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QUESTION: Hello Doctor Ramirez, I´m Oriana almost 34 years old, from Spain but living in Mexico City for 8 years now.

I´ve been reading you a lot your blog and you´re questions and answers here. First of all thank you for taking your time, and beeing so patient.

We´ve beeing TTC for over 5 years now. First naturally for 2 and a half year. Then i had a cloded tube, got it fixed and continue trying. At that time my husbands sperm exams where perfect. Then did 6 months of Clomid with no success at all.

Then we went with a real specialist about a year ago, and did all the test all over again, and now my husband had low sperm count. We did IUI with Menopur short cicle twice a day. I had many folicles, 6 on every side, but they stoped growing at 10mm for no reason and without explanation. My RE said it was strange, but didn´t seem to undestand why it happened. Only one made it to 19mm we still tried it, but was BFN, and i had a cyst that i had to get rid of.

From that i went directly to IVF, we did a cycle in wich i took Gonal and Menopur, i had 30 ovocites from which 18 where mature, 12 fetilized, but only 7 made it to 3rd day, all tipe AA. Obviously i had OHSS and had to froze all of them and cancel the cicle for two months.
So i did my first FET, with 3 beautyful embrios. I took Folic Acid (i´ve been taking it one year non stop by now), 8 mg of Estradiol (i don´t know how to say it englis but i belive is a kind of estrogen hormone), Progesteron 200 mg vaginally 3 times a day, Crimone by night, one Aspirin protect a day and antibiotics the firs 3 days post ET. On the fresh cycle the Estradiol gave me terrible headaches, but on my FET none of that. On that FET i got an infecction wich worried me terribly. My RE told me to take infection medicines and they worked but the cycle did not. I also had an infection on my IUI because of the vaginal progesterone.
So for my second FET i decided to prepare my body with a healthy diet, and taking really good care of my body. I kept taking Folic acid, and i complemented it with Women´s evening primorose oil 1300 (which is a natural source of GLA) a dietary supplement. Then i started my cycle and started again the Estradiol, the apirin, and my RE added Meticorten 5 mg (which is generic for prednisen 5 mg) once a day. So last friday i started the progesterone 200 mg three times a day but this time he decided to do it oral so that i woudn´t get no infection. On monday we did the ET and since day i also take Crimone 8% at night. Also since i have a very fisical job, i stop for during these procedures and my ER insist that I stay in bed for 3 days after the ET, do you think that is necessary?

1. I´ve been reading that you think oral progesterone doesn´t work and that concerns me. Do you think i still have chances having the progesterone oraly? My ER does´nt like the injections, he said they are not as good and he prefers i take it oraly.

2. And also since i started with the progesterone friday i get dizzy for over 30 minutes every day on different day moments, but it happens to me everyday a couple of times, and it worries me. My RE though it was strange but said: "i guess it´s because of the meds". But he didn´t seem too sure, i have never read about anybody with this strange sensation during 2ww. Sometimes i fall asleep and when i wake up is still there.

3. What do you think of the Meticorten 5 mg? It is esteroids, right? do you think they are going to help me or they are not?

Sorry for all the questions and the long letter, but above all i´m ery concern about the dizziness and the progesterone.

Thank you very very much in advance, you are just too kind.

Oriana

ANSWER: Hola Oriana de España y Mexico,

Como usted ha leído, la progesterona oral no es efectiva porque la mayoría de la hormona se pierde en el estómago y el hígado. Múltiples estudios han demostrado esto. Por esa razón, se recomienda como una forma vaginal o debe ser tomado por inyección. La inyección es el mejor método.

Creo que la progesterona no es la causa de sus síntomas de mareo, pero no puedo decir exactamente qué lo está causando. Se encuentra en muchos medicamentos que sería difícil saber qué está causando.  La progesterona es una hormona natural (la forma natural no debe utilizarse la forma sintética) y no debe causar síntomas. El efecto secundario principal de la mayoría de los pacientes tienen con progesterona es mal humor.

Yo uso Medrol (prednisona), pero en una dosis de 16 mg por día hasta que la transferencia de embriones y luego reducirla a 8 mg por día a partir de entonces. Lo uso en todos mis pacientes de FIV para reducir la respuesta inmune al embrión y reducir la respuesta inflamatoria.

Espero que no le importe la respuesta en español. Aunque hablo español con fluidez, y hablo todos los días porque la mayoría de mis pacientes son de habla española, que rara vez llego a escribir, así que es una buena práctica para mí. Espero que sea la correcta. Por favor, hágamelo saber si digo algo incorrecto.

Buena Suerte,

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.




---------- FOLLOW-UP ----------

QUESTION: Hola Doctor,

Le agradezco mucho su respuesta.
Su español es correctisimo, sobretodo la ortografía. Pequeña corrección par ver si así también le puedo ayudar yo en algo, se diría así: "Se encuentra tomando muchos medicamentos, por lo que es difícil saber qué los está causando".

Estoy usando una progesterona que se llama primogyn 200 mg, ¿es natural o sintética?. Y de todos modos, parece que por ser oral no sirve de mucho. En el formato inyectable ¿qué miligramos se deben de administrar al día?.

De verdad, infinidad de gracias por su atención, no tengo palabras.

Answer
Hola Oriana,

Lo comprobé en "Primogyn" y encontré que no es una progesterona, pero es un estrógeno sintético.  ¿Estás seguro de el nombre de la progesterona está tomando? Una de la progesterona natural es que uso se llama "Prometrium" y aunque se hace para tomar por vía oral, mando a mi pacientes a insertarlo vaginal tres veces al día.  Mis progesteronas vaginales preferidos son llamados "Endometrin" y "Crinone" en los Estados Unidos.  Para la progesterona inyectable, uso de progesterona en aceite con una dosis de 50 mg por día.  

Buena Suerte,

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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