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Done with follicular monitoring. Ovulation and follicle rupture was good. Treatment? - Online Doctor Chats

Date : 27-Sep-2013
User rating for this question
Very Good Posted in: Women's Health
Answered by

General & Family Physician
Practicing since : 2002
Answered : 106 Questions
Doctor:How can I help you?
User:can i spk to Dr
User:just a continuation of my yesterday chat wid her
Doctor:She is not available now.
Doctor:Would you like a call back?
Doctor:I shall convey your message to her once she arrives.
User:ok, if u cud see history chat
User:thn maybe i had one query
User:basically had taken a follicular monitoring cycle last week
User:month sorry
User:but somehow i was unsuccessful
User:while everything like ovulation, follicle rupture was good
User:was put onto medicines like progynova, argipreg, ecosprin, some vitamins, susten
User:my lmp last month was 1st aug
User:normally a cycle of 28-29 days
User:so if i wasnt pregnant my periods suf hav happened on 30th or 31st Aug
User:but finally the spotting only happened on 6th sept after i discontinued susten
User:and actual flow started on 8th
User:had gone to XXXXXXX the gynae yesterday
User:she has asked me to give rest to my ovaries this month
User:ovral-L is recommended by her for 21 days
User:after whch next month i can again try
User:also she has recommended me the hsg test for tubes
User:am little confused on why shud i take ovral L
User:seeking advise
User:u thr
Doctor:I would like to know if you been diagnosed with PCOS?
User:but my ovulation is normal and timely from last 2-3 months
User:without tabs as well
Doctor:I am sorry, how do you know that you have had normal ovulations?
Doctor:I mean did you get follicular scans for the last 3 months?
User:last month i had
User:prior to tht i tested thru test strips
User:which showed 2 lines on the 14th & 15th day both
User:in July
Doctor:Since when are you trying for pregnancy?
User:in a planned way from last 3-4 months maybe
Doctor:Besides the follicular scan what other tests have been done?
User:but sometimes naturally and in between 2 cycles of follicular
User:i had a miscarriage last sept'12
User:it was a very unplanned pregnancy
User:more of a chemical
User:post that thy asked me to not to try for 3 months
Doctor:Let me brief you.
User:thn i had also been going to few doctors on opinion for my posterior placed fibroid
User:one said it needs myomectomy
Doctor:Let me brief you now.
User:my current gynae does not want to operate since as per her the position will not effect growth of baby and operating may hamper uterus holdng the baby
User:pls go ahead
Doctor:By now you must have known that fertility is influenced by multiple factors.
Doctor:It is proved that you are able to ovulate by multiple tests - ovulation test and follicular scan.
Doctor:We also need to know that the quality of ovum that is released.
Doctor:So gynecologist often prescribe contraceptive hormonal pills to reset the body hormones
Doctor:to make sure you are able to ovulate quality ovum.
Doctor:Perhaps that is the reason why you been advised to use ovral L.
User:but will not make sense to just try naturally this month rather than stimulation
User:will that not help
Doctor:Age is a big factor.
Doctor:Since you are above 35 years of age, the quality of ovum reserve gradually declines.
Doctor:Therefore at this point assisted techniques are going to be the best approach to help you conceive.
User:ok because i didnt want to miss a month for trial
Doctor:If I were to be your treating doctor, I would not recommend you to try naturally and to keep assisted techniques either IVF or intracytoplasmic insemination at the earliest. Off course after discussing with your treating doctor.
User:as per u taking contraceptive wud be better than trying naturally this month for a good quality ovum?
Doctor:Ovral L is a means to reset your body hormones, so they fall in the right place to make you ovulate better.
User:u mean timely and quality both?
User:ovum produced definately is a better one?
Doctor:Yes. To make sure you ovulate at the right time when follicle has matured sufficiently.
Doctor:But if repeated natural trials are not fruitful, then do not wait to try assisted techniques.
User:hmm if u ask me my follicle which ruptured was the right size of 24mm
User:thn why it didnt lead to pregnancy
User:and on 13th day nite
Doctor:At this point of time, without looking at all the parameter (of both partners), I wouldn't be able to answer this question.
User:by intracytoplasmic u mean IUI?
User:or this is different
Doctor:We have to look at the sperm quality, whether uterus is patent enough or not, whether the uterine wall is ripened enough or not and various other factors to know the reason for failure.
Doctor:Many a times, even if all the parameters are rightly in place, we cannot be able to explain why it was a failure.
Doctor:Only repeated trials is the key.
Doctor:Since at this age, assisted techniques have better fruitful results, I suggested you to try that at the earliest.
User:which are?
Doctor:You should also know that with gradual ageing the success of assisted techniques also decline.
Doctor:Among the various assisted techniques, IVF has better success results (but that is going to be a bit expensive).
User:other than IVF?
Doctor:Other techniques that are feasible are IUI (intrauterine insemination) and intracytoplasmic sperm injections (ICSI). Of those two ICSI has better success results.
User:first one am aware, wht is the ICSI
Doctor:You will however need a thorough evaluation, FSH, LH, prolactin and various other tests done at timed interval
Doctor:to decide the best approach.
User:wht is done in ICSI
Doctor:ICSI is a process where god sperms are collected and injected into a good quality ovum.
User:tht is also done in IUI
Doctor:The rest of the process remains the same as in IVF
Doctor:Intrauterine insemination is a process where semen is injected into the uterus through an injection/
Doctor:IUI the fertilization occurs within your uterus.
Doctor:in IVF and ICSI - the fertilization occurs outside the uterus.
Doctor:* ICSI is the most advanced procedure of all the three.
Doctor:If no male fertility is involved, you will have a choice between IUI or IVF
Doctor:Do you have any other query?
User:in ICSI where is the semen injected
Doctor:In short and simple terms, IUI you will receive an injection into your worm. Fertilization occurs within your uterine walls.
Doctor:In IVF and ICSI, ovum is harvested from ovaries in specific container and sperms are made to fertilize it externally.
Doctor:The fertilized ovum is made to grow in a medium and at a specific stage transferred into the mother
Doctor:This mother can be you.
Doctor:And some couples choose surrogates to carry the fertilized ovum till pregnancy.
Doctor:Since assisted techniques are expensive and the success rates are 15%, you need to plan the whole set of process discussing with your treating doctor.
Doctor:Therefore, my opinion is that, follow your doctors advice for now.
Doctor:take ovral l as recommended.
Doctor:Check if this hormone reset helps you to conceive.
User:so i can miss this month for trial for btter results
Doctor:if you are not able to conceive say in the next couple of months,
Doctor:talk about assisted techniques.
Doctor:Hope it is clear to you.
Doctor:Do you have any other query?
User:next month shud i try another cycle of stimulation and follicular study?
Doctor:The decision to try by natural means should be taken by you couples. My opinion is that you should consider options of assisted techniques if natural means are not successful in the next 3-6 months.
Doctor:The more earlier, the better it is.
Doctor:Have you followed?
Doctor:Do you have any other query?
User:anoter query
User:if ovulation is happening normally, does follicular study require stimulation or can be without it
Doctor:If you choose assisted techniques, then stimulation with drugs will give better results.
Doctor:Have you followed?
Doctor:Do you have any other query?
User:u mean even the follicular study
User:n there r no side effects to ovral L
Doctor:Ovral L is a combined hormonal pill.
Doctor:it has no significant ovum stimulating effects.
Doctor:Most women tolerate ovral l very well.
Doctor:Since you are going to be on this drug for not more than one month
Doctor:I would not expect serious side effects/
Doctor:Have you followed?
Doctor:Thanks for consulting me.
Doctor:Bye for now.
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