AboutScott Roseff, MD, FACOG Expertise I can answer questions relating to ALL aspects of female infertility.
Experience I am Board Certified in Reproductive Endocrinology/Infertility.
Organizations Medical Advisory Board, Serono Labs, Inc.
Speaker's Bureau, TAP Pharmaceuticals, Inc.
The American Society for Reproductive Medicine
American Association of Gynecologic Laparoscopists
The International Society for Gynecologic Endoscopy
The Society of Laparoendoscopic Surgeons
The International Federation of Gynaecologic Endoscopists
U.S. International Foundation for Studies in Human Reproduction, Inc.
The Endometriosis Association
Fellow, The American College of Obstetricians & Gynecologists
American Medical Association
The Academy of Medicine of NJ
NJ Obstetrical & Gynecological Society
The NY Reproductive Medicine Society (Steering Committee)
The Society of Reproductive Endocrinologists
Resolve - National Chapter
Resolve - New Jersey - Executive Board
Publications Kettel LM, Roseff SJ, Berga SL, Mortola JF, Yen SSC. Hypothalamic-pituitary-ovarian response to clomiphene citrate in women with polycystic ovary syndrome. Fertil Steril. 1993;59:532-8.
Fischer UG, Wood SH, Bruhn J, Roseff SJ, Mortola JF, Rivier JE, Yen SSC. Effect of human corticotropin-releasing hormone on gonadotropin secretion in cycling and postmenopausal women. Fertil Steril. 1992;58:1108-12.
Kettel LM, Roseff SJ, Bangah M, Burger HG, Yen SSC. Circulating levels of inhibin in pregnant women at term: simultaneous disappearance with oestradiol and progesterone after delivery. Clin Endocrinol. 1991;34:19-23.
Kettel LM, Roseff SJ, Chiu TC, Bangah ML, Vale W, Rivier J, Burger HG, Yen SSC. Follicular arrest during the midfollicular phase of the menstrual cycle: a gonadotropin-releasing hormone antagonist imposed follicular-follicular transition. J Clin Endocrinol Metab. 1991;73:644-9.
Roseff SJ, Kettel LM, Ulmann A, Bangah ML, Rivier J, Burger HG, Baulieu E, Vale W, Yen SSC. Accelerated dissolution of luteal-endometrial integrity by the administration of antagonists of gonadotropin-releasing hormone and progesterone to late-luteal phase women. Fertil Steril. 1990;54:805-10.
Roseff SJ, Murphy AA. Laparoscopy in the diagnosis and therapy of chronic pelvic pain. In Clinical Obstetrics and Gynecology. JB Lippincott Co., Philadelphia. 1990.
Roseff SJ, Murphy AA. Pelviscopy. In Manual of Endoscopy, by the American Association of Gynecologic Laparoscopists, Edited by DC Martin, GL Holtz, M Wenof. Santa Fe Springs. 1989.
Roseff SJ, Bangah M, Kettel LM, Vale W, Rivier J, Burger HG, Yen SSC. Dynamic changes in circulating inhibin levels during the luteal-follicular transition of the human menstrual cycle. J Clin Endocrinol Metab. 1989;69:1033-9.
Roseff SJ, Bernard JM. Seasonal changes in carbohydrate levels in tissues of Carex lacustris. Can. J. Bot. 1979; 57:2140-44.
Education/Credentials Postgraduate Fellowship training in Reproductive Endocrinology & Infertility was done at The University of California, San Diego, School of Medicine.
Awards and Honors Mellon Fellow in Reproductive Endocrinology and Infertility, 1988, awarded for academic excellence in the Reproductive Sciences, for research efforts aimed at development of novel contraceptives.
Wyeth Service Award for Physician Education and Training in Norplant Contraceptive Implants.
Certificates of Service and Appreciation from Our Lady of Mercy Medical Clinic, Guadalajara, Jalisco, México, 1978-1982.
I have a 22 month old daughter (healthy, non-medicated pregnancy and delivery). My husband and I have been trying to conceive our second child for 13 months.
I have been charting my BBT for about 8 cycles. My trend is to have a 35-38 day cycle, with ovulation occurring around day 27, and a luteal phase of about 9-11 days. I spot for about 5 days leading up to menstruation. My 6 dpo progesterone during my last unmedicated cycle was 63.6.
In July, I was prescribed clomiphene 50 mg d3-7. This moved my ovulation up to day 19, lengthened my luteal phase to 12 days, and I only spotted slightly the day before menstruation. I managed to conceive during my second cycle on clomiphene 50mg. My 6 dpo progesterone during this cycle was 31.7. Sadly, I miscarried this pregnancy at 5w1d. I had no spotting at all until the day before my miscarriage.
I am currently at the end of my first cycle following my miscarriage. I did not take any fertility medication. I ovulated on day 20, and have been spotting/light bleeding since day 22 (8 days and counting). My BBT is still quite high.
I have been diagnosed with hypothyroidism (2.5 years ago). My last TSH (6 months ago) was 2.1. I take Synthroid 50 mcg daily, a prenatal vitamin, and 100 mcg of vitamin b6. My BMI is 22. I am 28 years old.
My Questions: Could you please explain my high progesterone level during my unmedicated cycle? I thought my progesterone levels would need to be low to cause spotting. In relation to my current cycle, why did I start spotting so soon after ovulation, despite a clear thermal shift? Finally, where should I go from here? What treatment or tests would you recommend? I am quite anxious to conceive again.
Thank-you
Jane from BC, Canada
ANSWER: Hi Jane,
To answer:
Could you please explain my high progesterone level during my unmedicated cycle? I thought my progesterone levels would need to be low to cause spotting.
==> Progesterone levels vary, and are produced in "pulses". If it was measured on an up-pulse, it can be higher. Also, it's possible to have ovulated more than one egg on a natural cycle. There are lots of reasons for spotting (such as polyps, fibroids, endometriosis, infection, and simply a breakdown of the uterine lining despite adequate progesterone levels). A high progesterone level doesn't necessarily prevent bleeding.
In relation to my current cycle, why did I start spotting so soon after ovulation, despite a clear thermal shift?
==> Again, there are lots of possible reasons, and they should be investigated by a board certified fertility specialist. You're certainly welcome to come here, if you want (I often see women from Canada!).
Finally, where should I go from here? What treatment or tests would you recommend?
==> I suggest you see a board certified reproductive endocrinologist. He/she can determine why you have spotting, why you're having trouble achieving pregnancy success, and best direct you. I'm assuming you were not MONITORED on your Clomid cycle -- If you weren't monitored with blood tests and ultrasounds, that can be a potential pitfall (as a thin uterine lining on Clomid can be one cause of miscarriage on Clomid). Also, it's critical to find out WHY you have abnormal cycles to beging with, as Clomid isn't always the proper treatment for women with 38 day cycles.
I hope this helps,
Dr. Roseff - Director
Palm Beach Center for Reproductive Medicine
Wellington, FL
Visit us on the web at www.reproendo.com
======================
Since Dr. Roseff doesn't know your entire history and hasn't examined you, any medical information given to you may be incomplete or inaccurate. Dr. Roseff and his staff are not responsible for any actions taken or not taken due to the educational information contained within these communications. All communications are for educational and informational purposes only, and should never be used to replace the information and care rendered by your own doctor. No part of any message may be reproduced, printed, or posted anywhere else without the express written authorization of Dr. Roseff.
---------- FOLLOW-UP ----------
QUESTION: Thank-you very much for your explanations, Dr. Roseff.
Unfortunately, seeing a RE is just not feasible for me at this time.
Is vaginal Prometrium helpful if the uterine lining breaks down despite adequate progesterone levels? What dose is standard? I had a normal pelvic U/S (and normal PAP), so does this rule out polyps and fibroids? If not, would an HSG diagnose this?
Also, is U/S the only way to diagnose a thin uterine lining? Can this be done with standard U/S equipment? I live in a very small and remote town so we do not have a lot of specialized equipment.
Sorry if I have asked too many questions, I just really appreciate your expertise.
Sincerely,
Jane
Answer Hi Jane,
We use either Crinone or Endometrin, rather than vaginal Prometrium. Prometrium is not approved by our FDA for vaginal use, but Crinone and Endometrin are. They are sometimes helpful for early endoemtrial breakdown.
Pap and regular U/S won't rule out intrauterine polyps or fibroids. One would need to distend the uterine cavity, such as we do with either HSG or saline infusion sonography (or hysteroscopy).
U/S is the only way to diagnose a thin lining. Yes, it can be done with standard U/S equipment.
Hope this helps,
Dr. Roseff - Director
Palm Beach Center for Reproductive Medicine
Wellington, FL
Visit us on the web at www.reproendo.com
======================
Since Dr. Roseff doesn't know your entire history and hasn't examined you, any medical information given to you may be incomplete or inaccurate. Dr. Roseff and his staff are not responsible for any actions taken or not taken due to the educational information contained within these communications. All communications are for educational and informational purposes only, and should never be used to replace the information and care rendered by your own doctor. No part of any message may be reproduced, printed, or posted anywhere else without the express written authorization of Dr. Roseff.
