Infertility/Fertility/natural cycle ivf

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QUESTION: Hi,

Doc I am 32 with AMH of 3.2 and fsh 5.
I am currently undergoing mock natural ivf cycle.
My day8 e2 was 93.
On day9 follicle size was 13mm.
On day11 follicle size was 15mm.
On day13 follicle was 9.5mm(suggestive of ovulation).

Do u think the follicle ovulated prematurely?

My lining was 9.5mm with good vascularity but not triple line.
What do u think would be the prognosis with the same events again?
I have a 29 day cycle which is regular.

ANSWER: Hello Ria from India,

I do not agree that ovulation occurred prematurely but can't explain to you what happened.  Follicles need to reach 18-20 mms in order to ovulate.  A mid luteal phase progesterone level could tell if ovulation occurred or not.  The value would need to be greater than 10.

A lining of 9.5mm is good.

No prognosis can be made based on this cycle.  It gives absolutely no information in preparation for an IVF cycle, and I don't know why it was done.

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.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at info@montereybayivf.com.  This service will allow you to have your own personal on-demand infertility expert

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

QUESTION: Hi doc

thanx for ur response.
The hormone values on day14(next day to ovulation?) were
LH-18
p4-4.5
e2-93

is this suggestive of ovulation?

Moreover I ovulate even on antag 2.5mg dose, what shud I do?

Answer
Hi Again,

No.  None of these values supports ovulation. The LH and Progesterone levels are indicative of nothing and have not basis for being tested on CD#14.  I don't know what your doctor is thinking?  Are you sure he/she knows what he/she is doing?

The E2 level is a valid measure prior to ovulation, which we follow when doing IVF, but the level is low.  Normally, a ovulatory sized follicle will produce a level of 150-250 when it is ready to ovulate.  The fact that the E2 is low shows that there was not an ovulatory sized follicle present.

As mentioned previously, a progesterone level taken in the mid-luteal phase (CD#20-23) can indicate that ovulation has occurred if it is at least 10 or higher.

My recommendation would be to change doctors and see someone who is competent in the treatment of infertility.

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.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at info@montereybayivf.com.  This service will allow you to have your own personal on-demand infertility expert

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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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