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Hi. I Would Like To Consult A Fertility Specialist Please.

Posted on Sat, 9 Jan 2021

Question: Hi. I would like to consult a fertility specialist please. I have irregular cycles (ranging 28-38 days), Never married before but planning to soon and would like to optimise pregnancy chances. My AMH and AFC are Ok, I did a follicular study this cycle, the dominant follicle has been growing today measuring 31mm (day 22 cycle), I am concerned. Please advise me what this follicle size mean. Thank you.

Answered by Dr. Dr. B. Radhakrishnan. Nair (6 hours later)

Brief Answer:
Need serial follicular study

Detailed Answer:
Hi
Greetings
Follicular study is usually done from day 2 or 3 of your menustrual cycle till ovulation happens.
Day 22 and 31mm cannot be confirmed as a normal follicle.
I suggest you to start again from day 2 of next cycle .
Follicular study is always done when you plan for pregnancy.
Hope my answer helps you
Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. B. Radhakrishnan. Nair (55 minutes later)

Thanks for that.
I have been doing serial ultrasounds this cycle from day 9 and it started as 10mm and kept growing slowly (0.5-1mm a day) until last few days started to grow quicker (2-3mm a day). Endometrial thickness 10mm yesterday, (picture of follicle on Lt ovary from yesterdays scan attached with initial question).
LH strip (urinary) was positive for a day (2 days ago)
Do you advise on using LH strips?
What will happen to this follicle? Will it be useful to check serum progesterone weekly till the period starts to see if it peaks (?indicates ovulation occured)?

Does this give any indication on my chances of conceiving?

Thanks again.

Answered by Dr. Dr. B. Radhakrishnan. Nair (2 days later)

Brief Answer:
YOU CAN DO IT

Detailed Answer:
Hi
This may not be an ovulating follicle.It usually decreases within 2 to 3 months.Hence I suggested follicular study from day 2 ,so that we can identify this follicle of previous cycle and concentrate on new dominant follicle.
If you are doing follicular study properly ,ovulation can be approximately identified.Serum progesterone is not necessary until you are doing IVF.
Strips may be used.
Hope my answer helps you
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. B. Radhakrishnan. Nair (2 hours later)

Thanks very much for your reply.
Do you know is it ok to have anovulatory cycles? E.g. how many anovulatory cycles per year is considered acceptable?
Anything I can do to make the cycles ovulatory rather than anovulatory?
I twice checked serum androgens and were within normal range. We don't have a family history of premature menopause.