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Infertility

Irregular cycles and infertility

03/27/2009

Question:

Hello: I am trying to conceive from about a year and a half. I was diagnosed with a large ovarian cyst and had it removed surgically from about a year. After the operation the menstruation stopped for 3 months (the doctor told me that this was very normal). Since the time my cycles came back they became very irregular and long, ranging from 40 to 60 day cycles. Moreover, I sometimes notice brown spotting (like old blood vessels and the last time it came with large pieces of tissue) in the middle of the cycle. I do not know whether this spotting is due to menstruation or another reason. Because I am trying to conceive from the time I got married, I performed several tests (hormones, uterus and ovaries scan, ...) several times before and after the operation and all came back normal. I am ovulating and the hormone levels are normal. I had the last doctor visit about 7 months ago and the doctors advised me to wait for natural conception since everything is normal (I got the same answer from 2 other doctors). As a result of my frustration, I was planning to visit the doctor again and start a hormonal therapy to regulate my cycles. Shortly before doing this, I was diagnosed with a fibroadenoma in my breast and the doctor told me that I shouldn`t take any medications containing hormones.

I know that online diagnosis is impossible and that I have to visit the doctor again (which I am planning to do in the very near future). However, I will really appreciate it if you just give me a possible answers for the following:

- the brown discharge and the tissue discharge - the cause of the irregular cycles and how to make them more regular - possible infertility cause - how to increase my chance of becoming pregnant - is it true that I shouldn`t take hormonal therapy

Answer:

You have a complicated story, and it is understandable that you are frustrated. You should definitely see a fertility specialist (rather than a general OB/GYN) if you have not already. Your primary problem sounds like you are not ovulating regularly, since your menstrual cycles are 40-60 days in length. This could also be why you are seeing "old blood". Early steps will be to exclude common causes of irregular ovulation and treat you with medication to induce ovulation. Other early steps include evaluation of your husband's sperm count and verifying that your tubes are open. Breast Fibroadenomas are very common non-cancerous tumors. They can get bigger with hormone therapy and pregnancy, but are not reasons to avoid hormones or pregnancy. It is recommended that fibroadenomas are biopsied (a small piece is removed for evaluation) or totally removed prior to trying to get pregnant. I hope that this general information is helpful to you.

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Response by:

William W Hurd, MD William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University