESTION: I have a beautiful boy who is nearly 2 - conceived first month with no issues except gestational diabetes and an emergency c-section. I breastfed for 12 months.
Pregnancy #2 was a missed miscarriage at 12weeks (first month conceived & heartbeat detected at 7 weeks) and pregnancy #3 was a miscarriage at 5 weeks.
Pregnancy #3 was conceived using Clomid (2 tablets daily starting day 5). I have low progesterone, although do ovulate on my own.
Today I was told that next month I will be on Clomid and will receive an HCG injection. I indicated that i ovulate on day 16 and he told me to come in mid cycle around day 16.
Would this be an hcg trigger shot to stimulate a better ovulation, or a shot to support the luteal phase as I understood it to be to support the luteal phase.
Can you have one hcg injection after ovulation only (rather than trigger ovulation and luteal phase injection)?
If so, how long after ovulation is the hcg injection needed?
and will i ovulate again as i have read that the hcg injection means that you ovulate around 42hours after it is given?
Thank you for your time.
ANSWER: Hello,
I am not sure what your doctor's strategy is in this case. In general, HCG is the "trigger" shot to induce ovulation. It is given BEFORE ovulation, not after. It may be that he is using it to support the luteal phase, but you would need to continue the injection in that case, since the HCG will wear out in a week. The better method for luteal phase support is progesterone. It can be given as a daily shot or as vaginal suppositories, which is what I would recommend.
I also cannot explain why your doctor is even using Clomid since you were able to get pregnant on your own before.
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.
---------- FOLLOW-UP ----------
QUESTION: I believe my dr is using hcg to support my luteal phase, and so from your information i would have weekly hcg shots until when?
He will also give me progesterone suppositories to support the luteal phase, so I will have both. Is this correct?
If the hcg is the trigger shot, I presume that I would need to go in to see him on day 14 (2 days before ovulation).
He gave me the progesterone suppositories for pregnancy #3 after the blood test came back with low progesterone, but it was too late and I miscarried the next day.
The clomid was prescribed because my bbt does not spike, and instead goes in 'staircase style' over a period of about 4 days where it reaches it's peak. With Clomid, the spike is a definite spike the next day.
My dr is about 70 years old - very experienced, but very old school in his methods and that is the reasoning for me questioning what he is doing to assist me.
Is low progesterone the cause of miscarriage, or is there an underlying reason that causes low progesterone - ie bad egg/sperm.
I have had some blood tests today and will know results in about a week. Can you please list the blood tests that I should be having after 2 miscarriages? I want to make sure that I am covering everything that should be.
Also, would miscarriage #1 (found out at 12 weeks that the baby measured only 9 weeks) be linked to miscarriage #2 (miscarried at 4.5 weeks) and is it likely that if I had low progesterone for the second miscarriage, that this could have been the cause for miscarriage #1 even though it lasted longer?
Any information you have would be gratefully received. It is a minefield out there for finding answers to questions!
Kind regards
AnswerHello Again,
If you are going to use progesterone, then you don't need the HCG.
Low progesterone can certainly lead to either non-implantation or miscarriage.
It is difficult to know or even surmise whether miscarriage # 1 has any relations to miscarriage # 2.
The most common reason for a miscarriage after 8 weeks gestational age is due to a major chromosomal defect or anatomical defect that kills the fetus.
The following tests are done for recurrent miscarriages:
1. Maternal and Paternal chromosomes.
2. Anti-Cardiolipin antibody
3. Anti-phospholipid antibodies
4. Hormone panel: FSH, LH, TSH, Prolactin, Estradiol
5. End of luteal phase endometrial biopsy for dating and B-integrins.
6. Hysteroscopy
7. Pelvic ultrasound
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.
