No period for 47days!

[kiran19]

Hi Dr Roseff,

My last month's period started on 11April where I bled for 10days and then had HSG done on day 12LMP.

I generally have short cycles of 23days occasionally with one long cycle of 38days which comes once in 4months.I am 42years old.
This month, if I assume I had a long cycle,I was expecting my period on 18th May , however its now 9days past and I still have no period!
I was wondering if It could be pregnancy or perimenapause.

I do not have any classic pregnancy symptoms of nausea or tenderness in breast though sometimes I feel some sensation in my breast and very light lower back pain. I have not yet taken any home pregnancy test as I intend to wait for another week before I do so. Also my RE is out of town and will be back this wk end.

I do understand you cannot tell without me checking up but if you could give me general info on what could be going on, it would be of great help.

Thanks in advance
Kiran

[Scott Roseff MD]

Hi Kiran,

At age 42, there are several reasons a woman may not have her period. These include, and are not limited to:

a) Pregnancy;
b) Perimenopause;
c) Menopause;
d) Persistent corpus luteum cyst;
e) Other type of ovarian mass;
f) Hormone imbalance unrelated to perimenopause (such as high prolactin or abnormal thyroid).

I hope this helps,
Dr. Roseff, Director - Palm Beach Center for Reproductive Medicine

[kiran19]

Understanding my system

Hi Dr Roseff,

Thank you for your reply.
I checked on 50LMP and the HPT was negative.Soon after I started with my period.

Q1)In your openion, wich of the below could be a possibility:
a)I did not ovulate in this cycle
b)Since my leutal phase is of 16days,I must have ovulated on 34LMP
c)It was a m/c?

Q2)Since this is the first time in my life I had such a long cycle of 50days,and prior to this I had my HSG done, do you think the contrast dye had something to do with this delay in period?

I would appreciate your reply on above as it would help me in understanding my system.
Thanks so much in advance
Kiran

[Scott Roseff MD]

Hi,

For your first question, options a) and b) are more likely than option c).

For your second question, no, the HSG didn't likely have any effect on your cycle length.

Hope this helps, Kiran!
Dr. Roseff at the Palm Beach Center for Reproductive Medicine

[kiran19]

IUI with injectables

Hi Dr Roseff,

Thank you for your reply.
I spoke with my RE and she has adv me to go for IUI with injectables.

1.My concern is, all over the net I am reading that success rate of IUI is as good as natural cycle in a 40plus woman and I am kind of apprehensive to even consider going for it even though my RE insists that the success rate with injectables is up to 50%.Do you think this could be correct for a 40+?

2.I would like to know if there is a gurantee the injectables will produce a viable egg or there could also be a possibility that an empty follicle develops.

3.Also, if a viable egg is produced and after HCG shot and follicle monitoring if IUI is done, why is there still a possiblity that pregnancy will not take place?

Sorry for asking too many questions again but then this website is the only one that gives me 100%correct information.

Thanks and regards
kiran

[Scott Roseff MD]

Hi Kiran,

for IUI with injectables:

1.My concern is, all over the net I am reading that success rate of IUI is as good as natural cycle in a 40plus woman and I am kind of apprehensive to even consider going for it even though my RE insists that the success rate with injectables is up to 50%.Do you think this could be correct for a 40+?
==> Natural cycle IUI gives the sperm a chance to fertilize one egg. Injectables/IUI (IF someone responds properly) can give the sperm more targets for fertilization, assuming more than one mature egg develops and ovulates. Since there are more targets/eggs to try to fertilize, the odds of pregnancy increase over natural cycle IUI.

2.I would like to know if there is a gurantee the injectables will produce a viable egg or there could also be a possibility that an empty follicle develops.
==> No guarantees here - One may develop only one egg (if she has diminished ovarian reserve of a poor choice in stimulation protocol), or there may be an empty follicle/follicles (though this is likely fairly rare).

3.Also, if a viable egg is produced and after HCG shot and follicle monitoring if IUI is done, why is there still a possiblity that pregnancy will not take place?
==> The egg may not be released from the follicle, the egg may not make it into the fallopian tube, the inseminated sperm may be "defective", the sperm may not fertilize the egg, the fertilized egg may fizzle out in the fallopian tube before it gets to the uterus, the fertilized egg gets to the uterus and doesn't implant, etc. etc. etc.

Your RE should be able to answer your questions accurately, Kiran -- If she can't or won't, then perhaps you need to be seeing an RE who will indeed serve your needs in your best interests....!

Dr. Roseff in Wellington, Florida

[kiran19]

Ref IUI

Hi Dr Roseff,

Thank you for your replies.

So with IUI & injectables the chance of having twins is high .Could you adv me the % of twin births?

Also what does your statistics say regarding IUI births generally favouring one gender i.e girls over boys, is that true?

Thanks in advance
Kiran

[Scott Roseff MD]

The risk of twins in an injectable IUI cycle depends on several factors, including (and not limited to) the woman's age and the number of eggs ovulated. My average multiple pregnancy rate on injectable drug cycles is approximately 20%, most of which are twins.

Gender is split 50/50.

Good luck,
Dr. Roseff in Florida