What is a monitoring visit and why is it important?
So your doctor has started you on Clomid or Femara and told you to schedule a cycle day 12 ultrasound. What is that for? You may have been prescribed these medications before by an OB/GYN and never had any ultrasounds or blood work. Why now?
For most patients, by the time you come to PREG or another fertility doctor you have been trying to conceive for a year or even more. At this point, we need to learn as much as we can about your cycle, how you respond to different medications, and when the best timing in your cycle is for planning intercourse or an intrauterine insemination (IUI). A monitoring visit (commonly referred to as your cycle day 12 ultrasound) will give us all of that information. A doctor or nurse will perform a transvaginal ultrasound that will allow them to see how many follicles you have developed after taking the medication and therefore, how many eggs you will likely ovulate. Ideally with this form of treatment, we like you to ovulate anywhere from 1-3 eggs in one month. Women normally ovulate only 1 egg each month, but ovulating 2 or 3 at a time may increase your chances of conceiving that month.
This also puts you at a slightly increased chance of multiples (conceiving twins or triplets). This is another important reason we do the monitoring visits. If we see on your ultrasound that you may ovulate four, five, or even more eggs at one time, we need to discuss those risks with you and possibly recommend abstaining for that month to prevent you from becoming “too pregnant.” Our goal is to help you conceive, but also to have a safe and healthy pregnancy.
We are not only concerned with you ovulating, but also in making sure that the uterus looks like the optimal environment for implantation to occur. We will also assess the lining of your uterus at the monitoring visit. We will make sure it looks clear of any polyps or fibroids that may decrease your chances of conception. We also will measure the endometrial lining (where the pregnancy will implant) to make sure it is an appropriate thickness.
After the ultrasound has been performed, the doctor and/or nurse will let you know the best time to plan intercourse or IUI. This is another important reason for the ultrasound. Based on the size of the developing follicles (the sac that contains the egg), we can determine the optimal time for planning ovulation and treatment for you for that month. We will even have you trigger ovulation with an injection you will give yourself in the stomach at the appropriate time. This takes the pressure off of you from having to guess when you’re ovulating.
We do these visits each month, even if you take the same medication that you took the month prior. Although you would think your body would respond the same way each month, the body is not a machine and will sometimes respond differently to the medications from one month to the next. This means you may not ovulate one month on a medication that caused you to ovulate the month before or you may ovulate more eggs than you did the month before. These are both things we would want to be aware of before recommending proceeding with treatment.
In summary, the monitoring visit gives us a lot of information. Did this dose of medicine work for you? Are you ovulating? How many eggs might you ovulate? When should you plan intercourse or an IUI? It may even tell us if we need to change your medication for your next treatment month to optimize your chances. We will make adjustments to your treatment plan as needed. By being able to answer all of these questions for you we hope that you will feel more confident in the steps you are taking to conceive and know that you are getting closer to welcoming home that baby you’ve been waiting for.