QuestionI am 29 years old and have never been pregnant. I have been trying for 3 years. I sought the help of an OBGYN who determined that I was not ovulating. He checked blood, did an abdominal scan and a trans-vaginal scan. I was prescibed Clomid. Here are my day 21 Progesterone levels.
1st cycle 50 mg: 10.1
2nd cycle 50 mg: 12.4
3rd cycle 50 mg: abnormally low
4th cycle 100 mg: 12.0
After each cycle, my periods have been extremely heavy, including large blood clots.Is this normal? My cycle lasts about 6-7 days with the heaviest flow on day 2 and 3. Would you advise to continue Clomid even though I am having heavy bleeding with each cycle? The doctor suggests to continue a 5th cycle at 100 mg.
After my second cycle on Clomid, I had my blood work checked on day 3 and these are the results:
FSH: 7.1 mIU/ml
Estradiol(E2): 53 pg/ml
LH: 4.8 mIU/ml
Prolactin: 13.4 ng/ml
TSH: 1.08 uIU/ml
Do these levels appear to be normal? At the same time that I had the bloodwork, I had a scan that showed 3 cysts on my right ovary with the largest being 1.3 x 1.4 and one cyst on my left ovary measuring 1.5 x 1.6.
Could these cysts cause the elevated estradiol level?
Thank you.
AnswerHello Vanessa from the U.S.,
A mid-tulealphase progesterone level above 10 is an indirect indication of ovulation. That means that you did ovulate in three of the four Clomid cycles at 50 mg. It does not indicate that you need to go to 100mg since the goal is to use the lowest effective dose.
Since you have not gotten pregnant with four Clomid cycles, and have shown ovulation in three of them, I don't know why your doctor would increase your dose and continue treatment. What is it that he is treating? Did you not have regular periods prior to the clomid, is that why he determined that you were not ovulating. For someone who does not ovulate, you are responding to low dose Clomid, which is unusual. In addition, if you had regular menstrual cycles for the past three years and did not get pregnant, I would suspect that something else were going on. Did you undergo infertility testing, such as checking to see that your tubes were open?
In terms of your questions:
1. a heavy period would indicate that you had a thickened endometrium and could be normal with Clomid. Clomid, given to an already ovulatory woman, would increase the number of follicles ovulated and therefore the level of estrogen produced. This would also thicken the endometrial lining.
2. As mentioned above, and you can probably read within my questions, I am not sure of the treatment plan your doctor has made. Therefore, I can't comment on whether or not you should continue the Clomid. I usually will try 4-6 Clomid cycles before moving on to a different treatment plan, but I use the clomid for specific reasons. I'm not sure of yours.
3. Your lab tests, including the estradiol, all look normal.
My recommendation would be to see a doctor that specfically specializes in infertility. Often, that can be a general gynecologist, but most Ob/Gyn's have minimal training in infertility and so are not the best ones to see. I would recommend one that does a lot of infertility and can do up to IUI's. Even better, would be a doc that can do ALL levels of infertility, and specializes in just that, like me. You would want one that does IVF. That way you know you are getting the most complete evaluation and treatment without wasting time and money. In addition, I would recommend that you look up my blog in regards to a post that I did on how I recommend doing Clomid cycles. That way you can gauge whether or not yours is being done well or not.
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
