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QUESTION: Hi doctor
Am from India.i have 40 days cycle.My doctor asked me to go for follicle study from 12th day for 6alternate days to know when exactly I ovulate.Today is my 15th day and follicle study shows my right ovary is 1.9*1.9cm and left ovary with no dominant follicle and endometrium thickness is 10mm.They asked me to come tomorrow.Kindly help me to locate when will I ovulate.And should I go tomorrow for follicle study as I have already gone today and is suppose to go on alternate days.
Thanku

ANSWER: Hello Sangeetha from India,

First, it is not normal to have a 40 day cycle.  It is likely that you are NOT ovulating.  However, if we assume that you do ovulate and your cycles are just naturally 40 days, then the period occurs 14 days after ovulation if you don't get pregnant.  So if you have a 40 day cycle, then you are ovulating at around CD# 26.  So if you are doing ultrasound surveillance to try to detect ovulation, then the ultrasounds should start around CD#24.

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: Hi doctor,
Day before yesterday was my 17th day and my right ovary was 2.2*2.4 cm  as per follicle study and yesterday was my 18th day and follicle got ruptured.Me and my husband  had contact these two days.My doubt is with a 40 days cycle ,is it possible to ovulate so early?And is follicle and egg one and the same?if not,will all follicle have mature eggs.In my case on the 18th  day of follicle rupture ,will there be any mature egg.What is the possibility of conceiving?My doctor asked me to take susten 250mg from today for 10 days?Kindly let me know what's that for?
Thank you,
SangeethaNair

Answer
Hello again,

Based on the only information that we have to predict ovulation (ultrasound or LH surge), your follicles were the appropriate size for ovulation and so your timing of intercourse was correct.  Ovulation should occur within 24-52 hrs.

Since we cannot see eggs, we have to rely on the follicle size.  The follicle size has been correlated with the maturity of the egg and the minimum size has to be 18 mms.  Now, not all follicles have eggs, but there is no way to know that.  Most do.

Since your timing was correct, there is a chance that you might conceive but keep in mind that there are still 9 steps that your body has to do naturally to get pregnant.  That is why women generally have to try several months before they achieve a pregnancy.

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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