QuestionQUESTION: Hello DR.EDWARD RAMIREZ;
I am 37yrs old having a very regular menstruation cycle
[28-29days]which lasts for 5 days.My F.S.H is 10mIU/ml.
I have read that superovulation with clomid leads to multiple follicle which increases the chance of a good follicle fertilising .
In a natural cycle i always ovulate one egg AND on CLOMID 50mg also I ovulate only one one egg . please tell me what dose of clomid will help me in getting multiple follicles and on which day of menses clomid is taken for superovulation.
THANK YOU
FATEMA
ANSWER: Hello Fatema from India,
The decision on how much Clomid to use is dependent on what your doctor wants to achieve and that depends on how you respond to the medication. 50mg is the lowest dose and 250 mg is the highest. Your FSH, if it was done on the 2nd or 3rd day of your period, is elevated, which essentially means that your ovaries have developed some resistance to stimulation. Clomid may not be strong enough. Your age is also a factor because your eggs are old. My recommendation would be to see a REAL infertility specialist, which is one that does IVF and get a consultation. In the U.S., if you are 37 years old with an elevated FSH, we recommend IVF as the treatment of choice.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate
---------- FOLLOW-UP ----------
QUESTION: Hello Sir,
THanks for replying.I have conceived twice in a natural cycle in the last two years but both the pregnancies ended in a miscarriage after the cardiac activity was diagnosed.
After that i had all the investigations done ;all were normal.my doctor is an infertility specialist who thinks that the miscarriages could be due to poor quality eggs because of age factor{37yrs};so to increase the chances of a good follicle fertilising she advised me clomid 50mg to get 2-3 follicles .
on day 3-7 clomid 50mg
on day 6 urofollitropin 75Iu inj{f.s.h inj} when there were 2 follicle of size 13m.m each
on day 8 urofollitropin 75Iu inj when there was a single follicle of size 16m.m
on day 11 h.c.g inj follicle size 21m.m; endo 8.8
on day 13 follicle ruptured; endo was9.2m.m
SO on clomid 50 mg i had only one follicle.KINDLY suggest a protocol to get 2-3follicles fOR I.U.I.what would be your protocol if i were your patient.
THANK YOU;
FATEMA{INDIA}
AnswerHello Again,
I agree with your doctor that your age is probably the major reason for the miscarriages. If superovulation is the goal, then I would increase the Clomid to 150 mg. The goal is to get you to ovulate 3-5 follicles. If that dosage is insufficient, then I would go up to 250 mg. I don't think you need the follitropin in addition to the Clomid, but if the 250 mg of Clomid is not sufficient, then then next step would be a Gonal-f or Follistim or Menopur cycle (follitropin) starting from the beginning and increasing as necessary based on ultrasound evaluations. Again, the specific protocols will depend on what your doctor feels comfortable with because there are many variations that can be used. We usually start with Clomid because it is the easiest to use and the least expensive medication. Ultrasound surveillance is required, such as you had done, to determine how you are responding. Because follicle recruitment occurs within the first 7 days of the cycle, usually the initial response is what determines how many ovulatory follicles you are going to have. That is why the strongest stimulation has to be done from the start.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate
