QuestionI'm wondering how estrogen and progesterone would be prescribed for use with clomid or letrozole to get pregnant.
I tried clomid 50mg, then tried clomid 50mg with metformin, then 100mg clomid (doc said to stay on metformin) and when those failed, I tried letrozole 2.5mg. Negatives all.
How does one use hormones with these meds? Please tell me dosages and when to typically take them during the cycle.
AnswerHello Katherine,
First, let me say that I am dubious about the doctor you are seeing. I'm not sure he/she is the right one (I suspect this based on what you have done thus far and your question).
Clomid can be used up to a 250 mg dosage (5 tablets) given on cycle da;y #3-7 or 5-9. We often start at 50 mg (1 tablet) and if there is no response, increase the dosage in the subsequent cycle. Some Ob/Gyn docs will go up by 1 tablet each month, whereas I go from 50 to 150 to 250mg to make the process quicker. Ultrasound should be used to monitor the response i.e. see if the ovaries are responding, how many follicles are present and growing and when to trigger ovulation with HCG.
Letrozole can be used at 2.5 mg, 5.0 mg or 7.5 mg in the same dates as Clomid. Again the dosage is increased until there is a response and ultrasound is used to determine this. If there is no response to maximum dosage, then you have to move to injectable fertility medications. These are more expensive and more complicated to use.
In terms of estrogen and progesterone, estrogen is usually not required in an ovulation induction cycle because as the follicle grows, it produces increasing amounts of estrogen. Estrogen is required to grow the uterine (Endometrial) lining for implantation to occur. Progesterone is usually used in ovulation induction to supplement the luteal phase, which is the phase that occurs right after ovulation. Progesterone is required to prime the endometrial lining (give it the ability for implantation to occur) and suppor the early pregnancy. It can be given as a vaginal cream, vaginal tablet or injectable. It is typically started after ovulation and the day after insemination or 5 days after intercourse in an intercourse cycle.
I would recommend that you look up my blog where I talk about ovulation induction in detail (that way you know if you are seeing a doctor that knows what they are doing).
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
