Understanding Spotting During Fertility Treatment: A Doctor's Advice

Question
Hello Dr. Ramirez,
I have asked you questions before and your info. is always helpful so thank
you.
I am 30 yrs. old w/ secondary infertility. I am seeing a R.E. and have been on
Clomid + HCG trigger for 4 months and have had 2 IUIs. Our infertility is
unexplained.
Before pursuing treatment, I had occasional spotting about 5-7 days before
menstruation (usually every 4-6 months). Now, since being on Clomid, I have
had spotting every month. I usually ovulate around day 11, have spotting
around day 23-25, and start menstruation on day 30. My doctor does not
seem to be concerned w/ this, but I think it's abnormal and I'm wondering if
this could be a sign of something that's wrong? What could be causing the
spotting? (I don't have any fibroids and my progesterone levels after ovulation
are always between 16-30).
Also, my cycles have always been 28-30 days long w/ ovulation between
days 10-12. Is this abnormal?
Thanks!

Answer
Hello Again,

The premenstrual spotting is not unusual and not abnormal.  It should not affect your fertility potential.

On the side, we recommend up to 4 IUI's.  If no pregnancy ensues at that point, then I recommend proceeding to IVF because the statistical chances decreases significantly.  If you have not had a laparoscopy, another option would be to have one to rule out endometriosis and/or pelvic adhesions.   However, most of my patients will elect to go straight to IVF since they want to be pregnant right away and the laparoscopy doesn't necessarily help you get pregnant.

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.