QuestionQUESTION: I had a HCG tigger injection on day 13 of my menstrual cycle after taking clomid (level 100). I was told to get 'busy' 36 hours later. However approximately 8-12 hours after the injection I experienced bilateral adnexal discomfort, similar to ovulation pain, which soon disappeared 12 hours after the trigger injection. 24 hours after the trigger injection a pelvic ultrasound examination demonstrated the follicles had reduced from 25mm to 18mm. Does this mean I ovulated too early? Does ovulating 12 hours after the trigger injection reduced the chance of getting pregnant, compared to 36 hours after the injection?
ANSWER: Hello Susan,
Yes, it is possible that you ovulated early. In fact, we cannot predict when ovulation actually occurs. It can be 24-52 hours after HCG, which will also vary because you are still in a somewhat natural cycle. That means that your body can still mount an LH surge leading to ovulation, regardless of the HCG injection.
Generally, the way I run my cycles is that once I give the HCG, I have my patients had intercourse each day for 4 consecutive days. For that reason, I stop them from having intercourse from day # 10 until I say go. You might want to try that the next time if this cycle fails.
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: I have been taking clomid to optimized my chances of getting pregnant after several miscarriage and an ectopic pregnancy (which has damage one of my fallopian tubes). When trying naturally I always conceived first time from the patent tube and ovary, and never conceived from the damaged tube and ovary, but showed to ovulate. However since taking clomid i have failed to produce a high progesterone level (9). This current cycle I have had a trigger injection. If my progesterone level is low again this cycle, I am thinking of just trying naturally. My question is, will my cycle return to normal immediately, usually, or is this an unknown question? Therefore how long will the effects of clomid affect my cycle after stopping the treatment? Also do you recommend that I stop or carry on with clomid?
ANSWER: Hello Again,
Clomid is a short-acting medication and will clear from your system immediately. It will not affect subsequent cycles.
I think you need to see a fertility specialist and have a clear treatment plan. This may or may not include Clomid, but the way that you are currently using it is haphazard and doomed to fail.
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 am just experiencing my 5th early miscarriage, one was an ectopic, a second had a chromosomal defect (but at no further risk of a recurrence), two unexplained, the the last one is just being karyotyped. Recently I have been told that I may have a blood clotting problem (?antiphospholid antibody syndrome), the doctor said my results were borderline (one result was 7, the other 4). For the next pregnancy I think I will be put on asprin to help my chances. Usually, do women with APS on asprin have a good chance of having a baby? Also could you explain the figures '7' and '4' for me. I am under a good doctor but will not see her until the karyotype returns (in about 5 weeks), but my curiosity is growing, and I find some Internet information confusing. Thank you for the help.
AnswerHello Again,
Antiphospholipid antibody syndrome is diagnosed through the evaluation of 23 markers, not just two. If you look up the Reproductive Immunology Associates website, they will give you detailed information regarding recurrent miscarriage and this syndrome. They are immunologists specializing in recurrent miscarriages.
In your case, I would prescribe Aspiring 81 mg tablets per day and Heparin 2000 U subcutaneous injection starting on the first day of your cycle, then add Endometrin 100 mg three times per day vaginally starting afer ovulation. This is how I treat my recurrent miscarriage patients.
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.
