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PCOS, taking Duphaston. Period not starting in present IVF attempt. What are my options?

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General & Family Physician
Practicing since : 2005
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Dear Doctor,
I am currently waiting to start my second IVF with ICSI . I have PCOS so my cycles are long (around 40 days)and my doctor gave me duphaston to take on days 16-26 of my cycle so that we could programme the dates to begin the injections. I took the duphaston as instructed but I am now on day 37 of my cycle and my period has not come. Although we have been having unprotected intercourse from day 7 through to day 27 of cycle I know there is no way I can be pregnant as my husband has only 20% mobile sperm (A grade) and a low count and combined with my PCOS they said it will be impossible to conceive naturally. I took the duphaston before my last IVF attempt in XXXXXXX and it worked perfectly so dont understand why it hasnt worked now. I am desperate to get started again and it is so frustrating waiting for my period. Please advise what are my options. Many thanks.
Posted Tue, 17 Apr 2012 in Infertility Problem
Answered by Dr. Prasad 22 hours later

Thanks for posting your query.

Your query is been forwarded to one infertility expert and answers from the expert are awaited. In the meantime, let me take this opportunity to provide you some information about your query.

Duphaston is administered to treat unopposed estrogen effects which are present in women suffering from PCOS. It is also has additional benefits of priming the endometrium to help in successful implantation. Withdrawl menstrual bleeding usually occurs when medication is stopped. You have not specified if you are still on duphaston or has it been stopped.

The chance that you could be pregnant cannot be completely ruled out. I agree that the chance of natural conception is very unlikely taking into consideration yours and your partner's health status. However since you had once conceived naturally, pregnancy cannot be completely ruled out. Hence I suggest you to take up home pregnancy test if you were not treated with HCG infections.

I can understand your anxiety and I apologize for the delay in getting you the answer from the expert. I look forward to your cooperation.

Above answer was peer-reviewed by
Follow-up: PCOS, taking Duphaston. Period not starting in present IVF attempt. What are my options? 1 hour later
Dear Doctor,
I stopped taking the duphaston 10 days ago, I am now on day 37 of my cycle and there is still no bleeding. (I took it days 16-26)
The previous pregnancy was with a different partner.
I was wondering, because by day 16 I probably hadn't ovulated, would that make the duphason ineffective?
I have not taken any HCG injections,
Please advise
Answered by Dr. Prasad 4 hours later

Thank you once again for your cooperation.

Let me answer your question first. Duphaston acts primarily on the uterine endometrium. This aids in successful implantation of fertilized egg both naturally as well as during assisted techniques such as IVF. It also helps in preventing early miscarriage. The action of Duphaston is not influenced by ovulation (egg release).

I have discussed your concern with one infertility expert - Dr. XXXXXXX XXXXXXX and have obtained a complete answer. You may want to know her detailed profile. This link gives information on Dr. XXXXXXX Jain's profile
The doctor agrees with me that pregnancy needs to be ruled out first in any person who is trying to get pregnant (irrespective of adverse factors like low motility). Natural conception is difficult but not impossible with 20% mobile A grade sperms. Hence go ahead and get the home pregnancy test done. If the test is negative it is wise to repeat the test after 3 days to rule out pregnancy.

If both the tests come negative, then you may need combination of estrogen and progesterone pills for a week. Bleeding usually follow on withdrawl(completing the course) of drugs. This can be planned along with your doctor.

Invitro fertilisation can be attempted by down regulation protocol in the next cycle. You can discuss this with your treating doctor. Eggs can be harvested upon reaching the size of 20 - 22 mm.

Hope I have helped you in obtaining useful information regarding your query. Should you have any concerns with respect to my recommendations, I will be available to address it.


Above answer was peer-reviewed by
Follow-up: PCOS, taking Duphaston. Period not starting in present IVF attempt. What are my options? 1 hour later
Dear Doctor,
Thank you for your reply. I am just a little confused by your last comment regarding using the down treatment for IVF. I am meant to begin the short protocol for IVF on day 2 of my next cycle with 7 days of PUREGON injections. I am meant to begin with the cycle that comes with my period. Would using the combined estrogen and progestrogene pills prevent me from starting the short protocol?
Thank you for your advice,
Answered by Dr. Prasad 18 hours later

Thanks again.

I shall try to assist you in detail first.

The 'Duphaston' (prescribed by your doctor) or Combined Oestrogen and Progesterone Pills (which I suggested earlier) are not the primary treatments. They hardly influence the primary treatment (IVF procedures).

The main aim to give this is to regulate your periods and help the expert to start the protocol. Since you did not get your periods try combined pills after discussing with your doctor. This induces withdrawal bleeds on stopping the pills.

We start the protocol when you have normal or withdrawal bleed after taking Combined pill. Combined pills are not continued after the start of IVF protocols. The need to continue the Duphaston is decided by the IVF Specialist later during the primary treatment.

So the initial goal of the expert is to prime the endometrium and regularise the periods.

Now what is down regulation?
Down regulation is a process where the expert suppress pituitary gland that control ovaries so as to take control over its actions. You would be given Gonodotropin releasing hormone (GnRH) analogues with or without GnRH antagonist. This will help in developing quality follicles which will later harvest the best eggs. It is particularly useful in women having PCOS so that more than one quality eggs can be harvested for later use if needed.

What is short protocol?
Short protocol is a procedure where GnRH agonist is given at day 2 of menstrual cycles, this is continued till the day of HCG. The gonadotropins (Puregon injections) start the same day or the day after GnRH agonist is commenced. The regimen is generally recommended for women who had previously responded poorly to the long protocol.

Once the follicles are stimulated, the expert takes the control of picking the eggs with certain other medications.

I am not sure what is your doctor's plan, but I tried to empower you with all the information in understandable terms. Discuss with your doctor and follow the medications given to you strictly.

Hope my answer is both useful and helpful. Wish you good luck.

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