Infertility/Fertility/amenorrhea

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Question
Dr. Ramirez,
  I was on the pill for 12 years, and stopped taking it back in September of 2012 to try and conceive.  I did not have a period for over 3 months, so I went to the doctor who gave me a progesterone injection.  About a week later, I had light bleeding for one day.  A month later, I had the same light bleeding for one day.  Five weeks later, I had nothing.  I went back to the doctor and got another injection.  Two days later I had light spotting and nothing else.  Is this considered a cycle?  I am suppose to start Clomid on day five, but I am worried that the progesterone is not working for me and that the absence of my period is something else.  Also, is there any difference in results if I were to take Provera instead?  I am 30 years old, and really want to start having children.  Should I try the Provera or just go on to an infertility specialist?  I am so impatient and ready to get started, but very frustrated.  Please help!

Answer
Hi Lisa from the U.S. (Tennessee),

Obviously your current doctor is wasting your time (or has done so three times), so I would recommend that you go see a fertility specialist.  Now only will you have an appropriate evaluation done to see why your ovaries are not working, but you'll get the appropriate treatment and get pregnant in the shortest time period.

Basically, progesterone injections and Provera (progesterone) accomplish the same thing, which is to induce a withdrawal bleed.  So, using Provera won't make any difference.  The reason the bleed wasn't much is because you probably did not have much of an endometrial lining formed.  In that case, the light bleed would be the first day of the cycle and the counting of the cycle days would start from then.  However, before starting the Clomid, a baseline ultrasound is usually done to confirm that you are on your period, as evidenced by a thinned lining, and that there are no cysts in the ovaries that might prevent ovulation.  Having a cyst in the ovary is a contraindication to using Clomid or any other fertility drug.

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

Infertility/Fertility

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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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