Infertility/Fertility/Failed IVF


Dear Doctor,

This is the repeat of the question I posted a few hours earlier with additional information regarding endometrial thickness

I am 40. I had two missed abortions at 37 both in the ninth week after heart beat was felt. Subsequently I did not conceive and my RE suggested IVF.

I have regular 29 day cycle. My Day 3 FSH is normal. My RE put me on long protocol and gave Lupron(0.5cc) from day 17. My periods stated on day 29.

On day 2 of the period,  she started with 600IU of HMG and 0.25 cc of Lupron for 3 days (cd 2-4).

On reviewing after on CD 5, she said no follicle and no endometrium growth is seen.

She continued the medication for two more days and (cd 5, 6) and examined me cd 7 and said that there are no follicles or endometrium and cancelled the cycle.

I stooped all medications.

On cd 12, I checked with a local ultra sound center. The Ultrasound specialist said there are about 12 foolicles on both
ovaries the largest being 10mm. The endometrial thickness was 6.5mm. I checked my FSH and E2 on the same day and the
FSH was 12.76 and the E2 is 58.00.

On Cd 16 I checked again and the Ultrasound specialist informed me that one follicle is 13 mm and others are still small. The endometrial thickness was 10mm.

Can I do anything at this stage to get a multiple ovulation in this cycle so that I can try naturally in this cycle (Like one or two doses of clomid or letrozole).

What do you infer from my endometrial thickness of 10mm though my follicle size is only 13mm.

What is your advice for future IVF cycle.

Thanking you in anticipation.


Hello Renu,

I just answered your question that you posted just prior to this one, but there is one additional (new) question in this second post so let me answer that one.

An endometrial lining of 10 mms is adequate and appropriate for implantation.  It is also a sign that you have adequate estrogen levels because endometrial growth is dependent on Estrogen.  Did your doctor ever check your estrogen levels?  Do doctors in India have to train to be specialists?

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


All Answers

Answers by Expert:

Ask Experts


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, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

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

©2017 All rights reserved.