QuestionHello,
I am 31 and TTC for the first time. I have tried 2 rounds of Clomid 50mg, which I am fairly certain I ovulated both time (due to work, did not have a chance to get my progesterone levels checked, but had +OPK and associated BBT rise). Both months, I ovulated around day 20 of my cycle. Now, my doc is putting me on the program with estradiol, clomid and prochieve. I am supposed to start the prochieve on cycle day 17, but the last two months didn't ovulate until day 20, so should I wait until after I ovulate to take it, and if so, when? Should I still do daily ovulation tests to be sure I catch the right window? Is there any use in having intercourse days 10-16 when I may not ovulate until day 20? Will this program make me ovulate sooner and how much does this increase my chances of getting pregnant? How many months can you do this program, and it still be effective? Last question, how much does stress affect your ability to get pregnant while on these meds?
I do see a general OB, and he has not yet referred me to an RE. If we don't get pregnant this month, then I am due for an HSG next month, although have had no prior STD's, surgery or endometriosis, and my husband will get his sperm analyzed, he is 35 and healthy.
Any advice will be greatly appreciated!
Thanks,
Stephanie from Atlanta
AnswerHello Stephanie from the U.S.,
I don't think that you are in the right hands. I would recommend that you seek out an RE or someone who specializes more in infertility. I see many patients like you, whose Ob/Gyn's arbitrarily start them on Clomid without reason, meaning no diagnosis has been made because an evaluation has not been completed, and lo and behold, there is some other overwhelming problem that Clomid does not cover. I am leery about your doctor because he/she is going about things wrong. I refer you to my blog under the topic "how I do my Clomid ovulation induction cycles." It will give you more detail on what you should expect.
If you are not ovulating on your own, then the purpose of Clomid is to get you to ovulate. Somehow you need to be monitored to see if this dose is adequate, how many follicles are forming and growing, when they reach ovulatory size and when to expect ovulation. Since your doctor is not doing any of the above, then you need to use a OPK or BBT. In that case, the progesterone would be started 36-48 hours after you show signs of ovulation, and not before. Forget the estradiol for now, it would need to be started from the beginning of the cycle, because this is only used if you have an inadequate endometrial lining, and since your doc doesn't check, why take a medication that you may not need?
Clomid works through an indirect route to cause the brain to increase the output of FSH (follicle stimulating hormone). It is an estrogen receptor blocker, so the brain thinks it is not producing sufficient estrogen, and it produces estrogen by stimulating the ovary via FSH. If you do consecutive Clomid cycles, key estrogen receptors, such as those in the uterine lining, tube and cervical glands, will be blocked and you won't get pregnant. For that reason, Clomid should not be used on an every month basis. Clomid is also given to superovulate a person, which means that it is used to increase the number of eggs that a woman ovulates per cycle. In order to do this, doses of up to 250 mg per day can be used. If you are ovulating already, and using 50 mg per day of Clomid, and only ovulating one egg, then it is doing nothing for you.
Stress can certainly play a role in getting pregnant. It is not a good contraceptive, however, but you should try to keep it down as much as possible by whatever means suits you. Some use medication, acupuncture, therapy, exercise, relaxation techniques, etc. for this purpose. Try very very hard, NOT to put pressure on your husband either. Not only will it make it difficult for him to perform, but it will make your intimacy less enjoyable and possibly cause friction in your relationship.
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 follow me on Facebook at http://bit.ly/9Iw9oV
