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Dr. Andrew Rynne

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Have subserous fibroid. Trying to conceive. Faint line on pregnancy kit. Tested for hormone. Any suggestion?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6009 Questions

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Posted on Wed, 6 Feb 2013 in Women's Health
Question: Hi,
I have a subserous fibroid of 8.5 cm*5.4 cm size at the fundus of the uterus.Also,I had miscarried in the month of August last year.Now,I am trying to conceive again.My doctor had asked me to take fertomid 50 as i wasnt ovulating even when i conceived last time.Last month (mc started from 5th Dec)also I had taken fertomid sarting from day 2 and on cd24 i started spotting, went to my GYN and she told me that maybe the progestrone is low and gave me duphastone 10,I was spotting on and off...On 7th XXXXXXX i took pregnancy test and initially it wasnt showing anything but after 15-20min it showed a faint line...But by 10th i got my periods...
On Cycle day 2 i went for blood test for hormones:

Thyroid:
T3: 1.12ng/ml
T4: 9.7ug/dl
TSH: 1.25uU/ml


S Prolactin: 13 ng/ml
LH: 3mIU/ml
FSH: 10.2 mIU/ml
S Estradiol: 59.8pg/ml
S Progestrone : 0.58ng/ml
Hemoglobin: 12.7gm/dl
Haematocrit 35.3%

Is the report is looking normal?

Again can I take fertomid from day6 to 10/day 5 to 9?
doctor
Answered by Dr. Aarti Abraham 1 hour later
Hello
Thanks for writing in.

The subserous fibroid is big, but subserous fibroids generally do not interfere with the uterine cavity, and hence do not cause infertility or abortions. I would be happy to have the details of the previous pregnancy , and if you came to know the reason for the miscarriage.

Also, please let me know how was it concluded that you are anovulatory? Was a follicular study done ? The commonest cause of anovulation is PCOD ( polycystic ovarian disease ) - It would help to know if any work up was done for the same.
Apart from taking ovulation inducing drugs like clomiphene ( fertomid ), various aspects of PCOD need to be treated, like hormonal imbalance, deranged blood sugars, lipids etc.

ALso, you should have a detailed evaluation of the causes of your previous abortion, before taking any ovulation induction treatment.

The reports you have written down are all normal, except that for day 2, the FSH is slightly high ( less than 9 is considered normal and 9 - 11 is borderline high, as in your case ). This indicates a slightly poor ovarian reserve, that is, capacity of the ovaries to produce mature eggs, and is also shown by your inability to ovulate. So, clomiphene is the drug for you to induce ovulation.

You can take clomiphene again in this cycle from day 2, however day 6 is too late to begin clomiphene therapy. Also, you should always start this treatment under regular monitoring by an Infertility Specialist, and with proper follicular monitoring, to improve chances of pregnancy. You might need trigger for ovulation also. Proper progesterone support after ovulation is a must, as progesterone deficiency is common in anovulatory women and in any cycle where artificial stimulation of ovaries is done.

Also, if you have been trying to conceive for more than a year now, your fallopian tube patency also should be assessed. Ideally, a hysteroscopy and laparoscopy should be done to assess the tubes, ovaries and uterus, including status of the fibroid.

I also hope your partner's semen analysis and basic laboratory work up is clear.

Take care, and feel free to ask for further clarifications.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Aarti Abraham 1 hour later
Following are the details of hormones levels taken before the last pregnancy,based on the tests, Clomiphene citrate was prescribed to me by my GYN...During my last pregnancy i started spotting during 5th week of pregnancy, and the sac was there in the uterus but was not growing as expected and the yolk sac wasnt visible even in week 7, got my blood work done and the HCG was increasing but not doubling as it should...i didn't get my progestrone count done during that time but as i was spotting doctor had prescribed me progestrone and HCG to boost the hormones...Also,i have started taking fertomid 50 from cd6,will this not help me with the ovulation this time??My doctor had told me to take on day 5 or 6 this time,for better egg quality...Also,i have never gone through follicular studies..Is there any way to boost progestrone level naturally or through vitamin supplements?
And how can I balance my FSH??And Every ultrasound report says that both the ovaries are normal,what tests should i go for to see if I have PCOS or not...
FSH: 9.9 mlU/mL

LH: 6.1mlU/mL

Prolactin: 24.3 ng/ml

Estradiol 2: 92 pg/ml

Serum Progestrone:1.2 ng/ml

Serum Insulin:2.6 ulU/mL

DHEAS: 0.9 ug/ml
doctor
Answered by Dr. Aarti Abraham 1 hour later
Hello
These hormone levels are near normal, and without follicular study, it is impossible to say that you are not ovulating.
Also, If both ovaries are normal, and these hormonal studies are normal, then PCOS is not likely, specially if your cycles are regular.
You can test your thyroid hormones and blood sugars to be sure.
ALso, there is no way to boost progesterone levels naturally or through vitamins, and adequate progesterone is given during the necessary time in the form of capsules or injections.
Also, the FSH indicates that the ovarian reserve is less than perfect, but there is no known way of improving it.
You should consult a proper infertility practitioner, and avoid taking clomiphene citrate blindly.
It should be coupled with a proper follicular monitoring , and to boost chances of success, with an IUI if 3 cycles of plain stimulation fail.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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