QuestionI have three questions (additional relevant information about my history is
provided below the questions):
1) After my first cycle of clomid -- my period consisted of abnormal,
coagulated chocolate brown sludge rather than my normal red/healthy
looking menstrual blood. Is this something I should be concerned about?
2) Does low progesterone on day 21 mean that I did not ovulate, or simply
that the corpus luteum is not producing adequate levels of hormone?
3) How concerned should I be about 7 mid-cycle days of abdominal
discomfort on a cycle of clomid (see below for description of symptoms).
4) How concerned should I be that my doctor did not do a baseline
ultrasound nor an ultrasound during my first cycle of clomid. (he did have a
dye test to make sure my tubes were not obstructed)
Last month I started my first clomid cycle (day 4-8). Mid-cycle (days 14-21)
I had abdominal discomfort. The pain increased to the point where it was
very uncomfortable to walk and I spent portions of each day in bed. I was
very thirsty and urinating frequently: 6-8 times per night. On night 16, I had
an episode of sharper more severe pain/low-grade fever, which subsided
after about 3 hours. I notified my doctor - they said this ovulatory pain is a
side effect that can occur. On day 21 -- progesterone levels were checked
and results were "low". They want to double my dose of clomid this coming
cycle and I am supposed to start the dose tomorrow -- I'm nervous about
this course of action given the pain experienced last cycle. I have a history of
cystic ovaries and weigh just under 100 lbs.
AnswerHello Tina,
1. No. Clomid can sometimes cause the uterine lining to thin out. In this case, the blood retained within the uterine cavity rather than flowing out and so old blood turns brown and thick.
2. A progesterone level of less than 10 ng/ml can signify either that ovulation did not occur, hence minimal luteal response, or luteal phase defect, which must be confirmed by endometrial biopsy at the end of the cycle.
3. It is most likely that the mid-cycle discomfort you felt on Clomid is due to the enlargement of the ovaries from multiple follicles. If you doctor did the Clomid cycle correctly, he/she should have looked with an ultrasound to time ovulation and hence would know how many follicles were in fact present and how big they were.
4. Whenever we seek expert advice, we expect that the person we seek out is in fact an expert. An infertility expert would have automatically done a baseline ultrasound to rule out ovarian cysts, which is the contraindication to taking clomid, and followed with ultrasounds to evaluate your response, make sure there were not too many ovulatory follicles and to time ovulation. In addition, Clomid is usually prescribed on cycle day # 3-7 or 5-9. The fact that your doctor did not do this shows me that he/she is not a fertility expert. He/She can certainly do infertility, and many Physicians claim to, but you have to decide if you want someone who is an expert or just someone.
I too am leery of the side effects that you had and whether or not they were related to ovulation. I would be worried that you over- responded, hence the increased pain. I would not recommend proceeding with a higher dose of Clomid without knowing for sure how you responded, despite the mid-luteal progesterone level. In fact, I would recommend that you seek a second opinion by someone that can take over care if needed.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Exeutive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
