QuestionWe have been trying to conceive for around a year and a half and just finished an unsuccessful round of clomid. I was on clomid for three months and my progesterone went down with every increase of clomid. My doctor thinks I many have PCOS because of my low progesterone, but I have regular periods. In the past year and a half my cycles average at about 26 days. So we are both confused by that. I was told I may just poorly ovulate. My husband has already had a semen analysis and that came back totally normal. With all that said what is my next step. Should I be encouraged that I do have periods, or is this more alarming that it is combined with low progesterone. I am not interested in IVF at this time, but there has to be other options? How can I improve my ovulation, if that is the case?
AnswerHello Catherine from the U.S.,
There are other options before IVF, but I am confused by your story. How much Clomid have you used (what is the maximum dose)? Did your doctor follow you with ultrasounds to see how you were responding and to help time the intercourse or did he/she just give you the Clomid and tell you to go try?
Not all PCOD patients have irregular periods. There is a subset that have regular cycles, but in that case, fertility is not usually an issue. The problem with PCOS is that the ovary is not functioning correctly and therefore does not ovulate. If you have regular cycles, you are ovulating. With a decreased progesterone, it is possible that you have a "luteal phase defect", whereby inadequate progesterone is produced to support the endometrial lining. I usually automatically given progesterone to my patients with all Clomid cycles because Clomid can induce an artificially luteal phase defect. Progesterone is a simple medication to use.
In addition, Clomid can be given in doses up to 250 mg per day. If your doctor is not monitoring you while you are on Clomid, then you are probably wasting your time. How can he/she know if the dose you are using is adequate, or how many follicles you are producing or when to time ovulation and therefore intercourse?
I hope this helps,
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 facebook and twitter with me at @montereybayivf.
