I have questions about my symptoms or situations before or after a treatment cycle

 

7.1 My period has been usually light or heavy since my last cycle with Clomid or injectables. Or, I have not even gotten it yet, although my beta was negative. Is this normal?

Yes, it is normal for menses to be light, heavy, or simply different, due to the hormone levels being different. Also, progesterone supplements can delay the onset of menses. Most women don't start their periods until the progesterone level drops to somewhere between 2-4, which may take a few extra days.

7.2 What constitutes early or late ovulation? Does late ovulation decrease fertility?

There is not complete agreement on this. You might consider "too early" to be cycle day 10 and "too late" to be cycle day 20. There are two problems with late ovulation. The first point is that you obviously you have fewer chances (less ovulation) over a given time period. Second is the fact that with late ovulation you may be releasing eggs that have not been matured properly. It is also possible that the other parts of the reproductive system (hormone levels) are not in sync with the egg. That is not to say you cannot conceive if you ovulate late---it happens all the time. It is just that your chances are somewhat reduced.

7.3 My doctor says I am not ovulating regularly. How could I get my period if I do not ovulate?

Menstruation only requires development and shedding of the endometrium in response to alternating levels of estrogen then progesterone in the blood stream. These hormones can be produced by the ovary even when an egg does not mature or release.

7.4 I am concerned that I may have poor egg quality. How can I determine my egg quality?

You can get somewhat of an idea from the size of the egg and the estradiol level at midcycle. But other factors arise as you get further into your 30s, such as whether the outside covering is too thick to be penetrated easily by the sperm. You really can't diagnose egg quality until you get the eggs out of the follicles, put them under the microscope, and see how they behave. There are some less invasive screenings for ovarian reserve/egg quality such as the Clomid challenge, FSH, and Inhibin B, but they are also not as accurate as looking at the egg directly.

7.5 What causes chemical pregnancies?

Many early pregnancy failures are due to genetic abnormalities, mainly "trisomies" where an extra chromosome is present in what should be a pair. Some pathologists believe that the earlier the failure occurs after implantation, the more likely it is to be genetic. You can also have implantation problems that would cause chemical pregnancies such as hypercoagulation, failure to form the needed blood vessels, or autoimmune issues. (