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Infertility and Reproductive Medicine Moderated by Scott Roseff, M.D.


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  #1  
Old 11-11-2009, 10:51 AM
KLB1974
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Default Ovarian Torsion

Dr. Roseff,

I have posted here a few times about my infertility struggles. I have had two IUI's (with 100 mg of Clomid and Ovidrel trigger).

On my last IUI, I had 5 follicles (3 on the left and 2 on the right). The 3 follicles on the left were all quite large (mid-upper 20's). The ones on the right were 14 and 19.

I found out last week that I am pregnant! Shortly after finding out I was pg though, I developed some odd pains on my left side. I didn't think much of it...thought it was pg related.

On Sat. a.m., I woke up to the most horrific pain I have ever had (worse than contractions). My husband rushed me to the hospital and they found that I had ovary and tubal torsion on my left side and that my ovary had infarcted. My left ovary was the size of a tennis ball! I had emergency surgery to remove the ovary and tube. The surgeon opened me up on the right side as well to look at my right ovary and it was fine. There was no evidence that the pregnancy resulted from the follicles on the right as no corpeus luteums were present.

The pathology report came back and said there was no ectopic pregnancy that caused the torsion. The surgeon belives it was likely from my ovary being overstimulated and/or from a corpeus luteum cyst that ruptured.

My fetility doc never told me that this could happen. I knew my ovaries could swell but I never realized I could actually lose my ovary and tube.

I was wondering how common this is for patients on Clomid/Ovidrel. Also, would pregnancy with multiples put someone at higher risk for torsion? My HCG levels have continued to rise and they are so high (was 6788 on Monday at 5 weeks) that they believe I may be pg with multiples.

I think I was too early in the pg on Sat. for them to see anything in my uterus. There was also alot of blood/fluid in my pelvic area so the radiologist could not get a clear picture on the ultrasound. I am going in tomorrow for another ultrasound.
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  #2  
Old 11-11-2009, 01:43 PM
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Scott Roseff MD Scott Roseff MD is offline
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Do you ovulate regularly and normally by yourself without Clomid? Do you get periods on a regular basis? Do you have PCOS? What was the reason you were placed on Clomid?

Dr. Roseff
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PERSONALIZED/SUCCESSFUL Specialty care....

As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.
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  #3  
Old 11-11-2009, 03:19 PM
KLB1974
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Default Ovarian Torsion

Yes, I do ovulate regularly (without Clomid) and I do have very regular periods. I do not have PCOS. The reason I was put on it is because I had a miscarriage last year and ever since, have not been able to get pregnant. I'm 35 and my FSH was a 13 with high estradoil count. The fertility doctor told me my chances of conceiving were low but wanted to try me on the 100 mg of Clomid and Ovidrel. I took 50 mg of Clomid alone for 3 months (no IUI's) and nothing happened. I was also told that Clomid help produce a "better" ovulation.

I'm very upset because I felt like I was put at risk for this and no one clearly explained to me that this could happen. Also, the chances for multiples was downplayed.

As it turns out, I have mild endometriosis. It was found during my surgery (on the back side of my uterus) and the surgeon said that could have been the likely culprit for my infertility. So it's doubtful I even needed the Clomid/Ovidrel. But not even in my wildest dreams did I think this combo would cause me to lose my ovary and tube. Even though we can never be 100% sure what caused it, I don't believe it was just a fluke.
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Old 11-11-2009, 08:07 PM
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Scott Roseff MD Scott Roseff MD is offline
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Clomid does not produce a "better ovulation". Clomid is a very potent medication. Clomid is not designed for women who ovulate normally on their own. Furthermore, if someone NEEDS Clomid to properly ovulate, she should be given the lowest possible dose that causes her to ovulate, and she stays at that dosage as there is no advantage to increasing the dosage.

I've copied/pasted some important excerpts from the actual package insert/prescribing information for Clomid, below (italics are mine for emphasis; quoted material from http://products.sanofi-aventis.us/clomid/clomid.html):

"Action
CLOMID is a drug of considerable pharmacologic potency. With careful selection and proper management of the patient, CLOMID has been demonstrated to be a useful therapy for the anovulatory patient desiring pregnancy.

INDICATIONS AND USAGE
CLOMID is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Impediments to achieving pregnancy must be excluded or adequately treated before beginning CLOMID therapy. Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome (see WARNINGS: Ovarian Hyperstimulation Syndrome), amenorrhea-galactorrhea syndrome, psychogenic amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.

CLOMID is indicated only in patients with demonstrated ovulatory dysfunction...

Ovarian Hyperstimulation Syndrome
The ovarian hyperstimulation syndrome (OHSS) has been reported to occur in patients receiving clomiphene citrate therapy for ovulation induction... In addition, the following symptoms have been reported in association with this syndrome: ...intraperitoneal and ovarian hemorrhage, deep venous thrombosis, torsion of the ovary....


To minimize the hazard associated with occasional abnormal ovarian enlargement associated with CLOMID therapy, the lowest dose consistent with expected clinical results should be used.

Postmarketing Adverse Events
The following adverse experiences were reported spontaneously with CLOMID.

Genitourinary: Endometriosis, ovarian cyst (ovarian enlargement or cysts could, as such, be complicated by adnexal torsion), ovarian hemorrhage, tubal pregnancy, uterine hemorrhage....

Recommended Dosage
Treatment of the selected patient should begin with a low dose, 50 mg daily (1 tablet) for 5 days. The dose should be increased only in those patients who do not ovulate in response to cyclic 50 mg CLOMID.


If three ovulatory responses occur, but pregnancy has not been achieved, further treatment is not recommended."

I hope this information is helpful, and I'm sorry to hear about your problem(s),
Dr. Roseff
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Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
PERSONALIZED/SUCCESSFUL Specialty care....

As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.
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  #5  
Old 11-11-2009, 08:59 PM
KLB1974
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Default Ovarian torsion

Thanks for the information. I feel so stupid for having taken his advice. I should have searched on my own rather than take these drugs without much question. I was really scared about proceeding when I had 5 follicles but was told my risk was "low".
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  #6  
Old 11-11-2009, 10:19 PM
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Scott Roseff MD Scott Roseff MD is offline
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DON'T blame yourself. It's ridiculous to think you could/should have known any of this on your own before you did what you did.... Is your fertility doctor a Board Certified RE??

Dr. Roseff
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Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
PERSONALIZED/SUCCESSFUL Specialty care....

As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.
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  #7  
Old 11-12-2009, 10:25 AM
KLB1974
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Default Ovarian Torsion

Yes, he is board certified. I just don't understand why he did this AND proceeded with my IUI with 5 follicles when he told me point blank at my first appt. he would cancel any cycle with more than 3.

Now, here I sit without an ovary and tube and pregnant with twins (confirmed today).
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  #8  
Old 11-14-2009, 07:14 AM
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Scott Roseff MD Scott Roseff MD is offline
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I'm sorry, but congratulations anyway....

Dr. Roseff
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Dr. Roseff - South Florida Institute for Reproductive Medicine - Boca Raton, FL
PERSONALIZED/SUCCESSFUL Specialty care....

As you’re not my patient, information herein may be incomplete/inaccurate & I can't be responsible for your actions. This is for educational purposes & should never be used to replace information & care rendered by your own doctor. No part of this message may be reproduced, printed, or posted elsewhere without express written authorization of Dr. Roseff or INCIID.
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