QuestionHello. I am 30, my husband is 32. We have a 3 year old, which we conceived
the first month of trying. We have been trying to get pregnant again for 16
months. We live in Columbus, Ohio and I am currently seeing a Reproductive
Endocrinologist. My cycles are normal - 28-30 days, good CM, normal BBT,
positive ov. predictor. My husband's sperm analysis came back normal (96
million, 70% motility). I had a progesterone check in May, which confirmed I
had ovulated. I had my Prolactin and thyroid checked. My day 3 FSH was 6.1 .
I had an HSG last month and my tubes were clear and the doctor said my
uterine cavity appeared normal. My doctor said to try for 3 months after the
HSG since that improves chances and then he mentioned Clomid. I'm
concerned that something is being overlooked. So, my question is, are there
additional tests that you would typically recommend for your patients before
proceeding to medication? What is the purpose of Clomid if I am already
ovulating?
Also, one other question-is it best to try every day or every other day during
my fertile time?
Thanks!
AnswerHello Kirsten,
Thanks for your questions. Your concerns are definitely valid and quite logical.
At this point, it sound like you have had most of the testing done. There is still one test that can be done as part of the basic workup. At this point, when I don't have an answer, I offer my patients this option: proceed with laparoscopy to evaluate the pelvis for adhesions (scar tissue) or endometriosis (which is very commonly found in patients just like you), or proceed with a trial of therapy with either ovulation induction and timed intercourse or ovulation induction with insemination. In a woman that is ovulatory, the goal of using a fertility medication such as Clomid is to increase the number of eggs that you ovulate per month, and therefore, increase the chances that one of the eggs will find the tube and be fertilized (eggs getting into the tube is not automatic but more chance). So for instance, you are trying to find a small island in the pacific. If you only send one boat to find it, the chances are small. If you send many boats out to find it, then the chances are higher that one of the boats will find the island. To the egg, finding the tube is like finding that island. It is purely random. So you if you ovulate 3 eggs at the same time, then the chances are increased. Make sense?
The reason for the laparoscopy is to check and make sure that there is nothing in the pelvis that could prevent the egg from finding the tube. The egg getting to the tube is the second step in the process to become pregnant, so if there is something inhibiting the egg at this point, the rest of the process doesn't work. Laparoscopy is the only way to evaluate the pelvis.
In terms of timing, the method I use is the following:
cycle day 1: menstruation begins (first day of flow)
cycle day 10: stop recreational intercourse
cycle day 13-17: have intercourse daily, only once per day, only one ejaculation per episode for five days. This is your fertile period. I know most will say everyother day, but if the sperm is normal it will be able to be normal for five days and there is a better chance if there is fresh sperm there at the time of ovulation.
Well, I hope this answers your questions. 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.
