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Forum Name: Gynecology

Question: High FSH need advice/help

subaru143 - Wed Jan 24, 2007 1:54 pm

My story, I will try to make it brief... I am 34, I have a daughter that is 4 years old. I was on clomid for 1 month, forgot to take the next month cycle and she was conceived the following month. Prior to that I was not on birth control etc and having unprotected sex with no pregnancies, trying for 5 years. I have been TTC since she was 1 year old, did 6 rounds of clomid with my obyn all negative. My Obyn did a lap. to ensue my tubes were not blocked and during the procedure found a cyst that he drained/removed. Then he referred me to a RE. When I started up with her, my hubby and I got treated both for mycoplasma. Sperm count is just perfect. When I did my hsg, the RE found a very tiny polyp on my uterus, sent me back to my obyn who said its very small to remove and he might not even get it and didn’t want to go in considering the size. After that my RE treated me with, 150 mg of bravelle, I had 5 (3 + 2) follies, lead was 19 when she triggered me on cd 8 + 2 IUI’s back to back, result bfn (blood work good & fsh level 6) 2nd IUI, 225 mg of bravelle, I had 4 (2 + 2) follies, lead was 19 when she triggered me on cd 9 + 2 IUI’s back to back, result bfn (blood work good & fsh level 9) MY RE SAID DIAGNOSED ME WITH LEUTAL PHASE DEFECT, that I ovulate too early for the egg to implant and my lining is too thin. 3rd cycle – (did estrace priming 2 pills vaginally from 1 week LF for 7 days) then did 375 mg of gonal F (expired/new stuff) (got it free due to no insurance) I had 5 follies, (3 + 2) didn’t grow past .07 was on it for 4-5 days (cancelled cycle – poor response) (blood work good & fsh level 11) 4th cycle - was suppose to do 450 mg of Menopur (blood work good & fsh level 16. 1) (cancelled cycle – elevated FSH) Nurse said to wait for next cycle to see if fsh lowered as it fluctuates. Said its impossible for me to get pregnant this month. I had 10 follies, 6 + 4. I have currently started taking ovulex on my own (all natural herbs) on this cycle as I don't want to waste any time. My RE wants me to check my FSH level on cd3 and if its lowered, and if so they will stim me. Can you give me your advice please? ? Any suggestions as to what can be the issue here or what a good protocol that should be used on women with my issues? I have researched the internet and got all this info and your help would be appreciated with a few questions. My questions are: will menopur work for my issue? Would a Micro Dose Flare work better? Would a lower dose of gonadotropins and Ganirelix and the bcp work better? Do women ovulate with high FSH levels? Is LPD my issue or not? THANK YOU SO KINDLY FOR YOUR HELP!!!

Dr. Leigh Anderson - Thu Feb 15, 2007 4:53 pm

Hi Subaru143 If there is any suspicion that there could be a diagnosis of LPD, a serum progesterone test will be performed to check levels of progesterone in your body. This test is done about seven days after ovulation. It is a simple blood test to check the levels of progesterone. Results that show less than normal levels indicate that progesterone production in the luteal phase is inadequate. An ultrasound, Uusually a Trans-Vaginal ) performed to view the lining, is also an option when looking for a correct diagnosis. This is normally done mid-cycle and is completely non-invasive. Another way of diagnosing LPD is by performing an endometrial biopsy. This is usually done several days prior to the day that the next menstrual cycle is expected. The biopsy is performed to determine if the lining of the uterus is adequately developed to sustain a pregnancy. A small sampling of the uterine lining is obtained and sent for evaluation. The information gathered from the biopsy is very detailed and precise. The pathologist will check to see if the lining can be categorized as typical of a certain cycle day. The lining will be considered out of phase if there is a discrepancy of more than a few days. If ovulation-induction medications are prescribed, it may be necessary to repeat the biopsy procedure during the treatment cycle in order to ensure that the problem is being corrected. Once this condition is diagnosed, it is extremely responsive to the correct treatment, according to INCIID. To get the appropriate treatment, it is important to find exactly what is causing the defect in the luteal phase. Treatment Options Progesterone supplementation during the luteal phase is normally the correct treatment if it is conclusive that the follicle development is normal. "Treatments include adding progesterone by oral, injection or vaginal suppository routes. We also use ovarian stimulation protocols to 'goose' the ovary into better hormone production. This is often done using Clomid (clomiphene citrate), a central-cycle center medication that tricks the body into thinking it does not have enough estrogen, hence an outpouring of more stimulation to the ovary to get going and gear up." I wish you sucess, please keep me informed as to your progress.

subaru143 - Sat Feb 17, 2007 12:04 am

Dr. Leigh Anderson, thanks for your reply! As for any any suspicion that there could be a diagnosis of LPD, not sure, I did all my testing and they all came back fine. My RE says my 2 cycles on injectable I have ovulated too early, cd7-cd8 and says that its not enough time for my lining to be thicken so she classifed me as LPF. This really doesnt seem right to me for some odd reason. All my ultrasounds etc look good as the numbers are where they should be. I have had an endometrial biopsy and that was fine too. I just finished a cycle of menopur, 6 vials a day, and triggered on cycle day 12 and had my iui on cd 13/14. I had 11 follies but 5 leading ones, 22, 22, 18, 16, 13, my RE said if this doesnt work to go for IVF - honestly I am confused as the nurse said it was a great cycle and to do another iui if this didnt work. I am doing progesterone, 2 x day vaginal supp. Can you shed any light on this? Do you have a number where I can contact your or a personal email address? thanks again, I await your response! Sue

Dr. Leigh Anderson - Sat Feb 17, 2007 1:41 am

Hi Sue, I want to check on a few things regarding your test results and the results that have been obtained. Hang in there I will try and post a reply for you shortly. Please provide me the dat of your LMP.

subaru143 - Sat Feb 17, 2007 2:51 am

Hi Dr. Anderson, The date of my LMP was Feb 1, 2007. Since I have been monitored and on fert drugs, I get AF every 28 days. Before I use to get it 24, 30, 21, 28, I figured I had ovulatory disfunction, but who knows, I am so confused. thanks again! sue

subaru143 - Wed Feb 21, 2007 12:45 am

Hi Dr. Anderson, Today is 7dpo iui and my P4 was 118 or 11. 8 if that makes any sense. thanks awaiting your reply!

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