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Question
Posted by: Angie | 2005/11/17

No menses after Gonal F??

Hi Doc,
I had Gonal F simaltaneously with Clomid for two months. The one month I had a couple of follies but they never matured properly and the next month I just had one huge one (33mm) on day 10. Well my gynae never gave me a trigger shot that month and my period started on day 24. The next month ws with no medication and I started a period on day 28 but first brown spotting then bright red blood for about 12 days (I normally only menstruate for 5 days). Well I am on day 42 now and still no period. What do you think the cause is? Maybe hormones gone weird? I went to my gynae on day 21 for a quick checkup cos I was a bit concerned about the bleeding for 12 days but when he did a scan he said all was fine just that my endo lining was a bit thin for day 21. What do you think is going on?

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Our expert says:
Expert ImageFertility expert

Dear Angie

From the history that you have volunteerd it appears that you have dysfunctional uterine bleeding which is secondary to hormonal imbalance, which in addition, has been probably started by the use of the ovualtion induction agents that you have mentioned.
My suggestion here would be to bring all the hormones to a baseline using combined oral contraceptives for at least one or two months. Thereafter you can start ovulation induction again provided that you are not in the perimenopausal range. It is of concern that despite the use of Gonal-F and clomid that you only developed a couple of follicles which never matured properly. I would be concerned that there maybe a problem in respect of your ovarian response .ie, that you may have resistant ovary syndrome or in fact may be in the perimenopausal phase of your ovaries . I would strongly consider changing the ovulation monitoring protocol after using the combined oral contraceptive for at least one to two months. The protocol I would recommend would be a high dose down-regulated program, which will afford us better control of your cycle and prevent or avoid the formation of single large follicles at a very early stage in your cycle, such as had happened in your second month.

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