Posted by: Sam | 2012/06/18

First unmedicated cycle

We have been actively trying to conceive since March of this year. My Gynae prescribed Fertomid 100mg CD5-10 for March - May as I''d had a complex cyst surgery in January and was strugglng to start ovulating on my own. My gynae was unfortunately away whenever I needed to be monitored so all 3 of my cycles were unmonitored. I had positive OPK''s each time and went and had my own progesterone test in May. My 7dpo result was 148.9 which I know is unusually high, so I decided to try this cycle unmedicated. I got my positive OPK on CD10, 6 days earlier than usual, would the early ovulation affect my egg quality? I had an ultrasound on CD7 as I had pain on my right side and the ultrasound showed a 30mm follicular cyst on my right ovary - would the size of the cyst indicate the size of the egg? Tx

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Our expert says:
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Dear sam,
In the first instance it is not advisable to use Fertomid doses of 100mg in consecutive cycles, as this may result in the formation of follicular cysts and may ultimately cause hormonal imbalance and furthermore ovarian hyper stimulation syndrome(OHSS).
The unusually high progesterone level is sometimes seen in the presence of an early pregnancy and this should be excluded as soon as possible, the early positive OPK on day 10 is certainly unusual in the light of your history, and I would recommend that ultra sound follicular tracking be the preferred root of monitoring in this instance. In patients with known PCOS one often finds false positive OPK results, if not interpreted correctly. The more accurate option would be follicular tracking particularly in light of your cyst. My advice in this instance is to abandon the use of Fertomid for at least two to three months and you may in fact benefit from some form of cycle control to minimise the risk of cyst forming. This can be done using the oral contraceptive pill or a progesterone taking daily in the form of primolut-n for at least two to three weeks. When all hormonal and cystic activity has returned to normal, careful ovulation induction maybe instituted.
Answered by: Dr M.I.Cassim

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