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Dr. Andrew Rynne

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What does my follicular study indicate?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6003 Questions

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Posted on Mon, 21 Jan 2013 in Women's Health
Question: I am currently doing follicular study and today is day 14 but the egg size is same as day 12. It is 12*14
doctor
Answered by Dr. Aarti Abraham 21 minutes later
Hello XXXXXXX
Thanks for your query.

Kindly provide me the complete details of the follicular study, if possible attach the reports. You have a feature to upload the reports by yourself on the right side of this query page. Please utilize it.

Also, please answer a few of my questions here:

Let me know the pattern of your previous menstrual cycles.
Any other significant medical history.
Previous treatment for inability to conceive etc.
Treatment that is given in this cycle.

Awaiting your response.
Regards,

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Aarti Abraham 26 minutes later
my normal ovaulation day is 14. My last follicular study was done in XXXXXXX and the ovulation day was day 15.

In this cycle I took Siphene and Progynova 1-1-1. Thickness is 8mm on day 14 but the egg has not grown.

I had conceived last year this time and within 1 month I had missed abortion and had to undergo D & C

Is is normal for egg to not grow its full size. I am desperatly trying for a baby
doctor
Answered by Dr. Aarti Abraham 3 hours later
Hi XXXXXXX,
I appreciate your query.

Follicular monitoring involves, not just one single scan, but a series of ultrasound scans during the important days of your menstrual cycle, in order to track the normal changes in the uterus and ovaries .

The ultrasound is done at an interval of few days serially to assess the size of the growing follicles ( eggs ) . Normally during a menstrual cycle, during initial days, multiple follicles get recruited, out of which one slowly grows as the dominant follicle, which finally ruptures ( egg is released from the ovary ) around the day of ovulation ( normally Day 14 in a 28 day cycle ).

Around the time of ovulation, the mature egg should be around 20 - 22 mm size.

Simultaneously, it evaluates the Thickness of the endometrial stripe (the lining of the uterus). Eight to 10 mm is optimal around the days of ovulation.

The endometrial thickness is alright ( 8 mm ) in your case.

In your case, Siphene ( clomiphene citrate ) was given , which stimulate multiple follicles, so ideally there should be 2 -3 mature ( 20 - 22 mm ) follicles, which is not the case.

You have only one egg in your case, and that too, of only 12 x 14 mm, which means that there is a failure of the eggs to mature / ovulate.

This is called failure of response to clomiphene and indicates anovulation.

There are various causes for this, but the commonest cause is Polycystic Ovarian Disease, where there are many eggs in the ovaries, but none can mature to ovulate.

For this, you should get the tests done such as FSH ( follicle stimulating hormone ), LH ( luteinizing hormone ), adrenal hormones, glucose tolerance test, fasting insulin etc. Also, your ultrasound would show multiple small eggs without maturation.

The treatment for this condition is weight loss/ exercise and other drugs like Metformin and further injections and drugs if you do not respond to Siphene for ovulation induction.

Other causes for non response in your cycle could be stress/anxiety / failure, thyroid disorders, increased prolactin levels / excessive weight etc.

Also, sometimes, the ovary starts ageing before time, and the quality and number of eggs decreases, so there is no ovulation . This is less likely to happen at the age of 36, but you should have your AMH ( antimullerian hormone ) levels done.

There is no reason to believe that you would not ever have children.

Various other factors like your partners semen analysis and the status of your Fallopian tubes also matter.
Please have them tested too.

Seek the help of a proper Infertility specialist, who would thoroughly evaluate you on the lines mentioned earlier, and guide you for appropriate therapy like ovulation induction or IUI ( intrauterine insemination ), or , as a last resort, IVF ( in vitro fertilization )

Take care and feel free to ask for clarifications.

Regards,
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Aarti Abraham 21 hours later
Thank you so much Doctor XXXXXXX for explaining the process in detail. Much appreciated.

doctor
Answered by Dr. Aarti Abraham 5 hours later
Thank you XXXXXXX, for appreciating. Please rate and review the discussion.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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