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Question
Hi Dr. Ramirez,
I'm 30 years old, in Ohio. I am a marathon runner, diagnosed in August with hypothalamic amenorrhea, after stopping OCPs for 8 years. I had monthly periods while on OCPs, and during that time, I lost about 20 lbs thanks to running. I cut down my running from 35 miles/week to 15 miles/week in August, with no response in my estrogen levels (staying around 30). I'm 5'9 and 150 pounds. My HSG and hysteroscopy were normal, and my husband's semen analysis was normal. We decided to go forward with taking menopur injections, 75/dose for 5 days, then 150/dose for 4 days, showed response in 2 follicles, about 18-20mm each. Then did the Ovidrel trigger (250 micrograms), and did timed intercourse. My progesterone level was 0.5 9 days after the trigger, and then I got my period on day 10 after the trigger. So, likely I did not ovulate. I've read that it is rare to have no ovulation after ovidrel. I'm waiting to see the next step my RE proposes. What could be the reason I did not ovulate? Would you recommend doing the menopur/ovidrel/timed intercourse again?

Thank you for you time.
Sarah

Answer
Hello Sarah from the U.S.(Pennsylvania),

Certainly the follicle size was adequate and the Ovidrel was adequate so I can't imagine that ovulation did not occur.  Rather, I wonder if the progesterone testing was done at the wrong time (it should be mid-luteal phase and your luteal phase was shortened#.  Also, that itself could be a problem because the luteal phase should be 14 days, which means that you may need progesterone supplementation #that is a standard protocol for ovulation induction so I don't know why your doctor left it out).

In terms of your subsequent treatment, as long as you responded to the ovulation induction, and two to three folliles are ideal to maximize your chances of pregnancy, then you should continue with that course of treatment.  I would not recommend more than 6 good attempts.  If it does not work by 6 attempts then you need to reassess your treatment options such as moving to IUI or IVF.

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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