Microsoft word - cycle monitoring guide for patients.doc
Cycle Monitoring Guidelines for Patients Earl W. Stradtman, Jr., M.D., P.C. Office telephone: (205) 933-5600 Answering Service (205) 930-4498 Fax: (205) 933-5602
WHY WE MONITOR OR STUDY OVULATION Normal, regular ovulation (release of the egg or oocyte from the ovary in a woman) is essential for pregnancy to occur and usually results in regular menstrual cycles. Ovulation can become irregular, of poor quality, or absent, which can contribute to infertility. The menstrual cycle can be divided into three parts: (1) The follicular phase, in which the follicle (fluid-filled sac containing the egg) grows under the control of hormones from the pituitary gland and ovary to maturity; (actually, the follicular phase begins with the period); The size of the follicle just before ovulation measured by ultrasound is related to the quality of ovulation. (2) The LH (luteinizing hormone from the pituitary) surge which occurs midcycle to trigger ovulation. (3) The luteal phase, the latter half of the cycle which follows ovulation lasting about 2 weeks, in which progesterone is produced to support early pregnancy. If no pregnancy occurs and the progesterone level decreases, the uterine lining sloughs off causing the period.
The basal body temperature (BBT) chart is an inexpensive way to confirm ovulation because the rise in progesterone causes a rise in the basal body temperature which can be charted on a graph. A BBT chart may be needed before more extensive testing in order to guide us when to start using an ovulation predictor kit. Its disadvantages include being tedious, not strictly predicting ovulation, and giving no indication about the amount or level of progesterone produced. CYCLE MONITORING In this cycle, we need to evaluate the quality of ovulation according to the methods and tests outlined below. Cycle day (CD) 1 is the first day of bleeding (normal flow) with the period. Please note when CD 1 occurs this cycle. (Date: ___/___/___) ____ Please call office nurse on CD 1, or first weekday, to let her know that you are having a monitored cycle (and any other test
or procedure such as a post-coital test (PCT) or intrauterine insemination (IUI)).
If you are taking a medicine to bring about or improve ovulation, such as clomiphene citrate (Serophene® or Clomid®), the directions for staring and stopping it should be included on the prescription. Otherwise, your natural cycle will be monitored. ____ Start your ovulation predictor kit (Clear Blue or Clear Plan Easy® [recommended] or other brand) on CD ____ .
Dr. Stradtman or the nurse should advise you which CD to begin testing, but if you are unsure, determine the day by subtracting 17 from the most recent cycle interval (number of days from the beginning of the previous period to the beginning of this one. For example, 31-day interval - 17 = 14. Therefore start kit on CD 14.) Use your first morning urine sample, when possible, for testing, and test the same time each day. Follow the directions on the kit to determine when the LH surge has begun. In general, the LH surge is positive or in progress when the color change from your urine sample gives a color as dark as or darker than the control color, which shows that the test was performed correctly. Usually ovulation occurs the next day. When the LH surge is positive, page Dr. Stradtmanbetween 6:00 and 7:00 am @ 930-4498 (7 days a week) so that you can be seen ____ that day for ____ a follicle ultrasound and/or ____ PCT, or ____ the next day for an IUI.
____If noLH surge has occurred by the next-to-last ovulation test strip, please call that day so a plan can be made. If you think you might surge over a weekend, please call the nurse by Friday afternoon to let us know to expect you. ____ Obtain a serum progesterone level 8 days after the LH surge occurs (or between CD ________ if no surge occurs) ____ at our office if you live in the Birmingham area or____ at a nearby LabCorp blood-drawing station or____ other laboratory to confirm ovulation.
____ Return for an office visit 12-13 days after the LH surge begins (or CD 26-30 if no surge has occurred) for ____ an
endometrial biopsy and/or ____ an exam to be sure no ovarian cysts are present, and/or to review the plan for next cycle.
____ Call 12-13 days after LH surge (or CD 26-30 if no surge) to discuss the plan for your next cycle.
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