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What Are Chances Of Follicle Rupturing In This Cycle?
Question: Hi Doc,
I am 29 years old thyroid patient and trying to conceive since the last 9-10 months. This is my 3rd cycle of fertyl 100 mg and susten 200.My gyno did not ask me to do a follicular study but I still got it done. Today is my 13th Day and my follicle size is 27 mm ( its growing by 3 mm everyday since last 3 days) and endometrial thickness is 12 mm. I have not been given any HCG trigger.I want to know what are the chances of this follicle rupturing and is it too big to conceive in this cycle ? Can I still take the injection in this cycle ?
Brief Answer:
HCG TRIGGER INJECTION SHOULD BE TAKEN.
Detailed Answer:
Hello,
Thanks for writing to us. Followings are my comments:
1) The dominant follicle normally grows 18-24 mm prior to rupture. Ultrasound can predict the approximate time of ovulation and determine whether or not the follicle has truly ruptured and released the egg for fertilization.
Egg follicle size more than 20 mm is considered quite GOOD for ovulation or egg release. However, if follicle is NOT ruptured after growing more than 20mm, HCG trigger injections should be considered to help with egg release and endometrial preparation. It is seen that ovulation can occur in around 36 to 40 hours after taking HCG injection,
2) Your endometrial thickness of 12 mm around ovulation time is considered to be good for implantation.
3) As you are trying to conceive for long time, I suggest to monitor cervical mucus changes and use OVULATION PREDICTION KIT (LH kit) to predict your ovulation time (along with the follicular study). It will be benefited for you.
4) You should start sexual intercourse soon after POSITIVE Ovulation Test (LH KIT). Do intercourse in positions that allow deep penetration for high deposit of semen. Do not change positions immediately after ejaculation, put pillows under buttocks to minimize semen spill and avoid getting up soon after ejaculation or at least 30 min.
5) Take healthy diet with Vitamin, Zinc and Folic acid supplement and consult with your gynecologist for regular monitoring and follow-up advice.
Hope, it helps for your information. Kindly, close the discussion if you don't have any other query.
Wish your good health and take care yourself.
Regards,
Dr Soumen
For future query, you can directly approach me through
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=63326
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
Thanks for your reply. I want to know couple of things :
1. Is it possible that since I am taking fertyl 100 mg ( from 5th day), the follicle has grown to a bigger size ?
2.What are the chances that it can rupture on its own without injection? Should I wait for another day to see if that happens? Is there any side effect of the injection?
3. I still have not got the LH surge in the predictor kit, but its only my 13th day and i normally have a 29 day cycle. Should I get a LH test done now ?
4. Why was I not prescribed a follicular study in the first place ? For 3 cycles I was just asked to take the medicines.
Brief Answer:
DETAILS ARE GIVEN BELOW.
Detailed Answer:
Hello,
Thanks for follow up queries. Followings are my comments:
1) Clomifene tablet (like FERTYL etc) is usually given from D3/ D5 to next 5 days only for therapeutic purpose. However, over dose or using this medicine for long period may cause bigger size of ovarian follicle - fail to rupture and release ovum, leads to follicular or corpus luteal cyst.
2) Current size of dominant follicle is quite big and mature. It needs to rupture at this time to release ovum.
You can wait one day to check whether it is ruptured or not before taking HCG injection.
Side effects of HCG is quite tolerable in most cases. It includes headache, mild swelling or pain, feeling irritable, breast tenderness, depression etc. However, it varies from women to women.
3) You should start LH surge test (Ovulation Prediction Kit) from tomorrow as your calculated ovulation day is 15th day of cycle.
4) Most patient conceives within 3 to 6 months after taking fertility treatment. However, treatment protocol varies according to clinical condition and response of current medication. Kindly, consult with your gynecologist regarding this.
Hope, it helps for your information and you can close the discussion.
Good luck and all the best.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks so much. That was helpful.
I still want to know if follicular study is a must with fertyl from the first cycle because I have not been asked to do it till now I.e. my 3rd cycle.
Also I directly started with 100mg. Was that ok or 50 mg is better to start the same
Brief Answer:
DETAILS ARE GIVEN BELOW.
Detailed Answer:
Hello,
Thanks for additional query.
1) YES, follicular study is MANDATORY and BEST INVESTIGATION to monitor your ovulation if you are unable to conceive within 3 months of fertility treatment.
2) Dose of FERTYL is gradually increased from 50 mg to 100 mg according to response (STEP UP approach) to avoid related complication.
Hope, I have cleared your doubts. Kindly, close the discussion.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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