Case of the month May '08: Episode #4
SUMMARY: Cora and Anthony are a very happy and affectionate young couple who have now been infertile for three years. The primary suspected problem is Cora’s endometriosis and subsequent tubal damage. Despite all this, her tubes are not completely blocked. They had a choice of IUI vs IVF and chose to do IUI. Cora is currently stimulating her ovaries with a sequential combination of Clomid followed by Menopur. It is day #15 of her cycle and she is here for an ultrasound.
RIGHT OVARY: (21×17) (11×11) (10×9)
LEFT OVARY: (25×18) (19×17) (11×11)
LINING: 10mm triple-layer
The target size for follicles is anywhere from 16 mm to about 22 mm. We see that there is one beautiful mature follicle on the right and two on the left. Once the optimal size has been reached, then it become time to launch the follicles. Before making that decision, we should ask ourselves if there is any advantage to going one more day. In this case, the next largest follicles are in the 11 mm range and therefore not likely to benefit from just one more day of stim. Had there been some 14 or 15 mm follicles, we might have considered extending the stimlulation, but not with what we see here. Today is the perfect day to launch.
When the ovaries are stimulated with injectable gonadotropins such as Follistim, Gonal-F, Bravelle, Pergonal, Repronex or Menopur, we give an injection of hCG in order to get the follicles to ovulate. The previously-mentioned drugs grow the follicles. The hCG releases the eggs from follicles. Once the injection is given, ovulation usually happens around 36-40 hours later.
Cora was instructed to take her HCG injection at 4PM and come back in the morning two days later with Anthony’s sperm specimen.
The morning of her insemination, Cora arrived with the sperm specimen. My assistants processed it and I performed the insemination. Twelve days later, the pregnancy test was negative.
We met again to discuss the next step.
Click here for episode 5
