AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question This makes my 2nd cycle of injects. I was taking 175iu follistim, 75 menopur and 5 lupron. No period was induced so i dont offically know my Cycle Day, so I make the first day of injections CD1. After my CD5 U/S and BW, I was told to increase follistim to 225. At my cd11 I had 2@1.7cm 1@2.1 cm1@1.6 and 2@1.3, my E2 was @695. I was told to take 10,000 units of HCG@8pm(7/1/09). Hubby and I had intercourse twice the next morn around 10am and 11am. We plan to have intercourse on 7/3/09, in the afternoon thru the evening. Due to his and i work, it will be impossible to have intercourse on Sat. My ?'s are.....How long does it take to ovulate after HCG, are we having intercourse @ ideal times, How long does it take the sperm to reach destination and will they stay in place until ovulation. I also will be taking 200mg of prometrium twice daily starting 7/6/09. When should I take pregnancy test. Thanku for your time....God Bless....I'm writing from St. Augustine, Florida
Answer Hello,
You seem to be in good hands in terms of your protocol and care. It is an expensive way to do a timed intercourse cycle, however, because of the cost of medications and lab tests, for a low pregnancy rate per cycle. I do use injectables with IUI, however. I generally don't do a timed intercourse cycle with injectables for that reason.
You should only have intercourse once per day, and you have started appropriately. I recommend my patients to have intercourse each day, once per day, only one ejaculation per episode for four consecutive days following the trigger with HCG. Twice per day is fun but overkill and might reduce the sperm count too much for the consecutive days. Time of day is not relevant.
Ovulation occurs anywhere from 24-52 hours after trigger. We have no way to know for sure because the "trigger" by natural LH surge could have started before your ultrasound and HCG injection. That is why you have to blanket the times with intercourse. The sperm will survive and stay in the tubes for adequate periods to fertilize the egg(s) if the egg(s) get into the tubes. We don't know how long it takes for sperm to get to the tube where fertilization takes place. The egg, on the other hand, has about 12 hours from ovulation to be fertilized.
I generally will do a pregnancy test 14 days from HCG. That is because, not knowing exactly when ovulation will take place (unlike with IVF where we know exactly), you have to allow for some extra time. In addition, after fertilization, it takes 7 days for the embryo to makes its way into the uterus and then additional time for hatching and implantation.
I hope this helps. Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
