Follicle Development & Ovulation After Endometriosis Surgery: What to Expect

Question
Two years ago i had an operation to remove some endometriosis from my ovaries.  Before this I was on on hormone injections to reduce the endometriosis.  Also after my surgery I was on Hormone injections again to stop my period ( I assume so that my ovaries could heal after op).  I am now showing signs of ovulation , regular cylcles and teh use of ovulation kits has shown that I am ovulating.  However on ultrasound checks now for two months my Follicle grows and my doctor tells me soes not release the egg to cpmplete the ovulation. So far I have had one round of ovulation boosting medication (similar to Clomid I guess) .  Again I must try a round again before being placed on injections.  My question is why is this happening in your opinion?  Is this type of problem common for women following treatment for endometriosis.  How long should I be on this medication before tring the injections.  Any help that you can give me I would be very grateful as I am getting upset about it quite often and very down.  I live abroad also and communication can be a bit of a barrier between my Doctor and myself,

Many thanks

Answer
Hello Marie,

Your current ovarian function has nothing to do with the previous endometriosis or hormones that you took.  If the hormones were still in your system, your ovary would still not work.  

The fact that you are having or had regular cycles with positive ovulation kits indicates that your ovaries are working correctly and ovulating.  Why your doctor is telling you that you are not ovulating is a curiosity, which I don't comprehend.

My recommendation would be to continue on the Clomid to assist your ovulation, or "boost" your ovulation to increase your chances of pregnancy.  Basically, we look with the ultrasound starting on cycle day # 10 then continue as needed until the dominant follicle or follicles are at least 18 mms.  Then usually an injection of HCG is given to trigger ovulation.  The only way to see if ovulation occurred by ultrasound from that point is to do an ultrasound each day to see if the follicle disappears.  Some physicians will draw a progesterone level but that is indirect, and sometimes Clomid will cause the progesterone to be low.  In any case, a competent fertility specialist will put you on progesterone starting 4-5 days after the trigger, so the progesterone test in that case does not help to detect ovulation.

I am not sure that I have full confidence in your doctor and if you are having communication problems, then maybe you need to seek out a different doctor.

I hope that helps,

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.