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Dr. Andrew Rynne

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Had miscarriages and ectopic pregnancy. Taking metformin, folic acid, clome. Chances of conceiving?

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Dr. Shanti Vennam

OBGYN

Practicing since :1989

Answered : 7335 Questions

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Posted on Sat, 16 Nov 2013 in Women's Health
Question: Hi Doctor,

I had 2 Miscarriages before, One in April 2012 which resulted in a Natural miscarriage. Before the miscarriage, I took an Injection called Life and Susten tablets. But Nothing worked and Miscarriage resulted. I was again pregnant in Dec 2012 which resulted in an Right Ectopic pregnancy. It was resolved with methotrexate Inj(only 1 Inj). We have taken a gap of 3 months, underwnet an HSG which said all is well. Now Been ttc from 4 Months and No result, I donot have PCOD or PCOS. But I am overweight by 16 KGs and 30 already. So My gynec subscribed follicle study last month and realized I did not ovulate on that month at all. So this month, she put me on :
1)metformin 500 -Once a day for 1 week and twice a day from next.
2)Clome 50mg twice a day from d2-d6
3)Folic Acid
At day 11 They see a 20x20 follicle in right ovary and 12X12 follicle on left. She said I should come back on D13. If i have no ovulated by then, she would give me HCG trigger shot. She also prescribed progynova 2mg twice a day for 5 days as my Endometrium is only 5 mm.
on Day 13, when i went back for a flollicle scan, she saw the 20x25 right follicle and 14X12 left follicle and Gave me a fertigyn 5000 IU (HCG) Injection.

Now My Question is :
1) I had a right Ectopic pregnancy, and Now I again have a right follicle, So what are the chances of next ectopic ?
2) waht is the minimum time does it generally take for me to ovulate after the Inj.
3) Do I need to take any particular care in order to avoid another miscarriage ?
4) any suggestions.

- thank you XXXXXXX
doctor
Answered by Dr. Shanti Vennam 50 minutes later
Brief Answer:
There is a only a 10% chance of recurrence.

Detailed Answer:
Hello Ms. XXXXXXX

Thanks for writing to us.

I can completely understand your anxiety and the trauma. I would like to go through your query step-by-step.

The chance of recurrence of an ectopic pregnancy depends to some extent on the risk factors and the treatment modalities adopted. Risk of recurrence is more when there is a previous spontaneous abortion, tubal pathology, persistent infection and non-conservative management of the ectopic pregnancy in the past. Nevertheless, there is a 90 % chance of an intrauterine pregnancy and the risk of an ectopic recurrence is only 10% according to statistics.

Also, studies have shown slightly reduced fertility rate in those treated with Methotrexate. This could perhaps be the reason for the defective ovulation now while you had two natural pregnancies in the past.

The size of the follicle in your right ovary may not release the ovum as it has crossed the ideal size and is likely to have gone into cyst formation. Also, size of the follicle on a particular side does not indicate the possibility of an ectopic pregnancy. It is the delay in propulsion that causes it.

The minimum time required to release the ovum after the injection is 24 hours. It can extend up to 36 hours.

The causes for the abortion in the past must be known well before hand so as to let you and your doctor to take proper care. For abortions due to hormonal defects, supplementation would help in the next pregnancy. Genetic defects do not usually recur in every pregnancy unless they are strongly hereditary. You can take folic acid as a prenatal precaution, avoid any infections of the pelvic region and have regular follow up.

Be on the watch for ovarian hyper-stimulation as you are on induction. Please report immediately to your doctor if you experience any discomfort or pain in lower abdomen.

Finally, please rest assured of a normal pregnancy as your chances of recurrence are very low and your age is not a limiting or risk factor.

Hope I have clarified your queries. Please contact for further information. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shanti Vennam 2 days later
Hello Dr. XXXXXXX

Thanks for your Reply.

Today i went to my doctor. She did a scan and told me that I have Ovulated in last 24 Hours.

She said she can see a collapsed follicle on my right side with some fluid. So She is Positive that I have ovulated this cycle. Though I am happy that I have ovulated, there is One Question.

On day 11 My Endometrium size was 5 mm, for which i was prescribed progynova.

On Day 13 it went up to 10mm

But today Day 17, it came down to 8.5 mm.
I have taken progynova for 4 days and Somehow broke on 5thday and continued the 6th day.

Is this the cause, When I asked my sonologist, she said, 8.5 is Ok. But I am worried if that will go down again.

My Doctor asked me to take Susten 200 starting tomorrow and no further scans are in place. Can you kindly advice me on the following

1) Make sure My endomentrium lining is in safe zone.
2) How to make sure it does not go low.
3) Any Mediacation for that
doctor
Answered by Dr. Shanti Vennam 1 hour later
Brief Answer:
Your endometrium is in the safe zone.

Detailed Answer:
Hi Ms. XXXXXXX

Thanks for your feedback.

Though your endometrial thickness has come down, it is still within the safe zone. A range of 6-14 mm. is good for successful pregnancy.

Declining values of endometrial thickness may be seen when there is a luteal phase defect and this can be corrected by progesterone supplements, which you are already prescribed in the form of Susten. Follow up sonograms can check the values again.

Vaginal estrogen creams can help to improve the endometrial thickness if it falls below 6 mm. Tamoxifen has also been tried in Clomiphene induced cycles to improve endometrial thickness.

As you have a good endometrial thickness and going through the standard treatment protocol, I think there should be no problem. Please monitor regularly.

Hope I have clarified your doubts. Please contact for any more information. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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