QuestionI am on my first round of Clomid. I took it CD 3-7. Yesterday, CD 19, I had dark brown spotting, like I usually get right before my period. I had intercourse that day. According my to my temperatures and the ovulation kits I have not ovulated yet. What could this spotting be due to? Should I be concerned?
AnswerHello Melissa,
Thank you for your question. How are you being monitored for ovulation? Is your doctor not looking with the ultrasound to see if you are actually responding to the medication? Not all women respond to Clomid and some need higher doses. It is possible that the bleeding is abnormal bleeding or breakthrough bleeding caused by the lack of ovulation. The endometrial lining will start to slough if there is inadequate hormone stimulation and there would be inadequate hormone stimulation if the ovary doesn't respond to the Clomid. I don't think you need to be concerned about the bleeding. I do think you need to be concerned about whether or not your seeing the right Physician for your problem.
Generally a Clomid cycle goes like this: Patient comes in at the beginning of her cycle (within the first 5 days) and a baseline ultrasound is done to look for any residual cysts, and to make sure that she is indeed on a period, and not having abnormal bleeding. Then I make a calendar of events to occur. She then takes the Clomid on cycle day #3-7 or 5-9. Either is okay. She returns on cycle day # 10 to begin ultrasounds to check to see if (1) she is responding to that dose of medication as manifest by growing follicles (2) how many follicles she has (we don't want more than 3), and when the follicles are ripe to be triggered for ovulation (18-22 mms). When the follice (s) are the correct size, then an HCG injection is given to trigger ovualation. I then have my patients begin intercourse the next day, once daily for four consecutive days. My patients then start on Progesterone supplementation from the 5th day after HCG. We then do a pregnancy test at two weeks after HCG. This is how a Clomid cycle is supposed to done and monitored. If your doctor is not doing it this way, then that doctor is not a fertility specialist and you should seek out a fertility specialist.
I hope this answers your questions.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
