Here are some explanations of the categories used on this blog:

FERTILITY STRATEGIES: Posts on how to logically approach the problem, choose the right decisions and take the right actions.

INSIDE VIEW: An inside glimpse of this reproductive endocrinologist’s daily work life

LIFE AND HAPPINESS: Bits and pieces from my personal life, my philosophies and beliefs, including political views

QUESTIONS AND ANSWERS: A mixed bag of reader questions

FERTILITY NEWS: News stories about fertility-related issues

REAL STORIES: Real cases from patients who have generously agreed to share their stories

UNCATEGORIZED: Anything that doesn’t neatly fall into any of the above categories

I realize I haven’t been posting often this month.

Many factors have led to this and any one of them could be enough of an excuse.

1. I’ve had to deal with the IRS. This was arguably a huge waste of time that didn’t accomplish much. The matter is finished and ironically, it turns out that I have actually OVERPAID my taxes. I mean that in the legal sense, that I paid more than I was obligated to by law. If we look at in the moral sense, almost all of us overpay our taxes, seeing how the government surreptitiously takes more than a third of every dollar that we make in some way or another through federal tax, state tax, sales tax, property tax, social security, medicaid, disability, and those $1.58 surcharges we see in our cell phone bills. To further interfere with our freedom, the government then goes on to devalue our dollar’s spending power even more by diluting the money supply and contributing to inflation. In order not to get angry thinking about it, I just realize there’s little I can do other than move to a different country. Sadly, neither of the two current major political parties seem to have any interest in reversing this runaway trend. I’ve learned long ago to focus on being grateful for the chance to do something fun and spiritually meaningful every day and not think so much about the unfairness of our over-regulating government.
2. I’ve taken time to make many improvements to our office’s workflow process. This has been very exciting and I’ll share more about this elsewhere.
3. I’m had some exciting welcome distractions in my personal life, for which I’m always grateful.
4. Honestly, I got a little bored of blogging. It’s been close to one year already since I started this site. As it happens often in my life, doing something the same way for a long time leads to my losing interest. However, this type of boredom is GOOD NEWS, as it inspires me to shake things up and try new things. As you may have noticed, I have upgraded the look and feel of this site, and I will continue to do so. I am about to start another blog (more on this later). I also have some other very exciting related projects on the horizon. I don’t want to say too much yet, until I’m ready to deliver!

So please grant me this little break and I promise you’ll see bigger and better things soon!!

Hi Doctor,

Your website is very nice and it helped me to learn more about these treatments….success stories really gives me hope…

I took clomid for 5 cycles but ovulated only once and didnt get pregnant. I had an ultrasound after the 3rd cycle and found a cyst on the right ovary. As the cyst was small they continued with the clomid for two more rounds. But I didnt ovulate. So my RE changed my treatment plan.

I took prometrium for 10 days and got periods after stopping it. I had my baseline ultrasound on cycle day three. Again they found a cyst on my right ovary and they put me on BCP for 11 days. On 12th day I had another ultrasound but the cyst was still there of the same size. So my RE said it might be the same cyst that I had 4 months back .RE said either it might be cyst hanging out on the ovary or on fallopian tube. I had an HSG earlier and my tubes are clear.

RE said this cyst won’t get affected by the stimulation. So she told me to start on the follistim.

I am confused now , because I stopped BCP and RE didn’t wait for the periods to come. She asked me to start on the follistim on the third day after I stopped the BCP.

Is this correct? Should I wait for the periods to come before starting the follistim? If I don’t wait will I get periods while I am on follistim?

It would be a great help if you could answer my question. Thanks in advance.

Annie

Dear Annie,

I can’t give an answer as to what is the best treatment for you, because there are a lot of things that I don’t know about your case. However, I can address a few general topics. As you may already know, the reason that we do ultrasounds prior to starting ovarian stimulation is to check for cysts. There are functional cysts and non-functional cysts. Functional cysts could react to the stimulation medications and end up growing. Since they are out of sync with the cycle, their continued growth would end up lowering the success chances of the cycle in many ways. For example, they could grow and cause the release of LH before the follicles have time to mature. There is also the fear that the stimulation might make the cysts grow so abnormally large as to risk of a lot of other problems (ruptured cyst, ovarian torsion). A non-functional cyst, on the other hand, will not grow in response to the stimulation. Non-functional cysts are inert. The problem is…you can’t tell a functional cyst from a non-functional cyst the first time you see it. You can only figure it out by seeing what it does over the course of time.

As far as not waiting for a period after starting the BCPs before starting stimulation, you have a very valid point. I usually wait for a period so that the old lueteinized lining is shed. BCPs make the lining post-ovulatory, so that it would not be receptive to implantation. You should discuss with your RE why she chose not to wait for a period. She might have a good reason.