I have had 2 miscarriages in the last 2yrs both after cardiac activity was seen.I am 37 yrs FSH is 10.I have regular menses and i ovulate on my own.This cycle i have
taken CLOMID 100MG from day3 to7.I had TVS TODAY ON DAY 9 WHICH showed ENDOMETRIUM of size 6mm.There are 4 follicles of size 11,13,14 and 17m.m. SIR do you suggest taking follistim 75u on DAY 10 to get multiple follicles.Do i need to take estradiol valerate 2mg from day 10 to improve quality of cervical mucous and to improve endometrial lining AS i am doing timed intercourse.what would be your protocol if i were your patient?

         THANK YOU

Hello Fatema from India,

I would not add Follistim at this time but rather, repeat the ultrasound daily with the goal of letting the larger follicle grow, up to 24 mms if need be, so that the smaller ones can reach a minimum ovulatory size of 16 mms.  Then I would trigger with HCG.  

In terms of the endometrial lining, I would add Estradiol suppositories vaginally or patches to try to increase the endometrial lining, which is inadequate at this time.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at 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


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.


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.

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

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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

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