Follicular monitoring as a part of Ovulation induction

1)      What else to document to maximize conception rate in Non-ART cycles?

In Follicular monitoring do not monitor the growth , size, shape , vascularity of Follicle &endometrium grading only . Follicular monitoring means many more like

1)      Per follicle E2 level should be about 150-300pg/ml. per follicle.If not thehn change the protocol I,e, go to some other agent if she is aged say > 28yrs and married for 6yrs or more.. Not to waste time and money.

2)      Dipstick urine test(home monitoring)-will hopefully detect LH surge and timing of marital relation .This  is more relevant cwhen husband or wife are employed in seprtae places si that coupk,e can plan to stay together by availing Leave from service/ workplace  alternately. IUI may too planed by this way (urinary LH monitoring). But it will be better if  when  second morning sample is best,  7 am to 10 am  best .

3)        When to initiate FM- when? - Better to commence on day 9.

4)      Doppler Velocimetry-though not commonly noy done in non ART cycles but may be done if doctor concerned is interested.  Perifollicular blood flow- 50-75%  wit RI of 0.4 – 0.48 is good enough.

5)      Midluteal Progesterone - 1) above 3ng/ml=means evidence of Ovulation. B) if above 10ng/ml  implies  adequate progesterone = Expected to be adequate luteal length. Quite often luteal length is less which can impede with onward development of zygote.

6)       What is clomiphene check+-- It means after each  cycle of failed CC(non conception cycle) - on subsequent Day 3 USG is  to be done to note evidence of any Cyst.(Residual cyst) in ovary

7)      If no conception after 3-4 cycles then move on for MG.

8)      If recurrently serum P on Day 21 is < 10 ng. then seriously consider either modification of stimulation either in dosage or type of agent .But if  serum progesterone is below  7 ng/ml ,then

9)      = Vag P suppl is a must.

10)    Recurrent Poor ET in absence of hyper prolactinaemia or Kochs./ Synechiae - Go for MG/Letroz.And after 1 yrs may consider ART(IVF) depending on age & yr of trying.