Infertility/Fertility/Ovarian Cyst

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Question
Dear Doctor,

I am 38. I have a very regular 29 day cycle.
My FSH values are normal.
I underwent ovulation induction for Super ovulation with Clomiphene (100mg for 5 days).
During the next cycle, on Day 2 baseline ultra sound the radiologist found a 25 mm cyst. Endometrium was 7.5 mm.
Since the cyst was found I did not start clomiphene.
On day 7 of the cyst it was observed that the cyst was 27 mm and the endometrium was 10.2.
On day 10 it was observed that the cyst was 12 mm and the endometrium was 10.5
I got my periods on Day 13.
In the subsequent cycle on day 3, the cyst was of 11 mm size and the endometrium was 6.4.
The cyst grew to 12.5 mm on day 9 with endometrium becoming 8.0.
On Day 12, the cyst became 10mm and the endometrium was 8.9 mm.
I again got my periods on day 13.
On day 3 of the subsequent cycle (the current cycle) the cyst was 12 mm.
I did FSH and E2 tests on the same day and the E2 was 74 and the FSH was 5.93. (My normal value of FSH used to be 7.85).
My gynaecologist is asking me to wait and watch.
What is your advice.
Thanking you in anticipation.

Prena

Answer
Hello Prena from India,

I am confused regarding your history and therefore am not able to give you adequate advice.  Certainly it was appropriate to not proceed with a Clomiphene cycle with a 2.5 cm cyst.  What I am confused about is all the other ultrasounds you had and why your cycles are so short.  That is, why are you having a period on day#13?  That is not correct and I wonder what the cause of the bleeding is.

Secondly, I only cancel a Clomid cycle if a follicle (cyst is 1.5 cms or greater).  I would have proceeded with the 11 mm follicle and 12 mms follicle.

At this point, because of all this confusion, I would probably put you on the birth control pill for 1 month and then resume the Clomid cycle with the subsequent period.

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.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at info@montereybayivf.com.  This service will allow you to have your own personal on-demand infertility expert.

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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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