QuestionI was diagnosed as a PCOS one year ago and was taking Yasmin 21 day tablets. now i want to become pregnant. I did not have my periods since Feb 09, and i saw doctor in July and she gave me Provera for 7 days and Clomid 50 mg from Day 2 to Day 7. I had my Day 21 blood test for progesterone but doctor says i did not ovulate this month even with Clomid 50, so she increased my dose to 100 mg. But i had severe ovulation like pain when i took 50 mg clomid. my question is am i ovulating, how do i exactly know that i ovulated this month.
Answer
Dr. Ramirez
Hello,
I just answered this question before you, so you can see that this is not an unusual problem. One of the ways that physicians use to check for ovulation is a cycle day#21 progesterone level. If this is below 10, then it is a sign of non-ovulation. The Clomid dose is then increase in the next cycle. The problem with this method, is that it does not give "exact" information. It is possible that you had an ovarian cyst that grew from the Clomid but did not ovulate (because it was not an ovulatory follicle). In that case you would have "pain" but not ovulation. For this reason, I do not recommend this very popular method of using Clomid.
Instead, I recommend that ultrasound be used to determine how you respond. You would have a baseline ultrasound within the first five days of the cycle, to rule out existing ovarian cyst. Then you would start your Clomid for 5 days at a dosage of 50-250 mg. From cycle day#10 on, you would undergo ultrasound to determine (1) if you are responding to this dosage, (2) how many follicles you have (you don't want more than three), (3) when to trigger ovulation with HCG and (4) when to begin intercourse. This is the method that I use and have found to be the best and most efficient method.
Sincerely,
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.
Check out my blog at http://womenshealthandfertility.blogspot.com and twitter with me @montereybayivf.
