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Trying to conceive, has irregular period. Given medicine, Newmon injection and estrogen tablets. Told to have sex. Suggest?

Mar 2013
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Practicing since : 1998
Answered : 5956 Questions
Hello doctor,
My wife has irregular menstrual cycle and since we are trying to conceive a baby we consulted a doctor. After initial checkups she was given medicines to induce mensuration and ovulation but the size of the ova was small and to enhance that she was administered 10 shots of harmone injection Newmon. She was also given estrogen tablets. Finally the desired size was achieved and she was given one injection to rupture the egg. We were told to stay together because we didn't want to go for artificial insemination. We have copulated several times but we don't know yet if she is pregnant. When can we do the pregnancy test with pregnancy test tool kit? This is her first ovulation induction treatment and I'm worried about the future side affects of the injection. How many shots of injection are considered safe in one treatment? Its been 29 days since she has her cycle and for the last five days her nipples are slightly sore and there is a rise in the body temperature(not fever). Is this normal side affects? We are hoping for the best results but if this treatment is unsuccessful what happens to the unfertilized ruptured ova and does my wife needs to take any medicines to get rid of it? We are not going for another induction treatment so will this treatment affect our future plans to have babies naturally? Will my wife be able to menstruate and ovulate naturally in the future and what does she needs to do to achieve that? Could you please explain harmone dependent malignancies and the affect of this injection on ovarian reserve. Doctor how long will it be before the medicine and harmone injection administered on her will subside and disappear eventually from the body? I'm worried about the affect of this medicine and injection on her body in the future. I'm very much hopeful that you will answer my queries with your expertise and help me in this matter.
Thank you,
Best regards.
Posted Fri, 4 Oct 2013 in Infertility Problem
Answered by Dr. Aarti Abraham 1 hour later
Brief Answer:

Detailed Answer:
Thanks for writing to us with your health concern.
Firstly , let me reassure you, as you seem to be extremely worried about the treatment you have undergone.
Lots of women undergo multiple cycles of ovulation induction and ovarian stimulation, and the treatment is relatively quite safe.
To answer your questions one by one -
1. You should go for pregnancy test once she misses her expected date of periods by 1 or 2 days. As she has regular cycles, you can also take the test 18 days after the ovulation was confirmed. By then you would have an unequivocal result.
2. During one cycle, normally 5- 7 injections are given, and sometimes more maybe required if the desired egg size is not achieved with lesser number of injections.
3. Nipple soreness and slightly elevated temperature are normal, and nothing to worry about. They could be signs of an early pregnancy, or could be indicative of her impending period , and also due to the hormonal changes due to the medications. Please disregard them if they are not overtly bothersome.
4. If you fail to conceive, then the ruptured ova would be absorbed by the body, as happens normally in each cycle, when the ruptured ova does not get fertilized. Only rarely a small cyst results , and that too would go away on its own. Your wife would not require any medication to clear away the unfertilized ruptured ova.
5. This cycle of treatment will not affect the future fertility at all.
6. If your wife did not have issues with menstruation and ovulation in the past, then she would not have them in the future, as a result of this treatment cycle. However, if she HAS irregular menstruation and ovulation, she should consult a proper infertility specialist. Complete investigations should be done - FSH, LH, TSH, Prolactin, assessment of ovarian reserve by AMH and AFC ( antral follicular count ), baseline ultrasound and ovulation study without stimulation, adrenal hormones, oral glucose tolerance test. Semen testing should be done. If any treatable cause for irregular cycles and anovulation is found ( that can be pinpointed only after the above tests ) - then appropriate treatment should be given for the same.
7. Some studies have shown association of long term ovarian stimulation with malignancies, but there is no conclusive proof for that. Also, with just one single cycle, and even with 3 - 4 further cycles, there is no risk for such malignancies. Ovarian reserve is depleted if such cycles are given continuously for multiple times ( more than 6 cycles without a break ), but upto 3 - 6 cycles, there is no such risk.
8. The medicines administered are metabolized and they disappear from the body within a few days. By the next menstrual cycle, their effect would be almost gone.
9. The medications are commonly used for infertility patients, and they are not as hazardous as you imagine. I reassure you that if prescribed correctly by a qualified reputed Infertility Specialist, then they have minimal side effects.

That was in response to your questions.
Now a few suggestions of my own -
Please let me know if the above tests were done.
Also, It would help me to know how long you have been trying to conceive.
Firstly , after the basic investigations ( above for your wife, and semen analysis for you ), a cycle of simple follicular monitoring should be undertaken. If no ovulation is detected, then a cycle such as you have undergone ( with stimulation ) should be done. If 2 -3 such cycles fail inspite of good ovulation and good semen count, you should have assessment of the patency of the fallopian tubes ( best done by a laparoscopy ).
If all attempts fail ( 2 - 3 more cycles AFTER a laparoscopy also - totally 6 cycles of stimulation ), then IVF ( in vitro fertilization ) should be considered.
Make sure that she maintains an ideal BMI, exercises regularly, does not stress out unnecessarily, and takes regular folic acid supplements.
I hope your queries were dealt with satisfactorily.
I would be happy to address any future follow up questions.
Wishing you luck always.
Above answer was peer-reviewed by
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