QuestionI went off the pill at the end of May '10. I started tracking ovulation in September. Since that time I have had three 40 day cycles where I have ovulated on cycle day 28. The new Ob/Gyn I went to back in September suggested I go on Clomid without having even met me before. I decided to give my body some time to regulate without hormones. My last cycle I had spotting from about 7 days past ovulation and got my period 12 days past ovulation. Do you believe it is necessary to take Clomid and/or Progesterone, or do you think I should be able to conceive just by doing as I have been doing- which is using a fertility monitor and charting basal body temperature to track ovulation? Thanks- AK in Denver
AnswerHello April from the U.S.,
I guess the answer to your question is how invasive you want to be at this time. Clomid, albeit a low level fertility drug and treatment, is still more invasive than trying naturally. If you wanted to be "natural" you certainly can continue trying with an ovulation kit and/or BBT and timing your intercourse until you decide that you have tried that enough (or 1 year whichever comes first). If that is not successful then you will be ready to move on.
If you were my patient, I would explain that a 40 day cycle is not normal and that your hormones are out of sync, and could be the reason you have not achieved pregnancy. The treatment for that would be ovulation induction using Clomid, Femara or injectable medications. These medications would reset your ovaries and get them to ovulate correctly and correct the hormone imbalance. This would be paired with monitored timed intercourse (using the ultrasound to evaluate your response to that particular dose of medication, seeing how many follicles are about to ovulate to prevent too many and to time when ovulation will occur or when to give HCG to trigger ovulation) or IUI (intrauterine insemination).
If you have been trying for one year or more without success, then the next step should be an infertility evaluation and NOT go directly to treatment. That way you don't waste your time on treatments that won't work. If your doctor does not suggest that, then you are seeing the wrong doctor!
Good Luck,
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
