I am writing from San Diego, CA. I was on 100mg Clomid on Cycle Day 3-7, then 2mg estradiol on cd 8-12. I went in for an ultrasound to check follicles on cycle day 13. My RE said that this was most likely a lost cycle because I had 2 dominant follicles at 26 and 31 mm. He gave me an HCG trigger because he did not want the follicles to get bigger and become cysts. My uterine lining was 14 mm, and my RE was happy with that. My husband and I had intercourse the day of the trigger and the day after, then skipped a day and had intercourse one more time.
Were the follicles too big? Do we have any chance of conceiving this cycle? I have also been feeling cramps since yesterday at 7 days after the trigger. Is this normal?
Thanks for your input. L. from San Diego
I don't have the ability to foresee the future, and certainly exceptions can occur, however, the follicle sizes were too big. Usually once the follicle is greater than 24 mms, the egg within is overmature and therefore no longer viable. Ovulation may occur but that is the main problem. Also, it is highly likely that these follicles will turn cystic (persist) and have to be suppressed with birth control pills. You need to make sure a baseline ultrasound is done to evaluate for this at the start of your next cycle.
So, statistically and physiologically speaking, this cycle is probably a bust. Unfortunately, your doctor missed the appropriate point by not doing the ultrasound early enough. Next cycle he should begin looking at cycle day #9 or 10, which is what I do. If I'm too early that's okay because nothing is lost and gives me a better idea of follicular development. If you're too late, as in your cycle, then then cycle is lost; a big price to pay.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.