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QUESTION: I am have just completed 1 of 2 freeze-batching cycles prior to future PGD. The last cycle was interesting. We got a good haul, in fact our best ever (7 A grade embryos frozen on day 3, most having 7+cells). So stimulation went well.

However prior to this on day 8 of gonalF I had a stressful day. Shortly before my ultraound on this day I had a small bleed (yes while on stims). This repeated twice on the same day and then stopped (no further bleeding).   The day 8 ultrasound showed I had a blood clot in the uterus and that was the cause of the bleeding. However the dr could proceed with egg retrieval and not worry about the uterus since no embryo transfer was planned?

I triggered on the evening of day 9 and had egg retrieval 36 hours later.     

I tried looking for information on this and it appears that what happened is a rare situation?

Have you heard of mid-stim-cycle bleeding on gonalF before?

(it was my 4th egg retrieval and I never experienced this naturally either)

Do you think the medications caused it?
Is it strange that egg stimulation went well but endometrium development did not? (ie the clot)

ANSWER: Hello Louise from Australia,

I have not heard of mid-stimulation bleeding like you describe.  I don't know if it is rare or not because I've not heard of it.  I wonder if there was something going on within the uterus that caused the bleeding and it was not from the uterine lining.  My presumption is that you have not had a hysteroscopy done to examine the uterine cavity since you are not planning an embryo transfer.  Some things like polyps, endometrial hyperplasia or other masses can bleed with increased estrogen.  I don't think this was caused by medication.

Good Luck,

Dr. 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.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate



---------- FOLLOW-UP ----------

QUESTION: Thankyou for confirming this situation is not well documented. Thought so...

We are batching right now to create a few cycle worth of embryos while we wait for appropriate treatment early next year (I am 37 and usually get 1 good blast per cycle). I have had detailed gynae-ultrasounds once per year for 5 years (due mainly to a past ovarian cyst) and the uterus always looks good.

My Dr did an investigative hysteroscopy about 12 months ago, with no issues found in the uterus. Following that I had 2 gonalF stimulated cycles (one in August, one in October).

My period came right on schedule following this recent cycle (11 days after ER or 13 days after trigger, as with 4 out of 5 of my prior gonalF/ovidrel IVF/IUI cycles).

I hope the uterus has cleared itself out of whatever caused the clot.
Might it be appropriate to do another hysteroscopy done?
Or could masses be identified with an ultrasound?

My follow-up appointment with my Dr is next week.
Can you suggest any other questions I might ask?

Thankyou.

Answer
Hello Again,

Since it has been 12 months since the last hysteroscopy and you had this strange bleeding episode, it might be a good idea to repeat the hysteroscopy.  The alternative would be a sonohysterogram (ultrasound where fluid is injected into the cavity).  However if the sonohysterogram is positive for something, a hysteroscopy will then have to be done.

Can't think of any questions for you to ask at this point in time.

Good Luck,

Dr. 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.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward 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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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