QuestionHi Dr. Ramirez,
I am Wendy from Vancouver, WA. I am 38, husband is 42 and we have been TTC #1 for a year with no success. This past fall I did 3 cycles of Clomid 50 mg, CD3-7. I ovulated each time, but did not get pregnant. We decided to take a break from the Clomid. I started it again this cycle, except I took it on CD 5-9. I use a CBFM, and I kept getting highs until CD 18, then I finally got a peak reading. Also got my 2nd peak reading on CD 19, and got a temp rise CD 19 and 20. On CD 19, I had a tiny bit of brown spotting and EWCM. On CD 20, a little more, and it's now CD 21 (3 dpo) and I have mild cramps and continued brown spotting. Is the Clomid causing the spotting? Am I getting my period? I never spotted on Clomid before. Any answers would be greatly appreciated. Thank you!!
AnswerHello Wendy from the U.S. (Washington),
I can't explain why or where the spotting is coming from. It is not the Clomid. It could be the onset of your period. It is possible you know that answer by now (sorry for the delay in getting back to you#.
I would also like to make a comment regarding your current treatment strategy and I apologize in advance if it is too blunt. Are you willing to give up the chance of having a child using your own eggs? If that is okay, then you can certainly continue using a treatment method that gives you a 1-3% chance of pregnancy per month. I don't know if your doctor explained that to you but I suspect you are not seeing an infertility specialist because even your Clomid cycles are not appropriate.
With Clomid, when advanced reproductive age is the issue, the goal is to increase the number of eggs that you ovulate. The thinking is that we know that there are only a very few good eggs available, if any, and the goal is to increase the chances that one of those eggs will ovulate. In addition, since you can't count on the egg finding the tube every time #it is not automatic#, the increased number of eggs increase the chances of an egg finding the tube. The number of eggs can only be increased if you use an increased dosage of Clomid or any fertility medication. You should probably be using 200-250 mg per day.
In addition, you should be having the most aggressive protocol which means that nothing should be left to chance in each cycle. In order to do that, you need to have ultrasound surveillance to see if #1# you are adequately responding to that specific dosage of medication, #2)how many follicles are growing (3)when ovulation will occur. You are not doing that so your chances are more hit and miss.
Finally, you have a decreased natural chance of pregnancy because of your age. So, although there are pregnancies at your age with natural treatments like Clomid Ovulation induction with intercourse, most fertility specialists will recommend a more aggressive treatment strategy. That involves IVF. The chances of pregnancy with IVF is 50% per cycle (month) in your age group in a good IVF center. I know that it is more invasive, but it is the best way. You may eventually get to that point if the "natural" method doesn't work or IUI (another natural method) doesn't work, but by then you will have reduced your chances even with IVF because your eggs will be older. If you are NOT seeing an infertility specialist, I would strongly recommend that you do. Don't waste time with your general Ob/Gyn who is doing the only thing that he/she can do because they don't do IVF.
I hope that I didn't overstep my bounds in giving you more information than your question required, but I wanted to make sure that you got adequate counseling. If you've had this counseling before but still chose to take the "natural" road, then so be it, and I wish you the best of luck. The is chances is not zero so I'll hope for the best for you.
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
