Provera, then period, then clomid, then what?

mcodea88

Oo so I realized after leaving the doctor that I may be missing a step in my "to do" list. I am 37, TTC #1. No period for years due to loestrin and not sure if I ovulate. So OB said if I don't get my period by cycle day 40ish,then take provera once a day for 10 days. Then, when I get my period, I take clomid from cycle day 5-9. Ok, got that part. Then what??? Is that just to boost my chances some or am I supposed to be doing something after that? I temp, use OPKs, and sometimes CM chart too. But I'm just starting so I don't have enough info to form any patterns. So, what comes after all that? Oh, also had bloodwork done and am waiting on results for all my levels. DH is going to urologist on 9/4 to get checked out too. Ok thanks in advance for filling in the gaps!

hooligans4

I'm giving my honest opinion based on what I have seen in these boards over the past few years. Never take clomid without being monitored. I personally would only take clomid if you are seeing a RE. Have you had all your bloodwork and HSG to make sure your tubes are open. It's good that your DH is going for SA. Clomid can do a lot of damage so it is important to have sonos while taking it to check your lining and for cysts. Just do a search of clomid on the bump and you will find a ton a ladies who took it without monitoring ( usually prescribed by their OB) and ended up being benched for months because of the damage.
Do your homework and make you own decision. Good luck

kelley72

pp gave you excellent information, ps the only thing else is to have intercourse...

emsmama15

I agree.  It seems like your OB is jumping into Clomid pretty quickly since you just stopped birth control in June.  Coming off long-term birth control will make you irregular.  I'd probably use the OPKs and chart temps for a few months before I jumped to any conclusions.  Or do you have a diagnosis and I just missed it?  

My personal experience with Clomid - it THINNED my lining big time.  This time around we're using Femara and I have a big ovarian cyst that may need to be surgically removed.  My follicles also stalled out.  Without a CD10 ultrasound, I'd have no idea what was going on in there.  

Oh, and one more step in there -- make sure you're not already pregnant!  OBs tend to think everyone has a 28 day cycle, but if you ovulated late, you could still have a chance at CD40.

Just a few thoughts!  Good luck to you!

mcodea88

Geez this isn't at all what I was expecting. It scared me to know so many feel negatively about this. I guess I was really excited when I left my appointment. We have been trying for maybe 2 months. I did get my blood drawn, just waitinfb for all the numbers to come back. I imagine that will be this week. What the Dr said was that she doesn't see the reason to "wait" to see how things progress at my age and the fact that I have always had a very irregular period (from when I first got it, It might come once every 4 months or so), to then going on Loestrin and not having it for years, she thought this was the way to go. I am almost too afraid now to try it. Maybe I'll just keep the meds but try naturally for a few more months? Why would chlomid be prescribed if it's so bad? Ugh, I've gone from excited to bummed. I really do appreciate the advice. Just a little let down it's not a good route to take.

tlc35

It isn't that clomid is bad it itself; it is a fairly powerful drug that can have significant side effects.  So you want to know if it even has a chance to work.  If your tubes are blocked or your H's sperm counts are too low then it won't do anything useful.  It may not work or it may work too much and you could have multiple follicles and be at risk for multiples. If you are not being monitored there is no way of knowing that. It can have side effects of a lining that is too thin or ovarian cysts and you may not know about these without monitoring.  Can it work for people without monitoring?  Sure it is possible to get lucky, but there is a poster on 3T who ended up in the hospital with a cyst.
I agree with her in that with your age and irregular cycles it makes sense to initiate treatment and not just continue naturally but since time is not on our side it is even more of a reason to know there aren't other problems (blocked tubes, male infertility) and to know that the drug is effective by monitoring.  Otherwise you are still wasting time AND risking side effects as well.

emsmama15

I really didn't mean to burst your bubble.  I'm just speaking from personal experience.  For what it's worth I'm actually an unmonitored Clomid success story.  I happened to have had my RE consult while doing a round of unmonitored Clomid, so I knew that my lining was very thin.  My RE started me on progesterone right away and everything went well, but I was very scared that I'd lose the baby because it wouldn't implant correctly.  I also work in a NICU and I've seen a lot of triplets and some quads that were the result of OB prescribed Clomid.  Thus, I was also freaking out until my first ultrasound, worried that I'd made a horrible mistake and I'd have a bunch of babies in there!

I'd agree, if you have a history of irregular periods, seek out a RE.  The reason I suggested temping/charting/OPKs a little longer is because (1) you're coming off birth control and periods can be wonky (didn't know they were like that pre-birth control) and (2) I'm not sure if you could have issues with your insurance coverage if you're going to see a RE before 6 months.  

Again, good luck.  Don't be bummed, just research it a little.  Clomid works, it's just best to have monitoring to avoid thin linings, cysts, and higher order multiples.

mcodea88

Thanks to everyone for all this great advice! I'm listening to you all for sure. I'm on FF and temp and OPK, I had that link set up on my profile but maybe when using my phone it doesn't post? Who knows, but I have been really diligent in temping so I am going to continue on soon that, and after I get my bloodwork results and DH gets his results, I'll seek out an RE. I will check out my insurance coverage to see what's up. You guys are the best! Although I feel slightly bummed, I'm equally thankful that you all jumped in so quickly to steer me on the right path! I'm so new at this thatt I sit day after day just reading forum posts to try to learn as much as I can. Thanks again!!!

gscoville

One more thing to add to the excellent advice above - Clomid also has a limit to how many times you can use it, 6 cycles lifetime max. Extended use can increase risk of ovarian cancer and/or other kinds of cancers, as it messes with hormones at a deep level. This is why it's so frustrating to us when OBs hand it out like candy, because you're basically wasting limited cycles with doctors who have not actually been trained in fertility treatment in the first place. 

Ultimately, I'm glad you're heeding the great advice here, OP. Just because you're 37 is not a reason to rush into an unneeded or even dangerous course of treatment. I say this to so many women, it's not like a woman turns 35 years old and her eggs and hormones suddenly realize their age and go kaput. Stats say fertility decreases after 35, but in reality fertility decreases overall as we age even before 35, and it's a pretty gradual process. 35+ is not an automatic death sentence for fertility. You've only been off of BC for a couple of months - allow your body some time to sort itself out, keep temping/charting, and wait for some of your test results to come back to see what's what. If you hit 6 months after coming off of BC without success, seek out an RE, s/he will be able to interpret those numbers more accurately to determine a path forward, not to mention will likely request more thorough testing at appropriate times (much of the testing an OB does is not done at the right times for a woman's actual cycle, they base it off of averages which are so wrong for many women).  Fertility treatments can be expensive not to mention stressful, there's just no sense in jumping in before it's really indicated, or doing testing or treatment that's inaccurate or improperly monitored and will only have to be redone down the road.

Radiantly

Yea sounds good. I saw an RE after 7 months of ttc and got a HSG and I have a blocked tube and endometriosis. This the Re said he wouldn't do clomid because it doesn't matter how many eggs I release if they cant get down the tube. He would goto IVF after a surgery. I'm trying natural a few more months.

mcodea88

Well, my OB nurse called today while I was traveling and at the airport with work colleagues so we didn't speak long. She said my bloodwork was "fine", but had low progesterone, and asked my cycle date (which I have them when I had my appointment!) so she said it's low, and she sees that the dr prescribed the provera and clomid so to go that route. I just thanked her and asked that she mail the results of my bloodwork to me. Not going to take the meds now. I'm just going to get my results, wait for DH to get his results, and then decide next steps. I have, of course been reading about low progesterone since the call today and it doesn't sound great.

katie0919

Yes, agree with PP's - you really need to be monitored by an RE while taking Clomid.

I took it this past month because I was diagnosed (by an RE) with weak ovulation and a luteal phase defect.

I had a vaginal sono on CD 3 to make sure there were no cycts on my ovaries prior to starting Clomid. There weren't - so I took clomid (50 mg) from CD 3-7. I went back in for a sono on CD 12 to see how my ovaries were responding to the medication. I had two maturing follicles, one on each ovary. They were not quite mature, so I went back again on CD 15 and only one follicle was getting bigger, so they gave me a shot to trigger ovulation, we went home and had sex, then waited. I also took prometrium in the 2WW and am still on it now until I reach 10 weeks. 

Clomid can have crazy affects on you - your ovaries can hyper stimulate and create crazy amounts of follicles (think octomom), or it may absolutely do nothing for you at all and like pp's said, you can only take Clomid a certain number of times in a lifetime. It's serious stuff. Personally I would not take Clomid from an OB...and this is something I never would have known if it weren't for the TTGP board. 

katie0919

mcodea88 - I have low progesterone/luteal phase defect and it can easily be remedied...I would actually say low progesterone is a relatively "easy" fix compared to other fertility issues. I take 2 suppositories vaginally a day and that takes care of mine. Side effects were kinda crappy at first, but you get used to it.

Austrogermokee

Side effects for progesterone were fairly bad for me, but got better after a few days. The bloating was the worst part - I swear this is how I felt:

mcodea88

This makes me happy to know that Low P is fixable. I am hopefully getting all my bloodwork results in the mail today. So I'll share anything new. I am NOT taking any if the meds prescribed. You have all really assured me it's unsafe without supervision. I'm currently CD43, no signs of AF. Last BD was CD32 (we have both been traveling). OPK test negative. Sigh...

gscoville

mcodea88 said:

Well, my OB nurse called today while I was traveling and at the airport with work colleagues so we didn't speak long. She said my bloodwork was "fine", but had low progesterone, and asked my cycle date (which I have them when I had my appointment!) so she said it's low, and she sees that the dr prescribed the provera and clomid so to go that route. I just thanked her and asked that she mail the results of my bloodwork to me. Not going to take the meds now. I'm just going to get my results, wait for DH to get his results, and then decide next steps. I have, of course been reading about low progesterone since the call today and it doesn't sound great.

Was your progesterone bloodwork done at 7 DPO?  Many OBs order it done on CD21 which based on averages may be 7 DPO for some women but not most.  If yours wasn't done 7 days after ovulation then it's quite likely inaccurate - it's the levels on that specific day relative to ovulation that are needed, progesterone levels at any other point in your cycle don't tell the true story.

mcodea88

the bloodwork was done on CD34. I don't know if I ovulated it how long my cycles are. It's frustrating to read that basically the bloodwork could mean nothing. I got the rest if my results in the mail today (I asked her to mail them) and will need some time to even know what I'm looking for. I'll report back when I figure that part out.

mcodea88

Here is my blood work. Ignore the glucose and fasting tests... I wasn't fasting.

mcodea88

I'm actively looking for one. I posted on the Philly board but no answers yet. Doesn't seem to be as active as this one. Thanks everyone!!! I read out all your comments to DH today, he is happy you all gave me the warnings about clomid!!!

zeynsom

Thanks @IFinTN. @mcodea88 I am doing IVF and I have diminished ovarian reserves so I need a good RE and good lab. The information that I will give you now may not very useful if you are trying naturally or with IUI but u=in any case, here it is:

The best clinic in Philadelphia is RMA Philadelphia. Their surgery center is in King of Prussia but you can use their center city office (some where around Chestnut and 8th) for all your monitoring appointments etc. You just need to go to King of Prussia for stuff like HSG, egg retrieval, transfer etc. I started working with Dr. Castlebaum there and he was very good. He was very thorough and also very responsive to email messages (not something I experience with other REs often). The main problem with RMA is they are expensive than other options. They have good insurance coverage for stuff like monitoring, tests, and IUIs but when it comes to IVF, if your insurance is not covering it you are looking at  around $12500 for a one fresh IVF cycle + one FET package (excluding meds and the initial tests). 

The other option I considered briefly was UPenn. Their office is at 3400 Market. They are cheap. I believe their fresh IVF cycle is only 5k (again, excluding meds and initial testing). Some people are happy with them. However, my first appointment was unimpressive. The doctor was not ready for the appointment and did not know my history in advance. His suggestions were things that other doctors would rule out. He, for instance, suggested IUIs for me, which have almost zero chance for me. I am DOR and have bad hormone levels. While the RMA doctor was talking about donor eggs, UPenn's suggestion of losing time on IUI was absurd. On the other hand, if you do not have any obvious issues and cost is an important factor for you, you may as well try UPenn. 

mcodea88

Wow thanks so much for all this awesome info! My plan for now is to a) not take meds, b) wait until DH has SA on 9/4 and get those results, then c) decide next steps which will most definitely include an RE. I feel like my trip to the OB was a waste, so I would rather not call her again for more lazy info. In the meantime, I'll try to will my AF to come... CD44 today. That way I can begin a new cycle temping and charting from CD1. New wondfos ready and waiting.

mcodea88

Oh nice info @IFinTN‌ !! Thank you! I'm currently CD46, and THINK I'm in LF now. I'm 7th day higher temp so I'm hoping it will come soon. I believe I totally missed ovulation due to inaccurate OPK testing.