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Doctor's responses 3-8-2010
Susannah D Copland, MD, MS posted:
Below are some thoughts and suggestions regarding your discussions:

Last dose of provera:
The period usually occurs 2-7 days after the last dose of Provera. Women are usually given Provera when they are not ovulating. Women who do ovulate get a cyst of ovulation (corpus luteum) that makes progesterone for two weeks. If they are not pregnant, the cyst goes away, progesterone falls, the period arrives. Women who are not ovulating take Provera to have a period and keep their uterus healthy. If the period does not arrive by two weeks after the provera, she should check a pregnancy test and call her doctor. Sometimes a woman may have been in the process of ovulating on her own, so the period does not come until her own cyst of ovulation goes away. Sometimes a woman may not bleed after Provera because her estrogen is low. In either case, failing to bleed after Provera is a reason to call your doctor.

C/s and fertility
While any surgery can cause infection, bleeding, and scarring, an uncomplicated cesarean usually does not harm a woman's chance of pregnancy in the future. Check with your doctor to see if anything about your cesareans may cause concern.

Ovulation/BD and CM:
Ovulation predictor kits and cervical mucus are two great ways to target intercourse for fertility. As the egg moves toward ovulation, cervical mucus water content increases. Target intercourse when you notice a change in your mucus to wet, slippery or smooth feeling and/or transparent, stretchy/elastic, watery, liquid or reddish in the days prior to ovulation. After ovulation, intercourse is recreational and cervical mucus changes may be related to other factors.

Ovulation predictor kits detect the mid cycle LH surge that preceeds egg release. A positive kit predicts ovulation within the following 24-48 hours. The interval of greatest fertility is the day of the surge and the following two days. The best single day is the day after the first positive kit. Remember that sperm can survive in the fallopian tube. While most babies are conceived with intercourse in the two days prior to ovulation, pregnancies have been reported with intercourse up to 6 days prior to ovulation. So having intercourse every other day in the fertile window should be fine. For those woman using donor sperm who only have one chance at sperm exposure, we try to plan insemination for the day following the first positive test.

Have a good week.
An_191475 responded:
I have one blocked fallopian an OPK still a good tool for me?

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