You are here:

Infertility/Fertility/Stimulation start day in short antagonist cycle

Advertisement


Question
QUESTION: Hello. I started 150iU Menopur on cycle day 2. I introduced .25mg Certrotide on cycle day 5. My period was still full until CD6, after which it has become old and spotting. Usually my full bleed is only 3 days or so. It is probably a good thing that it means my lining has truly shed, but I am concerned that there will not now be time for a new, thick lining to grow. Today is CD6 (day 5 of medication). I have my first scan on stimulation Day 8 (CD9). I am worried that my follicles will be ready, but my lining won't; but please can you tell me whether, given the rising oestrogen now, I can hope that the lining may indeed reach suitable thickness prior to egg collection?

My own doctor says not to worry. But I worry about every little thing.

Thank you

ANSWER: Hello Jenny from the U.K.,

Certainly your worry is completely logical, but usually as the follicles grow, the estrogen level is significantly increased and develops the endometrial lining.  Although sometimes linings will not grow adequately in any IVF cycle, it is usually not the case where a follicle reaches maturity without producing high levels of estrogen and hence growth of the endometrial lining.  Cycles are NOT solely dependent on the days of the cycle, rather it is more dependent on the progress of the developing ovarian follicles.  That can be 10 days, 12 days, 14 days or sometimes longer.  There is no definite schedule in IVF.  It is completely dependent on your response.

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

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

QUESTION: Thank you for your great answer to my previous question, which has reassured me. I have one other. For various reasons, it was convenient to do my baseline blood work on cycle day 1 at my clinic (it was me that asked for this). I started stimulation drugs (menopur) on cycle day 2. I noticed on these websites that many women only have their baseline on cycle day 2, and some start their stimulation on day 2 or day 3. I am worried now that my stimulation was started a day early and that this will perhaps affect things. Had I gone in for a baseline on day 2, I might've started menopur on day 3. But would my consultant have made me wait if there had been any issue in my bloodwork on day 1? My clinic does not do baseline scans.
I am today day 12, going in for a scan and will hopefully trigger tonight. Day 8 scan looked very good, with about 9 follicles on each ovary, the largest at 15mm; the day 10 scan was a little disappointing - two at 19mm streaking ahead, one or two others over 16 and the rest still 15mm or smaller. My menopur was increased after stimulation day 3, and remained at 300 until day 10 when it was reduced to 225.
I am really beating myself up that I had the baseline on day 1 incase that has made a difference to where I am at now, and if I had started a day later, I might be more optimally positioned right now. That said, my clinic's literature says that most women have their baseline on day 2 and "if the results are fine, will commence stimulation later that day". So perhaps I worry about nothing. Thank you once again for your valuable time.

Answer
Hello Again,

The "baseline" is just that and only to confirm that everything is ready to start for the stimulation.  The blood test is to show that the ovaries are now in their base state and there is little to no hormonal function.  The ultrasound is used to make sure that there are no cysts in the ovaries but not all doctors check for this as long as the estradiol is low.

The day to start stimulation is a designated day and not actually related to your normal cycle because IVF is an artificial cycle.  So whether a doctor calls the start day#1, day #2 or day#3 is irrelevant.  By convention in the U.S. (and I can't explain why it is like this), we designate the start of the stimulation cycle as day#2.

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.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

Infertility/Fertility

All Answers


Answers by Expert:


Ask Experts

Volunteer


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

©2016 About.com. All rights reserved.