Does concieving during progynova course harm the baby?
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Hello. I am XXXX, 28, married for the last 3 years and trying to conceive for the last one year. I weigh 68 kgs and am 5'4" tall. My TSH level is 4.60 uIU/ml and my doctor put me on Thyronorm 25 mcg which i am taking daily. Also i take folic acid tablets 10 mg each night. My periods are a little irregular(34-35 day cycle) and my doctor has put me on siphene. I took 50 mg dose for 5 days last month and since we did not suceed the dose was increased to 100 mg. My last period was on nov 7 2013, i took siphene 100 mg from nov 9-nov 11 and follicular scan on nov 16 showed the size of the follicule to be 15mm and another scan on Nov 19 showed its size was 24 mm. On nov 19 i was given HCG (5000 IU) injection and also the doctor has prescribed tablet PROGYNOVA ( 2mg, Twice a day from nov 20-nov 30) and tablet DUPHASTON (10mg , twice a day from nov 21-nov 31). I wanted to know 1.why has she prescribed progynova and duphaston? 2.If i get pregnant during the 10 day progynova course will it harm the baby in any way? 3.Is my doctor going too fast with the treatment? 4.What are the chances of getting pregnant with the prescribed course? 5.What are the adverse effects of these hormones? I read the leaflet that came insided the progynova box and the precautions say it causes increased risk of breast cancer and cardiovascular infration and stroke and i am worried regarding its use. I am taking it for 10 days only but how harmful can that be? 6. Is progynova given commonly to people trying to conceive? 7. what should be the next step of treatment ideally ? for how many cycles is it safe to undergo the hormone treatment? 8. Though the doctor saw only one follicule what are the chances of multiple pregnancy in my case since i'm taking all these hormones? Please help. regards
Posted Mon, 30 Dec 2013 in Infertility Problem
Answered by Dr. Aarti Abraham 36 minutes later
Brief Answer: DETAILED BELOW Detailed Answer: Hello XXXXXXX Thank you for writing to us with your health concern. I would be glad to assist you with your doubts. Let me answer your questions in the order in which you have asked them - 1. Progynova contains estrogen, and Duphaston contains progesterone. Once ovulation has occurred, you have high chances of conception. In case pregnancy gets confirmed, then these two hormones will support the growing pregnancy. Women with irregular cycles often have deficiency of progesterone, so it is often prescribed. Estrogen will increase the blood flow to the uterine lining, which also will help the fertilized egg to get implanted inside the uterus. So do not worry, both the hormones are given for pregnancy support. 2. If you get pregnant during the Progynova course, it will not harm the baby at all, it will only support the growing pregnancy. 3. The treatment protocol is perfectly correct. Since you have been trying to conceive since one year, some help is obviously required. I hope a thorough investigation for irregular cycles has been conducted. I suspect that you would be suffering from Polycystic Ovarian Syndrome - for that you need to have complete hormonal assessment - FSH, LH, prolactin, DHEAS, free testosterone, oral glucose tolerance test, fasting serum insulin . You would have been given Siphene if ovulation problems were suspected. 4. With Siphene, more than 50 % of women ovulate, and around 5 - 20 % achieve conception. If you fail to conceive with 3 - 6 cycles of Siphene stimulation, then you should go for assessment of fallopian tube patency ( via laparoscopy ). 5. Taking just 10 days of Progynova will not increase your risk of any of the conditions. Breast cancer, cardiovascular complications and stroke are complications that might occur only in very few users, and that too after prolonged use , for many years. 6. Progynova is commonly given to women having difficulty in conception, so do not be apprehensive. 7. As I said, once detailed investigation for polycystic ovarian syndrome has been done, semen analysis is normal, then you can go for 3 - 6 cycles more of siphene treatment with follicular monitoring. If this fails go for laparoscopy to assess whether your tubes are open. If tubes are blocked or no response to siphene / gonadotropin injections are achieved, then IVF ( in vitro fertilization ) should be considered. You can combine IUI ( intra uterine insemination ) with the siphene treatment cycles, it will improve chances of pregnancy. 8. As only one follicle was seen, there are no chances of multiple pregnancy in your case. With polycystic ovarian syndrome and clomiphene treatment, very very rarely some follicle might ovulate later on in the cycle also, but this is extremely rare, so if you conceive, in your case , in this cycle, chances of multiple pregnancy are very low. Do not stress out, your treatment is on the right track, just take regular folic acid supplements also, and keep your weight in check. You are young, and I am sure you will achieve pregnancy pretty soon. All the best. Please feel free to ask for further clarifications. Take care
Follow-up: Does concieving during progynova course harm the baby? 45 minutes later
Thank you Dr XXXXXXX for your reply . I am relieved. I am now wondering 1. I was never tested for PCOS. Is it common to have PCOS and do people get pregnant with this condition or does it depend on the severity? And if you suspect PCOS in my case just how severe could that be since my cycles are 34-35 days and last 4 days with quite normal bleeding and mild cramps on day 1 and 2. 2. The size of the follicle on day 10 was 15 mm and on day 13 was 24 mm ....is it growing too fast?? .from what i have been reading online its generally 18-19 mm on 13. Is mine too big for the conception to take place? also does every ripe follicle contain egg ? 3. Generally at what size does the follicle get ruptured to release the ovum? 4. I was given HCG (5000 IUI) yesterday at around 2:40 pm . What is the window period for the ovum to get released. 3. Laparascopy as you mentioned ...is it a diagnostic procedure or the treatment procedure for blocked tubes? How common is it and is it done under anesthesia.? if its a diagnostic procedure then what is the ideal treatment for blocked tubes and what are the chances of pregnancy if we overcome that problem? 4. You mentioned that generally 3-6 cycles of siphene treatment is done but can repeated dose of siphene cause multiple ripe follicles? I took 100 mg tablets this month ....what is the maximum high dose for siphene? 5. my husband who is 31 has not undergone semen analysis yet. Is abstinence required before we give the sample to be tested? 6. I have been taking folic acid supplement 10 mg each night....i am not sure what i heard when doctor prescribed the dose. Is 10 mg ok? because i take 2 tablets of 5 mg each and they dont manufacture 10 mg tablet. 7. If my tubes are open and husbands semen analysis reports are normal then is there any similar hormonal treatment with higher doses of pills and injections before we consider IVF? 8. at my height what should be the ideal weight? Regards
Answered by Dr. Aarti Abraham 5 hours later
Brief Answer: ANSWERED BELOW Detailed Answer: Hello again XXXXXXX Thank you for your appreciation . Again, to follow your order of questions - 1. PCOS is quite common nowadays in women of reproductive age , and with irregular cycles, that should be the first diagnosis which should be ruled out. The severity is not corelated with cycle length, many women have regular cycles but other features ( polycystic ovaries seen on ultrasound scan, difficulties in ovulation and conception, hirsutism etc. ). Women with PCOS often have difficulties in ovulation and conception, and require help of ovulation inducing agents like Clomiphene citrate, however, do not worry, pregnancy is quite possible with PCOS. 2. Normally, the follicle grows at the rate of 1 - 2 mm per day, it is acceptable for it to be 24 mm on day 13 ( it can be anywhere between 18 - 23 to 24 mm ). Yours is not too big, slightly on the bigger side, but not abnormal. Generally every dominant follicle contains an egg, sometimes there is the Empty follicle syndrome, when there is no mature egg present inside the big dominant follicle. There is no way of knowing that except from examining under a microscope. 3. Generally , the follicle ruptures at a size beyond 18 - 22 mm to release the egg. 4. After the HCG trigger shot, generally ovulation occurs within a window frame of 36 hours. 5. Laparoscopy is both diagnostic, as well as therapeautic. It is commonly done for infertility and various other gynecological indications. It is done under anesthesia. If blocked tubes are found, treatment depends on the cause. Some minor blockages can be corrected laparoscopically, and severe damage cannot be surgically corrected. Chances of pregnancy depend on the findings found at laparoscopy, and whether it was corrected or not. 6. Generally, more than 100 mg of Siphene is not given. THis is the maximum dose. Every cycle, with siphene, there is a risk of multiple follicles and ovarian hyperstimulation. After 3 cycles, a rest cycle is recommended before starting a fresh cycle. 7. It is against all logic and scientific evidence, for the wife to take Siphene ( which has certain risks and side effects ) before the husband has gone for the semen analysis testing, which is quite non invasive and risk free procedure. 3 days of Abstinence is required before giving the sample. It should be given at the lab itself, instead of being transported. 8. Maximum dose of folic acid per day should be 5 mg per day, 10 mg is not required. 9. If your tubes are open, and your husband's report is normal, then if there is no response to Siphene, higher treatments with injections ( gonadotropins ) can be tried before considering IVF. This is only if no ovulation is observed with Siphene. 10. You are just borderline overweight. Reducing merely 3 - 5 kgs. will place you in the ideal weight category for your height. I hope this answer helped you. Please feel free to ask further also. All the best dear.
Follow-up: Does concieving during progynova course harm the baby? 2 days later
Thankyou again Dr XXXXXXX for answering my questions.Your replies have been a great help. I have a few more questions . 1. I feel nauseated everytime after taking progynova. Is it normal? I am taking 4mg per day. 2. I took HCG (5000 IU) injection on 19-11-2013. My last period was on 7-11-2013. If i take Home pregnancy test at around the time when my period is due (7-12-2013)what are the chances of getting a false pregnancy test since i took the HCG injection? How long does the HCG levels in blood stay high after the injection? 3. Generally after how many days of conception can one experience signs of pregnancy? Is it possible to have no sign initially and still be pregnant? 4. I have read in a magazine lately that one should avoid using anti aging creams during pregnancy . Is it true? If yes which particular ingredient should one look out for? 5. Is folic acid water soluble? Does over dose cause any ill effect? 6.My TSH level is 4.60 uIU/ml and my doctor put me on Thyronorm 25 mcg which i am taking daily. Do you think at this level i should be taking this medicine? shold this be continued if i get a postive pregnancy test? 7. Doctor, is it possible that after the HCG injection the ovum gets released after more than 36 hrs? or 36 hrs is the XXXXXXX time frame for everyone. 8. why is it that the follicle does not rupture naturally sometimes? Why did i need help with HCG injections? 9. After HCG injection what is the guarantee that the follicle will rupture and release the ovum? . Thank you so much Dr XXXXXXX
Answered by Dr. Aarti Abraham 2 hours later
Brief Answer: DETAILED BELOW Detailed Answer: Hello again XXXXXXX Thank you for your appreciation, and I always look forward to your questions. 1. Nausea is common after taking Progynova, so do not worry. Estrogen does have that side effect. 2. After a shot of HCG, the levels stay high for upto 48 hours, taking a shot on 19th November, would not affect the pregnancy test results, when the test is taken on the 7th of December. Do not worry. 3. Generally, the signs of pregnancy occur only after the first missed period. The missed period is the first reliable sign - others like soreness of breasts, nausea, loss of appetite fatigue etc, might appear earlier, but are not reliable. Yes, it is possible to be pregnant without experiencing anything out of the usual. 4. It is not safe to use anti ageing creams during pregnancy, because of the main ingredient called Vitamin A. You should watch out for the names Oleovitamin A, 3-Dehydroretinol, Retinol, Retinoids, Retinol Acetate, Retinol Palmitate, Retinyl Palmitate, Retinyl Acetate and Vitamin A Palmitate on the cream labels. VItamin A causes teratogenic effects on the baby. 5. Folic acid is water soluble, its overdose rarely occurs. ONly very high doses, taken over many years - can lead to diarrhoea, rashes, depression, seizures etc. Do not worry, this rarely happens. 6. Yes, you should be taking THyronorm. Ideally, before conception, TSH levels of less than 2.5 are ideal. THe dose should be continued during pregnancy , in fact dose requirement increases. 7. Generally, the ovum gets released within 36 - 48 hours in more than 90 % of cases. ONly very rarely, delayed ovulation occurs. 8. Just as the basic problem in PCOD is hormonal imbalance, the problem in unruptured follicle is the same. Enough HCG / progesterone is not produced by the body, sufficient to cause follicular rupture. That is why exogenous ( outside ) hormonal injections are required. 9. As I said, there is no guarantee anywhere ! In most women, more than 90 % of times, HCG is enough to cause ovulation. It has to be confirmed by an ultrasound scan done 2 days after HCG shot to document ovulation. I hope this helps you. All the best. Please feel free to contact me directly on - WWW.WWWW.WW
Follow-up: Does concieving during progynova course harm the baby? 17 days later
Hello Doctor We went for semen analysis for my husband today. The sample was given after an abstinence of 3 days. We just collected the report and the readings (all prewash) are as follows: Volume: 5 ml Sperm count 20 mil/ml Motility 40% Activity 05(rapid),10 Moderate,15 (slow) ,10 (sluggish). Normal Morphology ~08% We have not consulted any doctor for his medication as yet. 1. What do you analyse from the report? How normal is it? 2. How long is the duration of course of medicines for male fertility problems and what are the chances of success? 3.What are the life style changes that we need to make to increase the sperm count etc? 4. Should we take another semen analysis before we start any medication? 5. My husband was a little too conscious/worried while giving the sample today...does this affect the result in anyway? 6. Which doctor should we see in person for his medication? Urologist or andrologist? Any doctor who you can refer in bangalore city? 7. I'm on my 3rd cycle with siphene 100 mg. Today i will take 3rd pill of the 5 day course. Last month the ovum was appropriate size and i took HCG injection too.but cudnt conceive. Are there any chances of pregnancy with this sperm count? Thankyou so much.
Answered by Dr. Aarti Abraham 4 hours later
Brief Answer: DETAILED BELOW Detailed Answer: Hi XXXXXXX I am glad you went for semen analysis since the report is not very good, and before undergoing ovarian stimulation, you should rectify and improvise the report. 1. His semen count is low ( just borderline ) and percentage of normal looking sperms is also less. 2. The duration of medication for male infertility depends on the cause. There are various causes for a suboptimal semen analysis - stress, anxiety, recent illness or fever, smoking, alcohol, drugs, hot tubs , saunas, wearing tight undergarments, prolonged periods of abstinence from sexual intercourse, damage to sample during transportation etc. Other serious causes include - hormonal deficiency ( low testosterone levels ), genetic abnormalities, infections, blockage of ducts carrying semen etc. Depending on cause, treatment differs and duration varies. Chances of success obviously too depend on the cause. Certain factors are easily corrected, while others need time and patience. Some are incurable. To answer this question, first you should visit an XXXXXXX / Urologist ( generally both specialities are practised by the same person ), and have detailed evaluation for the reason for this report. Only then can the prognosis ( success etc ) be determined. 3. In general, he should maintain ideal body weight. Smoking and alcohol, or tobacco consumption are a strict no - no. Avoid late nights, excessive tea and coffee and stress at home or work. Sleep early, rise early. Exercise regularly. Think positive. Wear loose trousers and avoid hot steam baths. Take regular vitamin and antioxidant supplements in addition to a nutritious diet. Have sexual intercourse atleast twice or thrice a week. 4. Yes, before starting medication, a repeat sample should be given, and another report obtained to confirm the abnormality. 5. Yes , stress definitely impacts the results. He should be relaxed and at ease. 6. I am not aware specifically of any good XXXXXXX in Bangalore, please consult any premier leading hospital and it should have an Andrology / urology department. As I said, both specialities are intermingled, and often the same doctor specializes in both. 7. I would ask you to optimize the sperm count before taking further cycles of siphene. ALso, after the third cycle, a laparoscopy to evaluate your tubal status should be done. Since you have already taken 3 pills, go ahead with the course. Eliminate any offending factors in your husband's lifestyle, and continue to be sexually active. Pregnancies have been reported with very low counts too, so dont lose hope. If you had not already started Siphene, I would have advised rest for you this time, and evaluation and treatment of your husband, but since, 3 pills have been consumed, go ahead and finish the course, and stay positive. It is not impossible to conceive naturally with this semen count, just that chances are less . All the best XXXXXXX I will look forward to help you with any more questions that you would have. Take care.