3 vs 4 weeks active pills BC's

[cinnamonstick]

Hello! Thank you for all your help!

I am planning on IVF in June and need to start BC's in May. I had the "borderline" FSH of 11.6, 37 years old in June, 19 AFC's at check. I did have a successful IVF three years ago round one w/ FSH then 7.6 and AFC 14. Unexplained IF/arcuate uterus.

I was hoping I could do 4 weeks of active BC's (vs three weeks of active) to make better timing for IVF/ER. My Doc said it was ok...but he also said USUALLY women do only three weeks of active BC's.



Thanks for any info! I appreciate your input! This is important NOT to mess up.

[Scott Roseff MD]

I would personally (in my patients) prefer not to prolong BCP's in my patients who may have DOR. I also don't do Lupron down-regulation in my patients who may have DOR.

I hope this helps,
Have you seen OUR renowned IVF success rates?!
Dr. Roseff in FL

[cinnamonstick]

THANK YOU!!!!

OK--got the Lupron part. I will discuss with RE. We didnt go over any "new protocol" with the discovery of the FSH. BUT-the OLD protocol said start Lupron three days before the active BC's are up--though stims....I guess that is "Down regulation-Lupron".

Do you use BC's at all still then? Just 2-3 weeks?

Thanks!

[Scott Roseff MD]

Yes, I use BCP's. Good luck!
Dr. Roseff in FL

[kiran19]

disfunctional uterine bleeding and pregnancy

Hi Doctor,

I would like you to answer my questions regarding disfunctional uterine bleeding and pregnancy.

Here is a bit about myself:
I am 42years and have been TTC for 1year.
I use to have regular cycles but then I was on BC for 4years. I stopped taking BC in 2007 July and have been TCC since 2008March.After stopping BC I have been getting regular but short cycles.
I did follicular monitoring and ovulated on day 15.
My FSH is 12.7. I took 1cycle of clomid last July 08 and ovulated on the 18th day.This was followed by a long cycle of 38days. I am getting worried about my short cycles lasting 20days to long cycle lasting 38days and to add to this worry list I have started having midcycle bleeding from this year Jan 09. Every month around my 13th or 14th day LMP I bleed for 3 to 5days, then after 9 days of no bleeding is followed by heavy periods lasting 7-8days.I start getting PMS symptoms on day 6 LMP. I am finding it more and more difficult to know when I ovulate if at all I do and am desperate for a baby of my own.
I got an ultrasound done and my uterus is normal so I assume polips and fibroids are ruled out.
Please guide me as to what should be done as I am planning for a kid and am getting quite impatient .
I was planning to get my HSG test done but am still bleeding so have to postpone it.

I also would like to know if my husband should get his semen analysis done as he is 56years old or age does not affect fertility in older men?

I look forward to hearing from you asap. I will keep checking for your reply anxiously

[Scott Roseff MD]

You SOOOOOOOOOOOOOOOOOO need to see a board certified reproductive endocrinologist yesterday!!! You're evidently spinning your wheels with your gynecologist and should see a specialist ASAP.

Clomid is contraindicated in women with poor ovarian reserve (it implies this in the package insert and medical good sense dictates this as well). Clomid seldom "works" in women over 40, and you are 42. Your FSH would be considered elevated by most specialists and may signify significantly diminished ovarian reserve.

It's also shameful to have a 42 year old put on Clomid without having her male partner's sperm checked. Also, sperm quality in a 52 year old male may be comprimised based on his age. Also, you should be counseled regarding your risk of fetal aneuploidy (genetic abnormalities) due to your age and your husband's age.

I could go on and on and on, but in the interest of your time I'm telling you to get thee to an RE ASAP!

Hope this helps,
Dr. Roseff in FL

[kiran19]

More questions on fertility

Hello Dr Roseff,

Many thanks for your prompt reply.
I am in India and have no luck so far finding a RE. We have gynaes and fertility experts here, do they qualify as RE?

I would like you to answer some of my specific questions:

1)My gyane suggested taking laterozole and go in for follicular monitoring(FM) followed by IUI. Do you suggest this as an effective option to get pregnant?

2)Should I get HSG test to check for fallopian tube blockage? My freinds tell me it is unlikely, as I did get pregnant naturally 13years ago but had to abort due to some personal problems.

3)About my mid cycle bleeding problem, since my ultrasound of uterus showed normal uterus, please advise that this rules out polips, fibroids and endometeriosis or do I still need to check further?

4)My husband is against the idea of getting his semen analysis done. He says that some 25yrs ago he had made his girlfriend pregnant so he is fertile and says his count is ok.Now if I assume due to age his semen count/quality is low, is there any medication that can be taken to improve it? He is perticular about medication as his father had prostrait cancer and he is taking precautions.

5)Last but not the least, I do understand IVF with doner eggs is an option but I am against the idea and want to use my own eggs.How good are my chances for IVF with my own eggs? I had my FSH checked thrice. It was 12.2, 2.3, 12.7 and different times on day 3.

Look forward to your reply anxiously.

Thanks/Kiran

[Scott Roseff MD]

1)My gyane suggested taking laterozole and go in for follicular monitoring(FM) followed by IUI. Do you suggest this as an effective option to get pregnant?
==> It's illegal for me to tell you what to do or not do, so I can't guide you on this (sorry). Letrozole is not approved by our FDA for treatment of infertile women (it's a cancer drug).

2)Should I get HSG test to check for fallopian tube blockage? My freinds tell me it is unlikely, as I did get pregnant naturally 13years ago but had to abort due to some personal problems.
==> My personal bias for my patients is to have an HSG sooner rather than later.

3)About my mid cycle bleeding problem, since my ultrasound of uterus showed normal uterus, please advise that this rules out polips, fibroids and endometeriosis or do I still need to check further?
==> An ultrasound may not rule out polyps or fibroids inside the uterus (we may need to instill a sterile liquid or contrast dye in order to distend the uterus and check for these things). An ultrasound does not detect endometriosis (unless it forms a cyst, which is less common). The ONLY way to diagnose endometriosis with certainty is by laparoscopy.

4)My husband is against the idea of getting his semen analysis done. He says that some 25yrs ago he had made his girlfriend pregnant so he is fertile and says his count is ok.Now if I assume due to age his semen count/quality is low, is there any medication that can be taken to improve it? He is perticular about medication as his father had prostrait cancer and he is taking precautions.
==> Sperm can change from fantastic to terrible in 6 months, let alone 25 years. Just because sperm was good two and a half decades ago it doesn't necessarily mean it's good now. If it's poor, the possible treatments to improve it depend on the evaluation necessary to find out why it is poor.

5)Last but not the least, I do understand IVF with doner eggs is an option but I am against the idea and want to use my own eggs.How good are my chances for IVF with my own eggs? I had my FSH checked thrice. It was 12.2, 2.3, 12.7 and different times on day 3.
==> An FSH without an estradiol done at the same time is meaningless. The FSH has to be taken into account for the normal values set forth by the lab that ran it, so an FSH of 12 in one lab may mean one thing while a value of 12 in a different lab may mean something different. Also, age has to be taken into account (and may be more important than FSH). For example, an FSH of 12 in a 30 year old may give a far better prognosis compared to an FSH of 12 in a 42 year old.

Hope this helps,
Dr. Roseff in FL (USA)

[kiran19]

Ovulation and luteal phase defect

Hello Dr Roseff,
I am extreamly impressed by your replies and am glad to have found your website !Thank you so much for your quick replies.

Here are some more details on my harmones taken in June 08 on day 3
FSH- 12.20mIU/mL
LH-20.75mIU/mL
Estradiol E2 -33.70pg/mL
Prolactin-17.11ng/mL
Estradiol E2 taken on day 12LMP- 117.83pg/mL

Please advise me the folllowing:
1)Do I have enough oavrian reserve and what can be done to increase egg quality besides a healthy diet?

2)When I did Follicle Monitoring done twice last year, I ovulated on day 15 and my luteal phase was 16days, the other time I ovulated on day 19 and luteal phase was 18days. So I can say that on an average my luteal pase is 17days past ovulation. Now of late, my cycles are getting mostly shorter from 20-23days and sometimes they are 38days long.
My question to you is, in the shorter cycle of say 23days, does it mean I ovulate on day 6from LMP? OR is it that I ovulate around day 15 and have a luteal phse defect?

3)I was earlier timing intercourse around day 6, but since I get mid cycle bleeding on day 14, does it mean that I take it as an indicator of ovulation and have intercourse around midycle to conceive? I am quite confused.I have got a LH surge predictor kit but do not know when to use it for testing due to this confusion.

4)Every morning for the past 1year I am taking my BBT.The rise in temperature use to take place around day 13 but in my shorter cycles with midcycle bleeding all has gone hawire.There is a rise in temperature around day 8 and then a dip during midcycle bleeding and then again rise in temperature for about 9days before it falls till next period arrives.
This is making me feel as if my leutal phase has reduced from 17days to 9days. Please advise if my thinking is correct.

5)If not laterozole and clomid, what should I do to ensure I ovulate?
I know my gyane will adv on injection drug to enhance ovulation but I am scared that I might put on unnecessary weight gain. Pls confirm if this is possible.

I look forward to your replies.

Thank you
Kiran

[Scott Roseff MD]

Kiran,

1)Do I have enough oavrian reserve and what can be done to increase egg quality besides a healthy diet?
==> My center would consider someone aged 42, with an FSH of 12.2, as having a low chance of pregnancy success. Ask the best fertility specialist you can find what their success rate is for someone at your age with your FSH level.

2)When I did Follicle Monitoring done twice last year, I ovulated on day 15 and my luteal phase was 16days, the other time I ovulated on day 19 and luteal phase was 18days. So I can say that on an average my luteal pase is 17days past ovulation. Now of late, my cycles are getting mostly shorter from 20-23days and sometimes they are 38days long.
My question to you is, in the shorter cycle of say 23days, does it mean I ovulate on day 6from LMP? OR is it that I ovulate around day 15 and have a luteal phse defect?
==> Without tracking your current cycles, it's impossible to say. However, as a broad generalization, I can tell you that as women age, they tend to ovulate earlier in their menstrual cycles. So, if a woman ovulates on day 9, and has a 14 day luteal phase, that would give her a 23 day cycle. This is seen in what we call "perimenopause" and is not a good sign....

3)I was earlier timing intercourse around day 6, but since I get mid cycle bleeding on day 14, does it mean that I take it as an indicator of ovulation and have intercourse around midycle to conceive? I am quite confused.I have got a LH surge predictor kit but do not know when to use it for testing due to this confusion.
==> Again, you may be perimenopausal, and should discuss this possibility with the best and most qualified fertility doctor you can find.

4)Every morning for the past 1year I am taking my BBT.The rise in temperature use to take place around day 13 but in my shorter cycles with midcycle bleeding all has gone hawire.There is a rise in temperature around day 8 and then a dip during midcycle bleeding and then again rise in temperature for about 9days before it falls till next period arrives.
This is making me feel as if my leutal phase has reduced from 17days to 9days. Please advise if my thinking is correct.
==> BBT's are inaccurate and difficult to interpret. Your short menstrual cycles may be a sign of perimenopause and you should discuss this with your doctor. Stop taking your temperature!

5)If not laterozole and clomid, what should I do to ensure I ovulate?
I know my gyane will adv on injection drug to enhance ovulation but I am scared that I might put on unnecessary weight gain. Pls confirm if this is possible.
==> Letrozole and Clomid are generally ineffective for achieving pregnancy in a 42 year old with an FSH of 12.2. Ask your doctor if injectable fertility drugs (such as Follistim) may be of benefit to you, vs. donor egg IVF.

In the interest of time, please try to limit your questions to the most important one or two. I would appreciate it.

Hope this helps,
Dr. Roseff

[kiran19]

Hi Dr Roseff,

Thank you once again for all your replies.Ok, I will ask only 3questions this time .

1)Pls adv why clomid/laterozole does not work in a 42yr old? when I took clomid, I did have 5 follicles developing and 2 matured simultaneously.I do know clomid is bad as it dries CM so maybe that' s why I did not conceive then ,but leterozole doe not cause drying of CM so why is this not effective in your openion?

2)Do you suggest after I get HSG test done,then I should go for Follistim shots with FM and IUI or should I surpass all this and go straight for IVF? I will proceed accordingly depending on what you feel is correct for me.

3)Would mid cycle bleeding cause any hinderance for either IUI or IVF?

Look forward to your replies asap.

Thanks/Kiran

[Scott Roseff MD]

Kiran,

1)Pls adv why clomid/laterozole does not work in a 42yr old? when I took clomid, I did have 5 follicles developing and 2 matured simultaneously.I do know clomid is bad as it dries CM so maybe that' s why I did not conceive then ,but leterozole doe not cause drying of CM so why is this not effective in your openion?
==> Clomid and letrozole are considered "low tech" approaches. The average success rate for these drugs in a 30 year old is around 10-15% per month, so these treatments tend not to work in a 42 year old who generally has a MUCH lower chance of success compared to a 30 year old.

2)Do you suggest after I get HSG test done,then I should go for Follistim shots with FM and IUI or should I surpass all this and go straight for IVF? I will proceed accordingly depending on what you feel is correct for me.
==> Again, it's illegal for me to tell you what to do or not do. Sorry. Either you will have to trust the guidance of your local fertility specialist or come here to be seen/treated by me if you want me to tell you exactly what you need to do.

3)Would mid cycle bleeding cause any hinderance for either IUI or IVF?
==> Potentially yes.

Good luck!
Dr. Roseff in Florida (USA)

[kiran19]

IVF treatment

Hi Dr Roseff,

Thank you for your replies.

I am still hunting for a good fertility doctor in my area where I could go for IVF treatment.
If I am unable to find a good doctor here, I would surely consider visiting you.

Thanks so much
Kiran

[Scott Roseff MD]

OK, good luck!
Dr. Roseff in FL

[kiran19]

Iui

Hi Dr Roseff,

I got my HSG done 2 days ago and was told my tubes are clear.
Also this time I did not get my midcycle bleeding when I was expecting it on 4/24. Pls adv if this has something to do with the HSG test?

If I plan for an IUI with injectables in my next cycle, would that be considered a prudent move?

Thanks/Kiran