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Infertility/Fertility/Follicule growing too fast with HMG


Dear Doctor,
I am 38. Trying to conceive since one year. I have regular cycles.
To improve my chances of conception, I was given clomiphene + HMG with natural intercourse.
I am prescribed 100 mg clomiphene from day 2 to day 6 and HMG 75 iu from day 2 to day 9.
With this protocol I get two or three ovulatory size follicles of nearly equal size like 22 mm and 20mm by day 12. However conception did not take place
On a trial change of protocol, my RE put me on HMG only protocol.
I was given 225 IU of HMG on day 2 and 150 iu of HMG from day 3 to day 8.
When I checked on day 9, it was found that the follicles were of 22 mm and 15 mm viz the follicles had grown faster and the lead follicle is much larger than the other follicle.
Similar results were obtained in the subsequent HMG only cycle where I was given HMG of 150IU from day 2 to day 8.
In short I find my follicles are growing more steadily and in equal size with clomiphene + HMG. But with HMG alone they are growing unevenly and the lead follicle is growing very fast. But considering my age I want to try HMG.
How can I get multiple follicles of even size with HMG.
Thanking you in anticipation,

Hello Deepti from India,

You need to find a better doctor that specializes in fertility and not one that simply dabbles in it.  Ovarian response to stimulation is more controllable with the injectables versus Clomid.  With Clomid, you can only give a certain dose and hope for a certain response.  With the injectables, you can titrate the dosage to the response you want.  That means, you can increase or decrease the dosage and you are in cycle to get the response.  That is the advanage of the injectables.

I have NEVER heard of anyone in the U.S. doing an injectble stimulation with timed intercourse.  It certainly can be done but it costs way to much for such a low yield treatment (your pregnancy rate would only be 2-3% per month).  In someone your age, you should be using a more aggressive treatment such as IVF.

With injectable cycle, unlike Clomid cycles, the medication is NOT given for a set time then wait for ovulation to incur like you are doing.  The injectables are given on a daily basis beginning from cycle day#2 or 3, then blood tests and ultrasound are done on a periodic basis (usually cycle day 5,9, etc) to determine the reponse, make adjustments and time the ovulatory trigger (HCG or Ovidrel).  That is how it is supposed to be done.

In my opinion, your doctor does not know what they are doing and your precious time is being wasted.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at 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 if you are interested in continuous access to me.


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Edward Joseph Ramirez, MD, FACOG


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.


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.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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