QuestionQUESTION: I have had 3 rounds of Clomid (100mg) by itself with no success. I have now done round 4 with IUI. I was told to take 100mg Progesterone intervaginally 2xday and 2mg of estrace 2xday. My question is this...should I have been given Progesterone with the first 3x of Clomid? I have heard Clomid lowers the progesterone levels and mine was only 7 to start with.
I have also had a history of lots of ovarian cysts which has been explained to me as one of the possible reasons I haven't conceived again...because cysts indicate being estrogen dominant.
With this in mind, I have looked up estrace and it is contraindicated in pregnancy...so now I am confused. Why am I being prescribed a med that is contraindicated in pregnancy, when that is what I am trying to achieve, and why if I am already high in estrogen?
I am confused and wonder if I should only be taking the Progesterone....
Help!
ANSWER: Hello Annie from Canada,
Practically ALL medications state that they are contraindicated in pregnancy. In actuality, if you read all the fine print, it says to consult your doctor. Both estrogen and progesterone are required for pregnancy to occur. The estrogen is required to prime the endometrium for implantation and the progesterone both converts the endometrium for implantation and supports the pregnancy. They are both used in fertility treatments, and have been for many many years. No problems so far! So, you don't need to worry about using them.
However, I am not sure that you need the estrogen supplementation, especially in the luteal phase (after ovulation). It is usually required in the proliferative (endometrial proliferation in preparation for implantation) phase. The progesterone is required in the luteal phase #after ovulation).
I use progesterone, but not necessarily estrogen, in ALL my Clomid cycles. Clomid is an estrogen receptor blocker and so extra estrogen might be require in the first half of the cycle to make sure that a proper endometrial lining is developed, but that is not always the case. On the other hand, often Clomid with cause a lack of progesterone production, and progesterone is such a benign and easy supplement to use that I don't risk not having enough.
From what your have briefly described, I am not sure that you are in the best hands for this treatment. I know Canada limits the availability of specialists, but you might want to see a fertility specialist. I would recommend that you look up my blog, under "how I do Clomid cycles" and it will describe my recommendations for a proper Clomid induction cycle with or without insemination.
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
---------- FOLLOW-UP ----------
QUESTION: Thanks very much for such a quick reply.
I am seeing a fertility "specialist"..... :(
I have NOT had any ultrasounds during any of my treatments, nor did I before I started them. I would have to say that given your blog information, I am not feeling very confident in what is happening. I do remember that the Dr. said progesterone would only be prescribed for regular use only after one failed implantation. Personally I don't want to wait until I have another miscarriage before I go that route, so if he won't prescribe it (assuming this IUI takes - I will know in a week) what are my options for getting it OTC?
Should I be demanding an ultrasound to make sure I am not riddled with cysts, or is it too late for this cycle, and if so, just demand it for the next one?
I feel frustrated cause I am told I am only allowed a max of 6 clomid tx, and I am on number 4. Will I need to save my last one for SuperOvulation or is that done differently?
Thanks again for doing what you do on this site. This is a blessing for women out there to be able to access.
Annie
AnswerHello Again,
"Natural" progesterone is available in some health food stores. In most cases it is a cream. I can't give you a dose because I don't use that formulation.
It is too late to have ultrasounds in this cycle, but if the cycle fails, just tell your doc that you want to pursue a more aggressive and regimented ovulation induction protocol, and use the ultrasound for surveillance of the ovaries. If you tell him this, his eyes will widen in surprise, and he will have more respect for your knowledge of the subject.
"Superovulation" just means that you ovulate more than one egg at a time. This is done with any type of fertility medication including Clomid, Letrazole or the injectables.
Typically, my protocol is to try ovulation induction (OI) with intercourse, like you are currently doing, for 4-6 cycles. If that does not work, then I move up to OI with IUI for 4 cycles. If that does not work, then I move to IVF. OI in this case is superovulation with the goal being to have three ovulatory sized follicles. Also, this presumes that some other cause for the infertility that would preclude trying by a natural method (OI/Intc or OI/IUI).
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
