Luteinized Unruptured Follicle or Corpus Luteum Cyst?

[tvalero]

I'm 28 years old and my husband and I have been TTC for about 1.5 years. We have been pregnant twice, both of which ended is miscarriage (at 8 weeks and 6 weeks respectively). I ovulate on my own, but my hormone tests indicated that I may be ovulating "weakly" which would explain why it takes us 4-5 cycles to get pregnant and the pregnancies don't last. To combat this, my RE has put me on Clomid in hopes of improving egg quality. I had been monitored for several months and have seen the ruptured follicles post-ovulation in all of the cycles prior to my first medicated cycle. In my first medicated cycle (50 mg clomid, cd5-9) I was on vacation, so I could not get an u/s to confirm ovulation, but my period arrived on schedule so I'm assuming I ovulated.

In my second medicated cycle, I was put on 150mg clomid cd3-7. I went in for an u/s on cd12 and I had a 21 mm follicle and was told I would ovulate at any time. I chart my temperature and on cd14 I had a sharp temperature rise so I went in for an u/s to confirm ovulation. The follicle appeared not to have ruptured and had swelled to approximately 31 mm (the u/s tech specifically said, "It looks like you haven't ovulated yet."). Additionally two small follicles had appeared on the u/s which had not been visible on cd12. The blood work, however, "confirmed" ovulation (which makes sense based on my BBT) and my doctor said that she thinks that I did ovulate and what we were seeing now was just the formed corpus luteum, but I suspect that the follicle failed to rupture. I brought up this possibility to my doctor and she said that she really doubts that's the case since I have ovulated successfully in the past and it has been confirmed by u/s. That being said, all of those times I was not on medication, and I do not quite understand how my past ovulation would lead to this conclusion.

I'm wondering if you think that this sounds like a case of LUF? I am not pleased with the clomid and had planned on switching to injectables next month, but if the LUF is a side effect of the fertility drugs, then I'm not sure that's my best option. Any advice or guidance that you have for me would be greatly appreciated as my doctor is insisting that I successfully ovulated and I'm concerned that the medication caused my follicle not to successfully rupture and release the egg.

[Dr. Wisot]

I can't tell from here if it's LUF or you just ovulated a large follicle.

But what's important is when you use 150 of Clomid or more it's usually a good idea to trigger with hCG to avoid either of the above.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California