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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. Mahesh Koregol (15 hours later)

Brief Answer:
Please send AMH Value

Detailed Answer:
Hi,

I saw the images attached.

I am concerned about your higher age of 38 years. Dominant follicle image attached is good enough for ovulation. But overall follicle number AFC looks less.

Please send me AMH value so that I can advice further

Regards

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

Follow up: Dr. Mahesh Koregol (6 hours later)

Many thanks for your help.

I have attached AMH result and ultrasound reports of this cycle, attached in order:
Of day 9, day 14, day 19 and day 22 and have the number of follicles.

Today's ultrasound showed the follicular cyst size to be 3.8cm.
I have done random ultrasounds in the past but never had this size cyst previously.
So this will be an anovulatory cycle? Is it ok to have an anovulatory cycle? What advise you have please to optimise my pregnancy chances (getting married in one month time) please.

AMH was 30 (result attached)

Kind regards.

Follow up: Dr. Mahesh Koregol (1 minute later)

I would like to add please,last month we confirmed ovulation occured as my progesterone was 43 peak (according to our lab a progesterone above 30 confirms ovulation has occured).

Answered by Dr. Mahesh Koregol (43 hours later)

Brief Answer:
Delayed ovulation

Detailed Answer:
Hi,

Thanks for AMH report.This is absolutely fine.

Other parameters look good to conceive. There is nothing to worry.

Dominant follicle appears to be good.

Yes. Sometimes the follicle does not rupture and hence the ovulation May not happen or ovulation might get delayed.

Overall you have good chances of getting pregnant.
You can get married and try for pregnancy.

Let me know if you need any more help.

Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Mahesh Koregol (23 hours later)

Thank you for that, do you know of there is any number of anovulatory cycles per year is considered acceptable versus pathological?

Also in the event I try to conceive for 3-6months with no luck and we find I am having a few anovulatory cycles, which medications will be advised things like clomid? Metformin? Letrozole?

I saw a fertility specialist 2 months ago for a check up and she suggested cyclic progesterone saying with my occasional 38 day cycle (usually twice a year) I am at higher risk of miscarriage and cyclic progesterone will prevent that.
I am hesitant to take it in case it messes up with my hormones. Please let me know what you think?

Many thanks

Answered by Dr. Mahesh Koregol (19 hours later)

Brief Answer:
Cyclic Progesterone not required

Detailed Answer:
Hi,

Inj hcg can help to induce ovulation if you are not ovulating spontaneously. However, I still think you might be ovulating. Use ovulation detection kits to confirm ovulation along with follicular scan.

I don’t see any need of cyclic progesterone in your situation. It is not going to help.

Regards

Above answer was peer-reviewed by : Dr. Raju A.T