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Friday, August 29, 2014

I started injections for ovarian hyperstimulatimon



I started to take birth control pill 12 days before my expected menstrual period. I do it to make sure that I get my periods on time. There were times when I wait and wait for my periods to start and it never happened. The reason was, either I failed to ovulate that cycle or I ended up with a cyst which prevented my periods. So, to be on the safer side, I took birth control pills. After 7 days on birth control pills, I started taking lupron too (overlapping BCP and lupron). I stopped BCP after 10 days and continued only lupron. When my period arrived, I started FSH injections on day 3 of my menstrual cycle (lupron continued until egg retrieval). Don’t ask me the name of this protocol. This is what has helped me previous time to get more eggs and so we followed the same. 

I ordered medicines in Madurai. In the beginning, I was scared. Medicines necessary for IVF will not be available in nearby medical shop (definitely not in our village). In a small city like Madurai, I was wondering, where will I go in search for it? But to my surprise, I found that, I could order all the medicines from home. I just have to call the pharmacy and order the medicines and they delivered the medicines to my home safely in a cool pack. I never expected this in Madurai and I was relieved. If any of you staying in Madurai was wondering how to order the necessary medicines, please contact Vasan medicals. They are very sincere, and prompt. They do their best to get the medicines you ask for in time.

I called Vasan medicals and the first question I asked them was which FSH preparation is the cheapest in the market. FSH is available in 3 different forms – Gonal F, Menopur and Menogon. Gonal F is the purest form of FSH. It is a recombinant preparation (genetically engineered) and hence very costly too. Menopur and menogon are prepared from the urine of post-menopausal nuns and hence called as hMG (human menopausal gonodotrophins). They are of course purified (not as pure as Gonal F) and contain equal amounts of LH and FSH. Menopur is a much purer version than Menogon. Menogon is the cheapest. I ordered Menogon. I used Gonal F for my first five IVFs in Germany. My ovarian response to Gonal F is very, very poor. But when I came to Dr. Malpani for my 6th IVF, I was given menogon and I responded so well to stimulation and produced many, many eggs. Might be I needed LH too for getting my follicles to grow. So, when you are given an option to select between gonal F and menogon, chose the cheaper one. Scientific studies have failed to show that one form of FSH preparation is superior to the other.

When I got all the medicines and when my mom saw it, her eyes became so wide for a moment and then watery too. She asked with fear, do you have to inject them. I said, amma I am so used to it. I don’t even feel any pain. If at all I feel something, it is just like an ant bite. From that day onwards I made sure my mom doesn’t see me injecting the medicines. Many women who are about to start IVF ask me with fear, "I am so sacred of injections, will they hurt?” Believe me, they don’t. I think, when compared to all the emotional turmoil we undergo during IVF, pain caused by these injections are nothing, absolutely nothing. If you are afraid of these injections, how will you face the pain of child birth? They say childbirth is the worst pain you could ever feel. I actually like those injections (FSH) for another reason. They are like costly anti-aging drugs (who wouldn’t love to look younger!). This is what my RE in Germany says. I truly, truly believe so. When you take those injections and when your estrogen level starts rising, it is a wonderful feeling, at least for me (I know women who suffer from nausea and other side-effects because of it). I feel like a teen ager. My thoughts change. I become so optimistic, I sleep too well and my skin becomes beautiful. Do you remember the first time you fell in love as a teenager (your first crush), it feels exactly like that! As a scientist, I am amazed to see and feel by myself how hormones could control our brain, our thoughts, perhaps our actions too. Is there anyone out there who could relate to what I say (very curious to know)? So, please do not panic about your injections. They are not as evil as you might think. One another fear most women have about IVF drugs is, “will I put on much weight when I take them?" I have heard women complain – “only after I started using them I became fat”. Please be assured that it is not true! What makes you gain weight is the depression that you go through during your infertility treatment. Because of the stress and depression, you unknowingly increase your food intake. Eating food, especially which are rich in carbohydrates, creates a feel good sensation due to the release of a hormone called serotonin. In order to beat depression, many women get addicted to the effect of serotonin and overeat unknowingly. The best way to prevent weight gain during fertility treatment is to develop creative strategies for beating depression. In my case, infertility actually helped me to maintain a healthy BMI. I understand the impact of body weight on fertility and I don’t want to put myself through another problem, I think I already have enough problems to tackle!

Rajender came to Madurai. I was eagerly waiting for him. How happy I was to see him! The first question I asked him was, “did you miss me?” He replied with a naughty smile, “no, never!” But his happy face said otherwise. I took my medicines for the first four days in Madurai, and on the fifth day we were in Mumbai for my first ultrasound. I asked Dr whether I could come to Mumbai much later, after 8 days of taking stimulation drugs (I thought I will reduce the hotel expenditure there, Mumbai is of course costly!). He was not happy. He said, “If you want to do so, I need a very good digital picture of your ovaries after 4 days of starting stimulation”. I was so sure I wouldn’t be able to get a digital picture (I remembered the not so cooperative doctor in that scan center).  He said, “Manju, don’t be penny wise and pound foolish. It is better we monitor you closely so that we can adjust your stimulation drugs as and when needed, this will provide you with a high chance for having an optimal outcome”. So, we were in Mumbai a lot earlier this time and I love Mumbai.

Mumbai is very beautiful and lively. People are friendly. Shopping areas are amazing. But the most important attraction for me in Mumbai is the Marine Drive area. I just love to sit and watch the sea. I feel so happy and relaxed when I do so. One thing that makes me sad about Mumabi is the wide-gap I see between the rich and poor people. There are overwhelmingly rich people who drive BMW and dine in Taj, and on the other hand I could see poor people, especially poor children who are just left on streets. I really, really feel guilty at such times for pursuing a costly way to have a baby, after all a baby, which are present in abundance in India, even on roadsides (babies, babies everywhere but not even one for me !) Once I was walking near the Taj hotel. The beauty and richness of it always amazes me! There were so many Benz, BMW and Jaguars parked there. Rajender was telling how much those cars would cost. I was hearing it open-mouthed. I thought what a life it is! I wanted to be that rich too. I want to drive a costly car, enjoy my evenings in a five star hotel like Taj and want to live like a queen (who wouldn’t want to!) Caught up so much in those thoughts I forgot to see the foot path. I was about to stamp on something and Rajender pulled me aside and looked at me angrily (It happens many a time when we go out, most of the time I will be too attracted by what I see or will go into dream mode). I looked down and realized that I was about to place my leg on the hands of a 12 year old girl. All my excitement drained in a second. There lay a poor girl, near that richest hotel, clothed in rags and with a small torn bag under her head (I hope it is her only possession). She was fast asleep in that busy roadside (serenity amidst chaos!). I was ashamed of my inability to do anything for such unfortunate children, yet, desiring after things which could make my life even more comfortable. I felt guilty. I was angry and bitter, I cried. People like me, easily blame Karma for such inequality and unfairness, and move on with their life. I realized that there are so many things in my life I must be grateful for. I had a safe childhood, I couldn’t imagine the life that little girl was leading. How unsafe it is for a girl to live on streets! I have a shelter above my head, I have good clothes to wear, I have food not only to satisfy my hunger but I could have food for my enjoyment too. If I start writing the things I must be grateful for I need several, several pages. If that is so, do I have any right to complain about infertility, not being able to have a child?

I went to the clinic for my first scan after four days of taking 300 IU Menogon. I was very happy when I went in. I was eager to meet everyone, especially my Dr. I was very eager to know how I am responding to stimulation. But when I came out of the clinic I was too tired, tired of crying my eyes out!

43 comments:

  1. Don't leave us on that cliff hanger! I thought for certain that you'd get a decent stim, especially after the follicle count and AMH numbers. I'll be hoping for a good outcome for you, as always.

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  2. Manju, please give us a twist in the tale that all of us are praying and wishing for you! It is ought to happen come what may..thinking and praying for you!

    My ET went well yesterday thanks to all your wishes and guidance! We transferred 2 day-5 blasto grade A (one is hatching and second is early blastocyst) after they come out normal in a PGS..rest two were abnormal..I am little disappointed that from my 9 thawed embroys (all survived thawing), only 4 could reach a stage suitable for PGS and of which only two were normal..so no balance left now :(( I was very hopeful of having some balance, incase this one does not work out! Very sad due to that..

    you please keep us posted and never lose hope! There are just too many people praying for you to make your dream come true!

    ReplyDelete
    Replies
    1. Happy to hear that everything went well. What kind of genetic testing, did they test all the 24 chromosomes ? Enjoy your 2ww, Take one day at a time. I am sure your embies will snuggle in tight. Good luck ! May your dream come true !

      Delete
  3. Thanks Manju. Doc recommended me PGS (Preimplantation genetic screening ) due to my 2 earlier miscarriages in 8-9 weeks of gestation. Yes, the PGS they did screened all 24 chromosomes using some CGH-Arrays method. Does this screening really help?

    ReplyDelete
  4. It does help and definitely it will help you :) How old are you ? Are the previous conceptions via IVF too ?

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  5. I am 31 (will be 32 in Feb next year). No, all previous conceptions were natural..

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  6. Why did you ask that? Just wondering if you were going somwehere with this?

    ReplyDelete
    Replies
    1. Since you said you did PGS and two first trimester m/c, I was wondering about your age.

      You are young. Does anyone in your family ( close relative ) suffer from diabetes ? You do not seem to have PCOD. Is your insulin levels normal ?

      Delete
  7. Yes my mama (mother's brother) does have diabetes...but I doubt I have prod..I mean never had any issues with my periods ever..always had them two-three days here and there..not even sure if I tested my insulin ever...

    ReplyDelete
    Replies
    1. Thanks for the info ! Sometimes women with high insulin levels in their body, undergo first trimester m/c often. You don't seem to have any typical symptoms of PCOD, so I think it is very unlikely you have such issues.

      Delete
  8. Hi Manju,

    Every post of yours leaves us waiting eagerly for the next post. wishing you very best for this new cycle.

    I also have a question. Does high prolactin results in IVF failure?
    I have failed a few rounds of IVF. I tested my prolactin recently and it was 30.
    Rest everything is fine, and dr. Doesn't seem to understand the reason of these failures.

    ReplyDelete
    Replies
    1. High prolactin can result in poor egg quality. Your prolactin levels doesn't seem to be too high. When was it tested, before or after an IVF cycle ? What is your TSH value ? How many embryos you got during your IVF cycle ? How many were transferred ? Did the embryos develop according to their age ?May I know your age, please !

      Prolactin levels can vary a lot due to several reasons. Even breast stimulation could raise prolactin levels. Hypothyroidism can raise prolactin levels too. Since your levels are not that high, I wouldn't suspect prolactin levels to be the reason for failed IVF. Do you have PCOD ?

      Only if you could give the entire details of your cycle, we might be able to get a much clearer view.

      Delete
  9. Hi.I am 29. The levels were tested after the IVF cycle. I do have autoimmune hypothyroidism but tsh is below 2 due to throxine medicine which i take regularly.
    I do not have PCOD and my cycles are regular.
    got 5 embryos and they did grow according to their age. One of them was 10 cells on day 3. We have transferred all the embryos in total 3 transfers ( one fresh transfer and 2 frozen transfers)

    ReplyDelete
    Replies
    1. May I know the reason for IVF ? How many eggs were retrieved ?  

      Delete
    2. Reason for IVF is tubal scarring and adhesions.
      Total 9 eggs were retrieved.

      Delete
    3. Do you have endometriosis or the scarring due to some infection ? Is the cause for infection known ? Is your BMI normal ?

      I would suggest you to measure your prolactin before your next IVF cycle ? If it is elevated it can be easily brought down using medicines.

      You are young, produce decent amount of eggs and embryos. Your chance of success with further attempts is pretty high. Remember, 60% of women conceive within 3 IVF cycles ( you have gone through only one ). I hope your further cycles get even better and you conceive. If you are confident that you are with a good clinic and believe in their ability to create good embryos, all I would suggest is to repeat the cycle. You can try a blastocyst transfer next time. This will give you much insight regarding your embryos competence. Please see your embryos before transfer and make sure you get photos of them !

      Delete
  10. Thanks for the reply Manju.
    Yes, I am already taking cobergoline for prolactin.
    Tubal scarring was due to a bacterial infection.
    My BMI is also ok at 22.

    ReplyDelete
    Replies
    1. Is your bacterial infection treated appropriately ? Ask your doctor whether you could go on a course of antibiotic ? Make sure your tubes don't have hydrosalpinx.

      Delete
  11. Yes it was treated appropriately around 5 years back, when I had it.
    Do I again need to take antibiotic course for next IVF?
    Also, hydrosalpinx was ruled out by my doctor when I asked her this. She saw the HSG reports for it. But I did hsg around 2 years back. Laparoscopy has also been done.
    Do you think I need to repeat the tests for hydrosalpinx, since it's been time when we did it last.

    ReplyDelete
  12. Taking a course of antibiotics won't hurt. Please talk to hear doctor about it ! Both you and your husband has to undergo antibiotic treatment if your doctor suggests so.

    Other things you do not have to repeat.

    Please understand I am not a medical doctor, so please follow your doctor's instructions.

    ReplyDelete
  13. Yes Manju, I do understand. It is only the advice which I am seeking.

    I can now remember that doctor gave me 3 days of antibiotics before the cycle.
    But is only 3 days of course enough?

    ReplyDelete
  14. Hi Manju,

    My serum progesterone has dropped from 19.4 on 21st Aug (day 1 post transfer) to 12.1 on 25th Aug. Is this a sign of worry? I am taking uterone 50 injection every alternate day and Gestone 400 (vaginally) twice a day. I have sent an email to my doc but wondering if you have any thoughts?

    Getting scared!

    Thanks

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  15. I do not think fall in progesterone has any significance. I think it is not wise to check progesterone at this point.


    ReplyDelete
  16. really? Not sure why my doc asked me to repeat it then? And I just searched on net - ppl are freaking out with falling progesterone in the 2ww after FET! But just to understand it better, don't we need healthy amount of prog. for implantation and sustaining early pregnancy?

    Thanks Manju as I am really hoping for the best this time!

    ReplyDelete
  17. also, what is this thing on net about having prog. around 20 in the IVF cycles? Very confused.

    ReplyDelete
    Replies
    1. Vaginal pessaries deliver progesterone where it is needed most - to the uterus. They are not absorbed into the blood. So in FET where there is no corpus luteum, your progesterone levels in blood tend to register a lower value. In my clinic they never check progesterone levels after they put the patients on vaginal pessary. I never took progesterone injections too. When I was pregnant with my twins my progesterone levels at 10 weeks was 8 ! Your progesterone levels will not say whether you are pregnant or not. Might be the clinic which checks progesterone in blood believes a blood level below 20 will not support uterine lining which is obviously not true when you are taking progesterone vaginally.

      Delete
  18. Thanks for a detailed explanation Manju! very helpful. My doc has reverted with the advice to change the alternate day injection to a daily one! May be they just want to play safe and do everything to help us conceive!

    ReplyDelete
  19. Manju, i am glad to hear that you are working on a stim cycle and i wish you much luck. I am also struck by the cliffhanger in your post- if it is not going well, i hope that it may turn around by cd8. my best ivf cycle, i stimmed the longest and had the best results of all remaining cycles.

    ReplyDelete
    Replies
    1. Thank you ! That's very kind of you.

      Delete
  20. Hi Manju,

    Your blog is very informative and it really helps people undergoing IVF to take some time and think, plan and move ahead.
    I wanted to ask you for the protocol that you use before stimulation. I.e bcp with an overlap of Lupron . Was it being suggested by your current RE or is this something that you have researched and then started administering.

    ReplyDelete
    Replies
    1. Thanks for the kind words !

      I have used antagonist and microdose lupron flare protocols. The problem I had with both these protocols was, I ended up with few follicles and there was lots of discrepancy in their growth, they grew asynchronously. When I went to Dr. Malpani, I had to take BCP so that it is easier to plan the cycle. That time I came across Dr. Sher's article about why it is important to overlap BCP with lupron. Please do a Google search ! I also started with higher dose of FSH in Dr. Malpani's clinic. Something worked :)

      If you could give me your personal situation, I could help you better. Every human body is different. It is hard to pinpoint what works best. If the ovarian reserve is good, most protocols will work. The problem arises if the ovarian reserve is poor. If the AFC count is less, then it is impossible to coax the ovaries to produce more eggs than that. This is the sad truth !

      Delete
    2. Hi Manju,
      Thank you for replying back. Would you mind sharing how much dosage of Lupron were you on ? Did u continue the same Lupron dosage along with the stimulation FSH meds or did you reduce the Lupron.

      I am 34+ year old, diagnosed with anovulatory disorder/pcos since last 8-9 years. I have been thro' few IVF cycles myself. The first one was the long Lupron protocol. I took bcp piklls with overlap of Lupron. Then continues fsh stimulation with lower dosage of Lupron. It wasn't a great cycle as though I retrieved a large number of eggs (20), I got only 7 mature. 3 made it to blast, got positive beta in fet cycle, but m/c at 6 weeks. AFC was 21, AMH -> 6.1

      Same thing happened for Antagonist protocol. 19 eggs, mature 8 . Only one made it to blast.
      AFC was 20, AMH -> 4.5

      The current fertility specialist that I am referring is suggesting will start . Lupron for 3 days (from day 1 of cycle) and then Menopur (300IU) along with same dosage of Lupron.
      I am a little worried if 3 days of Lupron down regulation with Lupron will be enough. he hasn't mentioned to use bcp. Also, does the dosage of 300IU look too high ?
      I have been reading some articles on Dr Sher's blog too and he doesn't seem to advocate for high dosage Menopur for PCOS patients. Do you have any suggestions regarding this ?

      Delete
    3. Lupron 20 units everyday in a 100 unit insulin syringe. I am really, really sorry. I don't know the exact dosage. I continued the same dosage throughout my cycle. But, using lesser lupron doesn't lead to more eggs or promote the growth of follicles better. Lupron has an entirely different function, it acts on the receptors in brain. So please do not worry about the dosage of lupron. Three days of downregulation of lupron is enough to achieve a pituitary suppression. Please do not worry !

      I understand your fear and you are a lot confused too. You get lots of eggs. Your problem is that, the eggs retrieved are not mature enough. Perhaps your current RE thinks more FSH and longer stimulation can lead to mature eggs. I am sure they have enough experience in treating PCOD patients. I find no fault in the protocol he has suggested. The protocol you are going to use is flare protocol. Some people argue that it is not apt for PCOD patients. This is because lupron for the first 3 days of administration increases your body's own FSH and LH. This creates a flare effect which jump starts your follicles. After 3 days lupron prevents your body's own FSH and LH production. The stimulation meds you will be taking continues to help in the growth of your follicles further. Since PCOD patients already have high circulating LH, many don't advise using this protocol for PCOD patients thinking that high LH might compromise endometrial lining receptivity. But, you must understand that there are no universal rule. Every patient is different, there are no common pattern. Might be your current RE has good experience with this protocol for PCOD patients. I would follow his advice without worrying.

      But, you can do one thing. If you get enough embryos, please transfer only one in a fresh cycle ( or none) and freeze the remaining. Since you produce lots of eggs, your estrogen levels can rise too high which can spoil lining receptivity. Frozen transfer could overcome this problem.

      Are you on any meds for PCOD ? Myoinositol ? Metformin? Are you overweight, insulin resistant ?

      Hope this cycle goes well. Keep me updated if possible.

      Delete
    4. Hi Manju,

      I must tell you. You are doing a great service by providing guidance to confused souls like me. The whole IVF process itself, though being a boon for us, has so much unpredictability that each attempt feels like a roulette game. The only thing we can do is to try to know and understand what we can and probably be a better advocate for ourselves.

      Thanks for guiding me on the Lupron. In my first IVF cycle and also for the FETs, I had a long Lupron suppression and it was no fun at all. I was so miserable with severe headache due to lack of estrogen in my system and only when the estrogen support started, I felt better. I hope you did alright. So, I guess I should feel good about the fact that short Lupron suppression is being suggested :) . My body would probably thank me.

      Yes. You are probably right ..that RE thinks that more FSH with carefully monitoring stimulations/trigger could help me with more mature eggs. It is just that it is not a very recommended approach and that start playing with my mind. I guess, if I trust the RE, I will have to bring myself to trust the approach.
      You did make a very valid point of not transferring or transferring one embryo if the endometrial lining does look compromised. There is so much effort that goes in getting a good embryo. It doesn't make sense to transfer just for the sake of making use of the cycle.
      My last ivf (antagonist protocol) resulted in just one blast (fair quality). I had it transferred in a frozen cycle. I got good positive betas but unfortunately this one too didn't progress beyond 5 weeks. One thing that I was thinking after that failed cycle was to probably have a more bank of embryos and then do FETs. It's just that sometimes it becomes financially difficult to shell out lot of money for extraction cycles one after another. Plus there is lot of uncertainty that can creep up if an EC cycle doesn't go as per expectations. Hope I can hang in there enough to keep the tries on.
      I was on Metformin for a long time. Yes, overweight and trying to loose weight thro the diet and exercises. I did stop Metformin a year back as I was having of stomach issues, migraine flares. My fasting blood sugars were normal , haemoglobin a1c was normal. So, my RE suggested that I can take break from all medication except the thyroid medication that I was on. I very recently started Myoinositol. Read some positive reviews about it. Even if it can help a little percentage in egg quality, I guess I will take it.
      I will definitely keep you posted on my cycle. It is going to take some time because I am giving myself a little time to get a little more fit, let the Myoinositol work. I was being told for COQ10 too. I am yet to decide on that one. Have you tried it ?

      I sincerely pray that this cycle of yours goes well with the transfer. Sending you all the positive thoughts.
      "Life may not be the party we hoped for, but while we are here we might as well dance" Author Unknown.

      Delete
    5. Shivani, I am so happy that you are doing your best to learn things and advocate for yourself. That is the first step for having a successful IVF ! I am sure your efforts and your positive spirit will definitely pay off.

      It is very, very important to have a healthy BMI. Was your fasting insulin checked anytime ? PCOD women with high insulin are prone to early miscarriages too. Your decision to take some time to get back to a better health is very wise. Do your best and leave the rest to God/Nature.

      I wish you lots of good luck !

      Delete
    6. HI Manju,

      I looked thro' the hoards of blood work that I have done in the past and I don't see fasting insulin test result. I can see fasting glucose ( 74), Glucose 1 hr (94), Glucose 2 hr (105), Lipid Panel, Chem Panel, Haemoglobin A1C (5.0). I don't know why fasting insulin wasn't tested in all these years. Do you think i should talk to RE and get it done ?

      I agree on the BMI part. The more I read about it, more stupid I feel for not being able to maintain a healthy BMI all these years. It's not that I haven't tried. At times I have been on regular exercise routine and have been able to loose weight. But again, there were times of hectic work schedule with sedentary nature of work and negligence on my side , that did bring the weight back. Well, the time lost can not be brought back. I guess. next 1-2 months with focus on my health , I can just hope for a maybe better result.

      Delete
    7. Myoinositol and metformin both work as insulin sensitizers, they help your body to use insulin efficiently. This in turn leads to reduced androgen levels and gonodotrophins (LH) which leads to ovulation. Did you ovulate when on metformin ? Did metformin regularize your periods? Measuring insulin will just make sure that your body has insulin handling problem. If you wish to you can do it in a nearby lab too !

      Please don't beat up yourself ! We all neglect our health at times. I am sure now you will do a good job. If I were you, I will avoid all form of simple sugars and stick to only complex carbs. You can also look for insulin test diet on internet.

      Delete
    8. Hi Manju,

      Sorry, I missed to see your comment. With Metformin, I didn't have regular periods. I did ovulate at times (Tracked it using OPK's or thro' blood draws at RE) but they were still irregular. My RE (the one which I had done with my IVF's) has no recommendation for myoinositol, when I asked she said it is ok if I want to take a low dosage along with metformin (1500). As per her, my insulin resistance is not really a problem. They typically suggest testing it out if the A1C is higher than normal or fasting sugars is up. If they are in a normal range, then insulin is getting handled.
      Do you think it's unnecessary to have both Metformin and Myo-inositol ? Will it cause any harm ?

      Delete
    9. I don't think taking both will do any harm. But, if myoinositol could do what metformin does ( improvement in insulin resistance ) then why to take metformin which is very hard on stomach ?

      I don't agree with your doctor. A normal blood glucose or A1c doesn't guarantee that your insulin is normal. High insulin levels are detrimental. So please be on some insulin sensitizer. I would even continue metformin even after a pregnancy is established. It helps to prevent miscarriages.

      Delete
    10. Thank you Manju for providing guidance on this. Helps a lot.

      Delete
    11. Hi Manju, need some urgent advice!
      Sorry to disturb you at this time of pregnancy.
      I am about to start birth control pills (regestrone) from 1st Jan 2015 for fresh IVF cycle.
      My LMP date was 8th dec 2014. But today i got some bleeding. My period does arrive 8-10 days early, though very rarely. I don't know what to do now and my doctor is also not available on phone.
      shall i start regestrone right away to stop any further bleeding or shall i let the period start?
      Please suggest.
      Thanks

      Delete
    12. I am really sorry, I don't think I could help you much.

      But, in my opinion, you can let the period start and take birth control pill from day 3 of your menstrual cycle. This will suppress the selection and growth of dominant follicle.

      Please talk to someone in your clinic, they might help you decide!

      Delete
  21. Thank you for your valuable reply, Manju!!

    ReplyDelete

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