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What Are The Chances Of Pregnancy When Having Follicular Size Of 23mm?
Question: Hi, last month i was down on May 22nd and then got my follicle study went to hospital almost daily. On XXXXXXX 6th, my doc injected me saying the follicle size is big 23 mm & Endometrium is 9.9 mm.. we tried on XXXXXXX 6th & 7th.. now on 8th when i went for my ultra sound she said it has burst n there is internal bleeding.. some small cyst.. she said i might get pregnant.. Can u confirm?
Brief Answer:
I need few more details please.
Detailed Answer:
Hello
Thanks for writing to us with your health concern.
I need to know the findings of the ultrasound scan.
Generally when the follicle is 23 mm, it ruptures within 24 - 48 hours.
That is when there is highest chances of conception.
But the bit about a cyst and internal bleeding, that does not make much sense for me.
Can you upload a copy of the follicular monitoring scanning was done ?
I can have a look at that and give you my opinion .
Also, is this the first time that follicular study was done ?
Since how long are you trying to conceive ?
Are your periods regular ?
What is your height and weight ?
Have you gone for any other investigation / procedure so far ?
Looking forward to hearing from you.
Take care.
I need few more details please.
Detailed Answer:
Hello
Thanks for writing to us with your health concern.
I need to know the findings of the ultrasound scan.
Generally when the follicle is 23 mm, it ruptures within 24 - 48 hours.
That is when there is highest chances of conception.
But the bit about a cyst and internal bleeding, that does not make much sense for me.
Can you upload a copy of the follicular monitoring scanning was done ?
I can have a look at that and give you my opinion .
Also, is this the first time that follicular study was done ?
Since how long are you trying to conceive ?
Are your periods regular ?
What is your height and weight ?
Have you gone for any other investigation / procedure so far ?
Looking forward to hearing from you.
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
Hi Dr. XXXXXXX
Thank you for your reply. Let me start from the beginning.. I was diagnosed with endometriotic cyst in 2012 and was operated within 4 months post diagnosed as I had unbearable pain though the size of the cyst reduced post having some contraceptive pills.. my doc after operation told me that my fallopian tubes were swollen but she wanted to do the HSG post my marriage.. I got married in 2013 Nov and then in April i did my Hsg till then we weren't trying for baby.. My HSG report was normal. then since July 2014 we planned to have baby but not every month we could try because of my husband travel and other stuff.. In feb 2015 I again went to doctor for check up as i was confused abt my ovulation date.. she did the ultra sound (attached is the report) and she asked me to have Familon for 3 months and i took it for 2 months as the side effects are bad :( and then in May my periods wasn't normal for the first time.. spotting happened after every 3 to 4 days. Ok i keep having this discomfort in my lower right abdomen.. i was confused about my ovulation date so approached doc and she did my follicle study for the 1st time.. Fyi - my periods are very regular beside 2 changes in since last 10 months.. before i used to get heavy bleeding and in the beginning and then it used to reduced in 5 days periods were over, however, now i get spotting for 3 to 4 days and then heavy bleeding starts so total 7 days i get down something 9 days.. makes me irritated and i get confused about calculating my ovulation date.. My age is 34 will be 35 this Oct 2015.. my weight is 34 kgs (lately i have put on weight) and height is 5 ft.. Let me know if u need any more info.. my ultra sound report which was done in FEB 2015 and Follicle study (May 2015) is attached for your reference.. thanks XXXX..
Thank you for your reply. Let me start from the beginning.. I was diagnosed with endometriotic cyst in 2012 and was operated within 4 months post diagnosed as I had unbearable pain though the size of the cyst reduced post having some contraceptive pills.. my doc after operation told me that my fallopian tubes were swollen but she wanted to do the HSG post my marriage.. I got married in 2013 Nov and then in April i did my Hsg till then we weren't trying for baby.. My HSG report was normal. then since July 2014 we planned to have baby but not every month we could try because of my husband travel and other stuff.. In feb 2015 I again went to doctor for check up as i was confused abt my ovulation date.. she did the ultra sound (attached is the report) and she asked me to have Familon for 3 months and i took it for 2 months as the side effects are bad :( and then in May my periods wasn't normal for the first time.. spotting happened after every 3 to 4 days. Ok i keep having this discomfort in my lower right abdomen.. i was confused about my ovulation date so approached doc and she did my follicle study for the 1st time.. Fyi - my periods are very regular beside 2 changes in since last 10 months.. before i used to get heavy bleeding and in the beginning and then it used to reduced in 5 days periods were over, however, now i get spotting for 3 to 4 days and then heavy bleeding starts so total 7 days i get down something 9 days.. makes me irritated and i get confused about calculating my ovulation date.. My age is 34 will be 35 this Oct 2015.. my weight is 34 kgs (lately i have put on weight) and height is 5 ft.. Let me know if u need any more info.. my ultra sound report which was done in FEB 2015 and Follicle study (May 2015) is attached for your reference.. thanks XXXX..
Brief Answer:
Steps suggested for you.
Detailed Answer:
Dear XXXX
Thank you for a detailed update.
Generally we are supposed to answer a follow up query within 24 hours, but I have done my best to answer as early as possible, and will do so in the future too.
I have gone through your reports.
Regarding the follicle study, the follicle grew, but it did not rupture, atleast not till the 8th of XXXXXXX ( yesterday ) .
You should continue having the follicular study for a few more days , till you confirm about what happened to this follicle / cyst.
As of now, it appears that it has developed into a small cyst with slight internal bleeding.
It is possible that it might spontaneously rupture in a couple of days ( that is why it is essential to continue scanning it, so that we know what happened ).
More likely, it will persist as a cyst, thus making pregnancy not possible this month atleast, since it did not rupture and release the egg.
However, you can remain sexually active for a few days atleast.
Did you take any medication this month to induce egg formation, or was this just follicular monitoring of a natural cycle ?
Please let me know this.
Now regarding your problem about difficulty in conception.
There are 2 factors here.
The first is the history of endometriosis.
YOu have not mentioned an important detail.
When you got operated in 2012, what surgical procedure was done ?
This current scan has no mention of the left ovary, so was one ovary removed ?
Also, another scan mentions a small structure in the right side, but does not mention that right ovary was properly seen ?
So has one ovary been removed, or can you clarify what surgery was done in 2012 ?
The second issue is your age.
In females, after the age of 30, the capacity to produce good quality and number of eggs declines, so fertility declines.
At 35, you should be taking active steps to get pregnant, as with each advancing year, it will become more difficult.
The steps as suggested by me are -
1. Consult a good Infertility Specialist in your city ( if you let me know where you reside, I might suggest somebody I know ).
2. Get your husband's semen analysis done after 3 days of abstinence.
3. Get your hormonal tests done on day 2 of cycle - FSH, LH, AMH, TSH, Prolactin.
4. Get basic complete blood count, viral markers, OGTT done for both partners ( OGTT tests for diabetes ).
5. get a pap smear done.
6. Follow the cyst this month to know what happens to it.
7. If cyst persists next month too, you might need another 2 months of OC pills to resolve it.
8. YOu can go for maximum 3-4 cycles of follicular monitoring ( if natural ovulation is not happening, you may need drugs like clomiphene to induce egg formation ).
9. ONce this fails, you should then try IVF, because of the age factor.
However please get the reports done, and then revert to me.
In general, take 5mg per day folic acid tablets.
Exercise regularly and eat well.
Try yoga for stress busting.
You can reach me directly at any point, by clicking on the following link -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
Take care.
Steps suggested for you.
Detailed Answer:
Dear XXXX
Thank you for a detailed update.
Generally we are supposed to answer a follow up query within 24 hours, but I have done my best to answer as early as possible, and will do so in the future too.
I have gone through your reports.
Regarding the follicle study, the follicle grew, but it did not rupture, atleast not till the 8th of XXXXXXX ( yesterday ) .
You should continue having the follicular study for a few more days , till you confirm about what happened to this follicle / cyst.
As of now, it appears that it has developed into a small cyst with slight internal bleeding.
It is possible that it might spontaneously rupture in a couple of days ( that is why it is essential to continue scanning it, so that we know what happened ).
More likely, it will persist as a cyst, thus making pregnancy not possible this month atleast, since it did not rupture and release the egg.
However, you can remain sexually active for a few days atleast.
Did you take any medication this month to induce egg formation, or was this just follicular monitoring of a natural cycle ?
Please let me know this.
Now regarding your problem about difficulty in conception.
There are 2 factors here.
The first is the history of endometriosis.
YOu have not mentioned an important detail.
When you got operated in 2012, what surgical procedure was done ?
This current scan has no mention of the left ovary, so was one ovary removed ?
Also, another scan mentions a small structure in the right side, but does not mention that right ovary was properly seen ?
So has one ovary been removed, or can you clarify what surgery was done in 2012 ?
The second issue is your age.
In females, after the age of 30, the capacity to produce good quality and number of eggs declines, so fertility declines.
At 35, you should be taking active steps to get pregnant, as with each advancing year, it will become more difficult.
The steps as suggested by me are -
1. Consult a good Infertility Specialist in your city ( if you let me know where you reside, I might suggest somebody I know ).
2. Get your husband's semen analysis done after 3 days of abstinence.
3. Get your hormonal tests done on day 2 of cycle - FSH, LH, AMH, TSH, Prolactin.
4. Get basic complete blood count, viral markers, OGTT done for both partners ( OGTT tests for diabetes ).
5. get a pap smear done.
6. Follow the cyst this month to know what happens to it.
7. If cyst persists next month too, you might need another 2 months of OC pills to resolve it.
8. YOu can go for maximum 3-4 cycles of follicular monitoring ( if natural ovulation is not happening, you may need drugs like clomiphene to induce egg formation ).
9. ONce this fails, you should then try IVF, because of the age factor.
However please get the reports done, and then revert to me.
In general, take 5mg per day folic acid tablets.
Exercise regularly and eat well.
Try yoga for stress busting.
You can reach me directly at any point, by clicking on the following link -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
Take care.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Hi! Sorry for late reply & I wasnt aware abt the 24 hrs TAT, i thought its kind of live chat my bad.. answer to yr questions
My operation was conducted on July 2012 by laproscopy
No, my left ovary is very much intact.. my report talks abt right scan because i went to my doc with right lower abdomen pain..
My periods are normal every month..
My husband & I got all above tests done mentioned by u.. and touchwood everything is normal including his semen test and all.. no diabetes no pressure.. everything is fine..
It was a normal follicle scan for the 1st time conducted on me as i went to talk to my doc n mentioned i was confused abt my ovalution dates (y i mentioned it above pls refer) & no medication related to ovulation i have ever taken, however, as mentioned above on 4th day of my follicle study when it grew the right size my doc gave an injection of some 1000mg i guess dont know the name :( n cant understand her handwriting) plus forgot to ask the name.. thats it.... again i do have my left ovary n its absolutely fine touchwood.. i feel disconfort in right lower stomach thus scans are done that side..
I have stated taking foluc acid from this month my doc suggested too..
also surely suggestion of a doc in XXXXXXX . i might go for 2nd opinion post i get down this month..
Though my doc is quite XXXXXXX gynae and positive abt my case as currently she sees no prob but still i get worried mainly becoz of my age..
My operation was conducted on July 2012 by laproscopy
No, my left ovary is very much intact.. my report talks abt right scan because i went to my doc with right lower abdomen pain..
My periods are normal every month..
My husband & I got all above tests done mentioned by u.. and touchwood everything is normal including his semen test and all.. no diabetes no pressure.. everything is fine..
It was a normal follicle scan for the 1st time conducted on me as i went to talk to my doc n mentioned i was confused abt my ovalution dates (y i mentioned it above pls refer) & no medication related to ovulation i have ever taken, however, as mentioned above on 4th day of my follicle study when it grew the right size my doc gave an injection of some 1000mg i guess dont know the name :( n cant understand her handwriting) plus forgot to ask the name.. thats it.... again i do have my left ovary n its absolutely fine touchwood.. i feel disconfort in right lower stomach thus scans are done that side..
I have stated taking foluc acid from this month my doc suggested too..
also surely suggestion of a doc in XXXXXXX . i might go for 2nd opinion post i get down this month..
Though my doc is quite XXXXXXX gynae and positive abt my case as currently she sees no prob but still i get worried mainly becoz of my age..
Brief Answer:
As below.
Detailed Answer:
Yes, you should be slightly in a hurry because of the age.
Also, this month you should follow up and find out what happened to the follicle, whether it ruptured, or the hemorrhagic cyst has persisted.
My suggestions for you remain the same.
If you cannot decipher her handwriting, please upload the report to me, I will tell you what it is.
As below.
Detailed Answer:
Yes, you should be slightly in a hurry because of the age.
Also, this month you should follow up and find out what happened to the follicle, whether it ruptured, or the hemorrhagic cyst has persisted.
My suggestions for you remain the same.
If you cannot decipher her handwriting, please upload the report to me, I will tell you what it is.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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