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  1. sakharouba
  2. Infertility Discussion
  3. Saturday, 10 September 2016
  4.  Subscribe via email
Hello,

I am a 45-year-old female with history of on average 30 day cycle. Earlier this year, I found out i have a blocked fallopian tube. Given my age, we decide to proceed with IVF. In Feb 2016 I laparoscopy wherein both my tubes were cut in order to have a "clean" uterus. May 2016 I started a long term protocol (may 4 day 21) using first Arevkap to suppress pituitary gland, then Purgeon (75 units for 7 days and then 150 for 8 days), then lastly Pregynl = the result was 2 full size (2.0 in size) follicles and 1 small. However when it came time for extraction (May 25), they told us we had an issue with my husbands blood work (he is Hep C+) (they were not prepared in the lab), and by the time I got on the doctor's table (more then 37 hours passed since Pregynl injection) there was only 1 follicle (the other was too small) which they wanted to extract and freeze without fertilization attempt. I decided at my age i did not want to freeze 1 egg (embryo ok but no egg) and i would rather make another attempt. Tough decision but i thought it was better option!

Of course, I got my period on June 5 as and i went to see another fertility gyno and he suggested a modified cycle with Clomiphene. It was now mid July and my period was late so he suggested I take Primolut (Progesterone) pills 2x/day for 5 days and then 5 days later my period would come. By mid August and still did not get my period. So i went to see him again and we did ultrasound. He said I had follicle about to ovulate and should get my period in two weeks and we would start Clomiphene next cycle. In any event, maybe because I was eager for my period to start a week later i started seeing spotting and then even wiped blood on Friday Aug 26 so I thought I got my period. I called to say my period started but then the nurse told me i have to have actual flow not spotting. over next few days nothing came, so on August 30 I went to see the doctor and we did ultrasound and i showed him my levels which i took on Aug 29 (thinking this was day 3 if you count Aug 25 as CD1) which were E2=66.44, FSH 19.40, LH 16.04, PRG 1.10. he did ultrasound and said my lining was thin and said I may see more spotting and this was my period. I was in shock as i did not have a normal flow. So I suggested maybe we wait for me to have a regular cycle, however, he said it does not matter and my levels are ok to start Clomiphene. So on August 31 I started Clomiphene 50mg in AM, and by the time the afternoon came, my actual period came (CD1). I called the doctor and he said it was ok to continue so I did, taking another 50 mg at night, and continued this for another 4 days while i had my period. On Monday Sept 5 I tested my levels again (E2= 48.75 and FSH 47) and on Wed Sept 7 i went to see the doctor and we did an ultrasound and he told me I had no follicles!!!. I went again 2 days later and he still saw no follicles!!!.

So my question is, is it possible I took the Clomid too early (thinking it was CD5 when it was actually CD1?). I suggested to the doctor that maybe my E2 level at beginning of 48.75 was high for me to start because even after I did the hormone injections in May with 2 follicles right before ovulation simulation my E2 was only 108. Looking back at some of my previous blood work, I see at the beginning of my cycle my e2 is normally in the 30-40 range. I am now wondering if maybe it's better just to wait for a good natural cycle (since I seem to be ok with having at least one egg on my own) or do I try Clomiphene or perhaps another protocol again? I know my FSH level base is high to start but want to try. Thank you
Accepted Answer
DrCoffler Accepted Answer Pending Moderation
I would re-start with the next period with either Clomiphene or Letrozol and combine it with low dose gonadotropins at the appropriate timing.

Dr. Mickey S. Coffler
Reproductive Endocrinology and Infertility
Huntington Reproductive Center
San Diego (Oceanside) Office: (760) 758-2034 X 4
Newport Beach Office: (949) 287-5600 X 3
Responses (3)
DrCoffler Accepted Answer Pending Moderation
Please contact my office directly to discuss.

Dr. Mickey S. Coffler
Reproductive Endocrinology and Infertility
Huntington Reproductive Center
San Diego (Oceanside) Office: (760) 758-2034 X 4
Newport Beach Office: (949) 287-5600 X 3
  1. more than a month ago
  2. Infertility Discussion
  3. # 1
sakharouba Accepted Answer Pending Moderation
Thank you Doctor. I did another hormone test 5 days (CD10) after stopping clomiphene which I started CD1 and my E2 went even lower at 19.32 and FSH at 55.58. which I know I think is the result of the clomiphene since that was it does (lowers E2 and increases FSH). My endometrium lining on CD 14 with no follicles was only 2.5mm (I was told usually at my age day 14 should be about 6-7). so I'm not even sure if my next period will come. My Estrogen is very low.

Would taking Clomiphene again or Letrozol and combine it with low dose gonadotropins at the appropriate timing still be suitable for low estrogen producer like me?.

Sorry if I sound confused because I am. I just don't understand why the clomiphene alone didn't work. Did I start on wrong day? It is my age? If you have any insight on that would appreciate as well.
  1. more than a month ago
  2. Infertility Discussion
  3. # 2
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