Can follicles reduce before ovulation in spite of stimulation?

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Posted on Mon, 23 Mar 2015 in Infertility Problem
Question: Hi doc i am 25 yrs old ttc since 1.5 years, i am undergoing infertility treatment, i have low AMH of 1.36, for that she has put me on ovigyn dsr and folic acid, and my husband has morphology (normal forms)of 2%, he has been adviced to take paternia + twice a day. This is my 2nd cycle of try with ovulation induction, below are the details of my FM with tvs:
D1 - endo 5.6mm took ubiphene N 100 mg×5
D9 - endo 5.5 mm rt ov 1.4×1.0cm, 1.0×1.0cm, 0.8×0.7cm & 4-5 small gfs
Left ovary 1.1×1.0cm, 1.0×0.8cm, 4 small gfs
Prescribed inj. Folliculin HP(FSH) 37.5 mg×4days
Today D13 scan showed endo of 3.9mm & follicles in Rt ovary 1.1×0.8 & 3 small gfs
Left ovary 1.4×1.3cm, 1.5×1.3cm, 1.3×1.2cm she asked me to continue the FSH inj for 3 days but increased the dose to 75 mg/day & asked to visit again on d16 for a follow up scan
She told me that the bigger follicle which was there in my rt ov on d9 has had atresia
Can follicles reduce before ovulation in spite of stimulation, & can the endo thickness reduce in follicular phase... I am really confused and worried...& am i on the right track pls guide
doctor
Answered by Dr. Sameer Kumar 32 minutes later
Brief Answer:
ET should not reduce inless estrogen def is also present...explained

Detailed Answer:
Hello,
Thanks for the query to HCM,
Your concern is justified as the endometrial thickness is decreasing with advance in the proliferative phase which should not happen , unless estrogen levels are down as well. In that case you should have been placed of oral estrogens as well to support the phase.
Also , it is unlikely that the follicle may go atresia before ovulation. I think its a individual bias pertaining to the ultrasound reading of the follicular size and that of the ET.
iT IS HENCE SUGGESTED THAT you should get a repeat scan from outside in a diagnostic center on the day 16 after the scan with your physician so that you may compare the accuracy of both usg machines.
My concern is your husbands 2% normal forms , in this case i feel you are going for an IUI cycle after ovulation. The size of the follicle should reach 20mm to 22 mm before FSH can be stopped and hcg trigger may be given for ovulation , followed by IUI.
YOU ARE ALREADY IN DAY 13 of your cycle and the left ovarian follicles show good prospects . You may take 75mg FSH for next 3 days and go for the day 16 scan as called for , but get a comparitive scan on the same day from another diagnostic center which can remove the bias.

regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar 18 hours later
Hi doc forgot to mention she has also priscribed progynova 2mg twice daily...

But my doubt is are chances for the endo to come down from d9 to d13?

And is my low AMH and my husbands 2% normal forms a major cause of concern.... Does it mean that we will not be able to concieve naturally? Coz the doc said donor egg ivf is only the last resort for me and to be prepared for it, however in the meanwhile i can try 1 or 2 times IUI in the waiting time..

Also i shall update u after my scan on d16, saturday..
doctor
Answered by Dr. Sameer Kumar 47 minutes later
Brief Answer:
answered

Detailed Answer:
well,
Looking at the amh low values and endometrial response, you are basically given a trial to ovarian stimulation. If it fails then the option would be donor egg ivf for sure. You are entering into premature ovarian failure, that is likely and yes likelihood of natural conception may be less. But however i agree with your doctor to give a try before all follicles get atretic.
review with scan reports please.
regards
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Sameer Kumar 2 days later
Hi doc had been for the follow up scan today my follicles have grown and also endo improved
Endo 6.7mm triple line
Rt ov 1.0×0.9 cms
Lft ov 2.3×1.8 cms, 1.9×2.0 cms, 1.5×1.7 cms
I took a hcg shot inj.ovitrig hp 5000 iu, the doc asked me to come on monday morning 10.30 am fir IUI
doctor
Answered by Dr. Sameer Kumar 9 minutes later
Brief Answer:
adequate growth of follicles in left ovary....

Detailed Answer:
Hello,
Good to see that the left ovary showed adequate follicular growth of 23x18mm and 19x20mm. These are the right sizes when hcg shot should be given, as you have been given.
After 36 hrs you should report for IUI , ie on monday morning. Its perfectly fine. You are on the right track in this cycle now.
All the best for this cycle.
Keep me posted.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar 48 hours later
Hi doc had been for the iui this morning d18. My iui was around 9.30 around 48 hrs after the hcg trigger on sat morning at 10 am .. Is the time gap ideal?

Followed by iui she also did a scan and said that i have ovulated and all the eggs in the left ovary has ruptured.

She has prescribed progesterone Naturogest vt 200 for 20 days from today & to do a upt on 21st morning , if positive to visit her if not to wait for the cycle an then visit...
doctor
Answered by Dr. Sameer Kumar 10 minutes later
Brief Answer:
IUI done at ideal time and follicles ruptured ...good sign

Detailed Answer:
Hello,
Thanks for the follow up.
The timing for IUI is ideal and also that the USG showed that all follicles have ruptured , ensures better chances of conception this time.
Just want to reinstate that , after IUI, dont just rely on IUI itself, you both can have sex and intercourse after 24 hrs of IUI. THE MORE FREQUENT the intercourse , the better the chances of conception.
IUI would do its part, YOU both should do your part. I hope you understand what i mean .
So if you happen to miss your periods, then after 7 days or 10 days , say 21st march , get a UPT done .
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1656 Questions

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