Follicles and lining at CD14

[SchnitzelVonCrummsTum]

Asking for a non-mumsnet friend.

Friend was on letrozole (femara) CD3-7 and had an ultrasound at CD14.

She had two follicles, one 14mm and one 15mm, lining was 5.8mm.

Usually has a lot of ewcm but this month, bone dry. She would usually have ovulated by now but now is frightened that she won't ovulate at all or, if she does, that the lining will be far too thin.

She paid privately for the ultrasound because she isn't getting any monitoring, just a CD21 blood test. It's timed intercourse rather than IUI.

I'm really confused because I thought that letrozole was meant to avoid the side effects of clomid on the lining and cervical fluid, but this seems to have happened to her.

She doesn't have PCOS but does have recurrent miscarriages and the letrozole was to help her have a 'stronger' ovulation. Instead it seems to have sabotaged it?

Any, more experienced views on this would be hugely appreciated...

I'd say make with the dtd!!

I had a 13mm follicle on Monday, 'larger' on Wednesday (but significantly less than 20mm), and I ovulated Thursday overnight. That was a clomid monitored cycle.

Those follies could drop tomorrow or the next day!!

Ah okay, thank you! She's been sitting sobbing on my sofa so she will be cheered to hear that ...

She's also stressed because she doesn't get a 'trigger' shot. I have to admit I have no idea what that is but googling informs me it's hcg (I assume it acts like LH because they're structurally similar). It sounds like a trigger wasn't necessary for you @physicskate?

No trigger for me. I generally think they use that for IUI and IVF cycles...

I would suggest she uses opks as I had a positive on the Thursday and scan Friday early am 'confirmed' follie had burst.

Oh and rasberry red leaf tea for thickening the lining!!

14 dpo for me and bfn. Feeling sorry for myself today too. I remember crying after my two scans that said I hadn't ovulated yet. The worst thing was restoring hope... misplaced hope, it seems (for me, but hopefully not for her).

I’m not sure how soon the ovulation happens on these medicated cycles but with two equal sized follicles she might ovulate two eggs! So could have double the chance ;) Usually, women ovulate when the follicle is considerably over 20mm.

The lining is a little thin at the moment, but I wouldn’t be surprised if she doesn’t ovulate for another 3-5 days by which point the lining might be considerably thicker. I’d be opk-ing like mad to make sure she dtd at the right time and goes for d21 bloods at the right time (7 days after ovulation).

Also both ewcm and thickness of lining are due to rising estrogen levels and so correlated. She could ask about some support with that in the future. Alternatively, eat and drink stuff that helps with estrogen levels like licorice tea, soya, flaxseeds, beans etc.

Wow, thank you for the tips - I have sent her the link to the thread so she can read through them herself.

Wednesday was CD14 so she went back today (Fri) on CD16. The previous scan was transabdominal but this one was transvaginal on her request. The good news - lining is about a mm thicker at 6.7mm. The less good news - the follicles don't seem to have grown at all. The 15 mm follicle on the left is now measuring 14mm, and the previous 14 mm on the right is now measuring 15.7? I don't even know if she should trust the comparison though as surely method of measurement makes a difference ... and I'm sort of wondering whether the sonographer got her left and right mixed up on one occasion as surely follicles don't shrink (or maybe they do!).

Anyhow, she doesn't know what to think and is really upset again (I can totally understand this). She can't afford to go for any more scans this cycle so I guess she will just have to wait it out and keep taking OPKs?

What happens if she doesn't actually ovulate - at some point will her period just come anyhow?

Frankly, all she needs to do is have regular sex. Even every 2 days will do he job (provided her partner's semen is normal). That will help whether she ovulated in 2 days or 2 weeks.

If she's keen to catch her ovulation she could do opks and measure her temperature to monitor her cycle. Or use some other techniques like cervix observation etc (not much of an expert on those but there's lots of stuff online).

And yes, even if someone doesn't ovulate, they eventually get a breakthrough bleed so a period doesn't mean she's necessarily ovulated.

Thank you @JoJoSM2 I really appreciate your help.

Update is that she went back for another scan today and nothing at all had changed. She has been offered progesterone to take for 10 days to bring on a new cycle ( she has decided not to try femara again and just stick with her natural cycle).

What happens to the 15/16mm follicle in her ovary? Will it shrink down or still be there next cycle? Could it cause problems?

So sorry for all the questions xxx

Sorry to hear that. Bad luck. I think the follicles will probably just shrink back.