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Question
I am on clomid. Cd 5-9, I ovulate cd18-20. Had u/s cd 13 follies were 8,13,20,20,21. Uterine lining was 6. Will my lining thicken until I ovulate? And should I have an u/s on cd17 instead of cd13? Basically I want to know if cd13 is optimal because typical ovulation is cd14, or is it just the only day to judge?

Answer
Hello Jennifer,

The purpose of the ultrasound is to determine (1) if you are responding to that dose of Clomid, (2) how many follicles are present and (3) when to trigger ovulation.  It is not based on a specific time in the cycle. It needs to be done early enough to detect the follicles before they get too big or ovulate spontaneously.  In your case, your lead follicles were 21,20 and 20 mms on cD#13 so these sizes were appropriate for ovulation. You should have been triggered on that day with HCG and begun intercourse the next day or had your IUI's.  There would be no reason to wait any further.  In fact, if you allow the follows to grow past 24 mms, the eggs will be overmatured and not viable.

In terms of your lining, it is thin because it should be 9 mms.  There is a possibility that it can reach the appropriate thickness but not likely once the trigger is given (or the LH surge).  I would have given extra estrogen vaginally to try to thicken the lining.  I would recommend that you look at my Blog where I describe Clomid cycles in detail.

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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