QuestionQUESTION: Dear doctor,
I am from India. I am 39. I had two missed abortions at 36 and 37 both in the eighth week and after the heart beat was felt.
After leaving a gap of four months I have been trying to conceive naturally for 14 months without any result.
I have started Clomid 100 (day 3-7) at the advice of my fertility expert.
In the last cycle I got two follicles day-12 size was 22mm and 18mm. I was given an HCG 1000 shot and on checking on day 14, the follicles had ovulated. However I did not conceive.
This month I checked on yesterday day-9 and found only one follicle of 14mm size.
Do you think I should increase my Clomid dosage.
My periods are regular at 31 days. My FSH etc are normal.
I will be thankful for your answer.
Ramki
ANSWER: Hello Ramki from India,
Yes, I think you should use a higher dosage of Clomid. At your age, the goal should be to try to have 4-5 ovulatory sized follicles. The thinking is that after the age of 35, the number of eggs that are of good quality drastically decline. For example, studies in IVF have shown that at the age of 37, only 20% are chromosomally normal. With that in mind, the goal of IVF to overcome the "age factor" is to increase the number of eggs available with the hope that there will still be one or two good ones in that batch. That is not always the case, however.
Realizing that you have successfully achieve pregnancy in the past, my recommendation would still be to proceed to IVF rather than the natural cycles (Clomid ovulation induction or IUI) that you are doing. My worry would be that you are running out of time and IVF would give you the best, highest and surest chance of a successful pregnancy. With the passing of time, your chances are decreasing even with IVF. I'd hate for you to use up a lot of time and then get to the point where even IVF will not help.
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
---------- FOLLOW-UP ----------
QUESTION: Dear Doctor,
Thanks very much for your kind response.
During a routine ultrasound on day-5 before I started my Clomid my follicle sizes were 11mm and 9mm.
Do you think starting Clomid on day 2 and taking the tablet from day 2 to day 6 instead of usual day 3 to day 7 will help in producing more follicles in my case
I will be thankful for your answer.
Ramki
ANSWER: Hello Again,
It will not make any difference.
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
---------- FOLLOW-UP ----------
QUESTION: Dear Doctor,
Thanks for your kind response.
Probably I did not word my question correctly.
Can taking the Clomid on day 2-6 is better than day 3-7 from the point of view of achieving super ovulation.
Thanking you in anticipation.
Ramki
AnswerHello Again,
It does not make a difference.
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
