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Question
I am on my third cycle of clomid 100mg day 3-7.
Yesterday I had an ultrasound and I have 8 eggs many were large 24mm.
Prior to this my last two rounds I had 4 large follicles and was unsuccessful at falling pregnant.
I gave 1000iu of hcg to trigger ovulation last night as doctor felt it would take too long for the eggs to collapse. She said NO sex for 5-6 days as there is a risk of high multiples.
At this stage I am so desperate I am willing to try. Is this a really bad idea? Also if I do conceive multiples is there available procedures to reduce?

Answer
Hello Katie from Canada,

I know that because of the socialized Canadian medical system you don't have a lot of choice, but I would strongly recommend that you go see an infertility specialist because this doctor is not doing you good.  First, the surveillance should have been done more often as you got closer to ovulation so that the HCG trigger could have been given when the lead follicle was 20 mms, not 24 mms. Your doctor may have waited too long anyway. Second, you DON'T give HCG is you don't want ovulation to occur and risk what you are contemplating, which is trying naturally and possibly getting a super-multiple gestation.  The cycle should be cancelled and either the birth control pill or high dose progesterone given to prevent pregnancy and end the cycle.  

The problem with a super-multiple gestation (more than twins) is the high risk of losing the entire pregnancy.  For example, triplets have a 50% risk of fetal loss due to prematurity.  That loss rate increases with more babies.  Of course, there is a procedure that can be done at 12weeks gestational age to reduce the number of fetus', called an embryo reduction, but that is essentially a form of abortion and you have to morally accept that.

I hope this helps, but apologize if not.

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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