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pmblake, did you come back from the doctor's yet? Any confirmed ovulation?

Hi, from what my RE told me in the past, follicle sizes less than 15mm have less than a 50% chance of ovulating. Over 18mm is 80% +. What makes you think you are going to ovulate? The blood work, E2? It may be you are having a longer cycle and the follies will continue to grow, unless you are propelling it with HCG.

Hi there.. argh. how frustrating. I just got back my b/w results and my progesterone dropped below a 1 (or a .1 - i'm not sure what the nurse said). I was told that yesterday my LH was 19.3 and that was what made my RE think I was going to ovulate last night... what could have happened? My RE's office is not being very proactive in helping me understand which is equally as frustrating. Could I potentially ovulate later this month or is this cycle a bust. I typically do ovulate late so CD15 was pretty rare for me. Any ideas??? Pam

Pam, your doctor really should be looking at your estrogen levels and checking those everyday. They are very crucial to ovulation and spike up right before ovulation, sometimes in harmony with the LH surge. I would ask her about your estrogen levels, if they are surging yet. That is what my doctor looks at, and she's been right on the last few times, with confirmed ovulation via blood and ultrasound the day after. This cycle I am on my estrogen level surged above 2,000 before ovulation...it started out at about 400 about 4 days before it hit that....just to give you an idea. Your progesterone is low, and you probably didn't ovulate yet, but I bet your follicle sizes are growing rapidly now with the increased luteinized hormone numbers you had. I tend to think ovulation is around the corner for you...

I just called my RE office back and asked if they checked any other levels today - besides progesterone. I agree about keeping check on other levels. Well, my husband (dh) just said it perfectly. My RE is only interested in my cycle if I'm doing it his way... injfectables, iui, ivf, whatever he recommends. i'm the one who wanted to take a break so he's obvioulsy not interested in a natural cycle. Does that make sense? You're so luck you have a doctor who shows concern -- or who at least doesn't try to keep you overstimulated on injectables. Everytime I'm on injectables I have 15-20 mature follies and estrogen levels over 5,000. I'm clearly being overcooked and then I'm not even monitored to see if I ovulated. Time for a new doctor?? Do you go to an RE or your OB??

Good that you did that, let me know what your doctor said about the other blood levels. I am seeing an RE and it does get "McDonalds" like, in terms of attention and quality, especially the first time I had a medicated cycle. But since I didn't get pregant off the bat, and they became perplexed (after developing 4 good lead eggs that ovulated) they started to scrutinize the other blood levels too, mainly the estridiol (estrogen) and LH with daily ultrasounds the week of ovulation. That way, they timed my HCG shot more accurately, because it appears my LH surge wanes off as estrogen surges, which is why I probably have not been getting pregnant, not enough of a stimulation to make the follicle pop. So the HCG shot works well for me to actually complete the ovulation and not have a luteinized unruptured follicle. (Which is typical for PCOS). I think your decision to sit out a cycle is really a health decision that the doctor probably doesn't understand since he's more worried about "quick results" via proven meds. But what it comes down to is the doctor will not tell you to "stop eating sugar to curb insulin, he's trained to just give you the pill to fix it." That is why I always ask so many questions and make the doctor accountable for what he is doing on my cycle...even when it gets annoying to her. Then we talk about the possibilities why the cycle didn't work and try to refine it (and I do my own refining too with my own research.)

Good for you! Sounds like you ask all the right questions at the right time. It's comforting I'm sure that you have that type of relationship w/ your RE. I'm not new to the inferitilty thing (2 1/2 yrs) but I just left it in the hands of my doctors... Only now I'm I getting frustrated. Probably b/c it's costing so much and I'm not seeing results. but you know - thinking about it, I can't even talk to my doctor w/out an appt. He won't call to answer questions - I only speak w/ the nurse. Then, my u/s are generally performed by other RE's in the practice. I've only seen/talked with my RE a total of about 6-7 times in 6 months. Could be the problem right there. What's the sugar thing? I have been craving sugar like crazy the past 5 days. I've noted it b/c i'm typically a salt girl. yesterday I squirt choco syrup right on a spoon and ate it! so not me. I never knew sugar was a bad thing. Jeez, I"m so green.

I'm sorry, what I meant about the sugar thing is that a doctor is more apt to give a patient a drug to fix a problem right away instead of investigating what the patient is doing to cause the problem, like eating too much sugar causes diabetes, so doctors tend to give an insulin drug to get the number down instead of saying hey, change your diet, don't eat sweets. I don't want to paint a rosy picture of my doctor either. I rarely see her, I spend a lot of time with my nurse though and the ultrasound lady and really utilize those minutes to get answers. They relay the questions and concerns I have to the doctor and they are addressed right away the next day i talk with the nurse. Like my nurse pointed out that my endometrial lining was slim for having ripe follicles, and she thought that could be a problem as I asked her about it, so she asked the doctor about it and she was like "oh, I didn't notice that, thanks for pointing that out," and they then gave me the estrodiol pill. You know, 2-1/2 years with the same doctor is a long time without any results, maybe you should consult another RE. These things do take time but at 39, you really don't have that comfort of having years ahead of you to do this. Can I ask, have you had your FSH levels checked, your ovarian reserve levels?

I've been reassured repeatedly that my FSH levels are good. By both doctors. That's good news for my age. And my nurse - whom I really like - just doesn't like to Q&A w/ me. She just acts like she doesn't know.

Oh and thanks for clarifying the sugar thing! I'm laughing as I type this ;) So, I have been ttc for 2 1/2 years. 2 yrs with my OB (2 m/c) and then for 6 months w/ my RE (another m/c). I have 2 healthy children but age is definitely a factor right now. My 3 m/c hurt alot. I was able to get pregnant twice on 100 mg of Serophene (a sister of clomid) and then my last pregnancy was on 10mg of anastrozole. My RE really likes it compared to Clomid. SO, that's my story. Do you have one? You're 29... any children?

Thanks for sharing that. It sounds like you are producing quality eggs, enough to make babies in the past :) That is actually probably why they aren't being so "rush-rush, worry worry" with you because they know you CAN get pregnant. I'm not even there yet. I've never been pregnant before, never even had a miscarriage (that I know of). I have PCOS, with slightly elevated LH levels of 7 and my FSH was 4 so I know that the higher LH at the beginning of the cycle throws off the whole hormone balance. I got diagnosed after temping for six months and showed the gynecologist how late I was ovulating in my cycle (day 17-22) so she sent me to an RE. I am responding well too Clomid 50 and just did two cycles of Clomid 100 with HCG shot, but this month, they added metmorfin to the mix and crinone progesterone suppositories, I have had IUIs with all three cycles, two back to back each time. I sit in limbo worrying whether this dreadful disease will ever let me have a child, but I'm not going down without a fight.

Sorry to hear about your RE communication problems. I have a great RE that really is patient and his office is wonderful. they don't care if i call a lot for questions etc. Plus one of the nurses used to play soccer with me, so that helps. they really care and are open to options and letting you choose the path, of course they provide recommendations. I didn't know clomid thinned the lining either until my first IUI cycle. they put me on 100 mg. I had been on 50mg for 4 months before that with my ob/gyn and responded well. So RE upped it and again i took well. i had 7 follies of mature size (18-22) and then 4 of them ovulated. but my lining was too thin, so had to take estrace and got it up the next day. my second cycle, he lowered the clomid to 50mg, realizing it was thinning my lining- so it is nice they are paying attention and adjusting my treatments. my lining was fine that second time and i still had 7 follies/4 ovulated. but neither cycle worked. i can tell you though- having that many mature follies is painful! lol i would just keep on top of your RE to make sure they are supportive. if not, why not switch to someone else. My RE actually offered the choice to do a natural cycle my first cycle due to some progesterone problems, but i went for it anyways. they really cared about saving me the pain and money if the chances weren't great.

I'm sure it's crossed your mind - but how would you respond to IVF? Would you consider it? I'm not completely familiar w/ PCOS but my RE thought that I had it a few months back but he decided that I didn't. I'm not sure why. Would IVF eliminate concerns or create a whole new set of them? You're so young. Seriously... You don't seem as consumed w/ it as other woman in this forum. Which is in your favor. You're educated but not desperate. I don't picture you as the "freaking out" type. I just want you to know that you have such a long time ahead of you. It's got to happen for you. sorry ;) blah blah blah. I wish my nurse would call! I also asked her in my voicemail if I should keep taking OPK tests.

Pam, I think I am heading toward IVF my next cycle. It's like, enough is enough already, too many drugs and too much time wasted, I'm on my 12th month of trying (I've never taken birth control) so I tend to think that IVF will probably be the road I take if it doesn't work this month because if I have to move to injectionables, why not then go for the whole egg retrieval thing. My husband's insurance covers 4 IVF cycles, so I know that won't be an issue in terms of money. With PCOS, it literally could take me years and years, and I want a big family. 29 may be young, but I don't want to be 39 having my first child. I don't "seem" as consumed about ttc, but in reality, I am consumed with it. It really is all I think about and care about right now. How can you not think about it all the time when you have to take all the meds we do. I suppose I would be more calm if I knew I was able to carry a baby to full term, cuz at least I could think "at least I have one." But, I do find myself frantic with grief sometimes, feeling sorry for myself that I have PCOS. But then I snap out of it and move on and gain optimism. Are you still doing OPKs? I find that they don't work for me anymore, but my case is different then yours.

Look what JenG just wrote on another thread, I didn't know this...but it is useful info....Hi Ladies, They call the 2nd HCG shot post IUI... "HCG Booster Shot". For some women, injection cycles will cause the corpus lutem to short circuit and shorten the luteal phase. This happens to me, so I have the booster shot (which only 1cc) to make my 2nd half stays strong. With that I cannot test till 14 days post 1st HCG shot.

you have such a good attitude about this! Sure it's frustrating but you have a handle on your condition and that's key. I don't even know what the heck is wrong w/ me. imagine that. 2 unplanned pregnancies and 3 m/c's. and 4 IVFs! Yes, you need to take advantage of that. That's an awesome ins. plan. would you be doing it w/ injectables or clomid? You could possibly get 10+ follies w/ injectables and that would just improve your chances of fertilization. I know 4 is adequate but I'm always on the what-if those 4 wouldn't fertilize? If I did IVF now my RE said he would take out 13+ and go thru the 5 day fertlization and implant 3-4 back in. I'm on the fence w/ doing it. We're considering it but that's as far as I've gotten with it.

That booster shot is definitely something to consider next time around. Thanks! I'll write this down so if/when i have my next IUI I"ll mention it to my doctor.