Clomid Question

NicoleD54

Last month was my first cycle taking clomid. Yes I am being monitored. My cycle was 21 days, I ovulated on day 13 and my luteal phase was only 8 days. Meaning my progesterone was way too low to sustain a pregnancy.

My doctor was a little confused as to why my progesterone was so low even though ovulation was confirmed, so he said one more try at this dose (50mg), but he wasn't very optimistic that I would have a good outcome.

Today is cycle day 19 and we are fairly certain I will ovulate today. Has anyone had this drastic of a change in ovulation dates on the same protocol? Does it seem a reasonable explanation would be last cycle I didn't ovulate a "good" egg, and this cycle I am, thus the difference in cycle length, and hopefully difference in progesterone level?

NicoleD54

No, my luteal phases have always been short. My doctor thinks progesterone is a result of poor ovulation, in my case ovulating around day 60. Therefore creating a better ovulation=more progesterone. However, he tested it again on cycle day 4 this month, but I haven't gotten the actual lab value.

Shayliz

BrazilianPeach:

Ugh.... I would get a different doctor. If you have a short LP, that is a very easy fix (speaking from experience) by taking progesterone. I take progesterone lozenges from 3DPO until CD1. 

From here I gathered you can only have 6 round of clomid for a lifetime. I would save that for when you are further on the process. How long have you been TTC? 

ETA: Actually I would say get a second opinion from a different doctor. I don't have a medical degree and can't be sure your doc is wrong. 

Progesterone can supplement and make an LP longer, but it's not always a fix all. Clomid can produce mature follicles which in turn their CL cysts produce progesterone. 

OP - Did the doctor test your progesterone levels 7 days past ovulation? Are you being monitored with ultrasounds or just bloodwork? How many follicles did you have last cycle? 

NicoleD54

BrazilianPeach:

Ugh.... I would get a different doctor. If you have a short LP, that is a very easy fix (speaking from experience) by taking progesterone. I take progesterone lozenges from 3DPO until CD1. 

Some doctors believe that progesterone deficiency can be fixed with just supplements, but many other doctors believe the same as mine. 

I really don't want to switch, as I just had a still birth, and my doctor has been absolutely wonderful through it all. He knows my history and has a plan for my next pregnancy that I am comfortable with.

I had been using NFP to avoid for about a year before we started trying. About half my cycles are anovulatory, the other half I ovulate very late. I had a miscarriage in march of 2011, and got pregnant again in April. My doctor attributed my pregnancy that I took to 23 weeks a result of the miscarriage the cycle before because I actually ovulated at a decent time in my cycle and my hormones were still high since recently miscarrying. So in short we tried form January 2011 to April 2011 and from September 2011 to now.

 

LexiSophie55

NicoleD54:

Last month was my first cycle taking clomid. Yes I am being monitored. My cycle was 21 days, I ovulated on day 13 and my luteal phase was only 8 days. Meaning my progesterone was way too low to sustain a pregnancy.

My doctor was a little confused as to why my progesterone was so low even though ovulation was confirmed, so he said one more try at this dose (50mg), but he wasn't very optimistic that I would have a good outcome.

Today is cycle day 19 and we are fairly certain I will ovulate today. Has anyone had this drastic of a change in ovulation dates on the same protocol? Does it seem a reasonable explanation would be last cycle I didn't ovulate a "good" egg, and this cycle I am, thus the difference in cycle length, and hopefully difference in progesterone level?

I don't have any advice on the progesterone piece, but I wanted to give you a little insight on this piece of it.  on 50mg of Clomid, I o'd on CD16.  CD12 I had a 7.6mm follie and a bunch of 5's.  CD16 - 30mm CL cyst - followed by a BFP on CD28.  That ended in a m/c and I think it might have been a bad egg.  My dr. said that a bad egg won't be fertilized to begin with...but is it a quality egg when it grows 5mm a day?....I've never heard of that before.  Anyways, onto 100mg of Clomid - CD27 I O'd.  What gives?  I had O pains for about 2 weeks. 

So yes, bodies can change on the same protocol.  Mine should have changed the opposite way it did...this stuff is so unpredictable. 

Good luck on your cycle.  I do think that last cycle you might not have had a "good" egg.

Shayliz

BrazilianPeach:

Shayliz:

BrazilianPeach:

Ugh.... I would get a different doctor. If you have a short LP, that is a very easy fix (speaking from experience) by taking progesterone. I take progesterone lozenges from 3DPO until CD1. 

From here I gathered you can only have 6 round of clomid for a lifetime. I would save that for when you are further on the process. How long have you been TTC? 

ETA: Actually I would say get a second opinion from a different doctor. I don't have a medical degree and can't be sure your doc is wrong. 

Progesterone can supplement and make an LP longer, but it's not always a fix all. Clomid can produce mature follicles which in turn their CL cysts produce progesterone. 

OP - Did the doctor test your progesterone levels 7 days past ovulation? Are you being monitored with ultrasounds or just bloodwork? How many follicles did you have last cycle? 

Thanks, Shay - I totally learned something new today. ::hides and butts out in shame:: 

Oh no, was my answer to you too bitter? Sorry  I'm glad you learned something new, quit hiding.  

Shayliz

BrazilianPeach:

Shayliz:

BrazilianPeach:

Thanks, Shay - I totally learned something new today. ::hides and butts out in shame:: 

Oh no, was my answer to you too bitter? Sorry  I'm glad you learned something new, quit hiding.  

Please! Not bitter at all (I come from the pre P&R board time, remember - haha). I just genuinely learned something and feel bad for the bad advice. 

All of the advice wasn't bad - progesterone supplements could definitely help in this situation. It's just not the ONLY thing that can help.  

ansi29

Shayliz:

BrazilianPeach:

Ugh.... I would get a different doctor. If you have a short LP, that is a very easy fix (speaking from experience) by taking progesterone. I take progesterone lozenges from 3DPO until CD1. 

From here I gathered you can only have 6 round of clomid for a lifetime. I would save that for when you are further on the process. How long have you been TTC? 

ETA: Actually I would say get a second opinion from a different doctor. I don't have a medical degree and can't be sure your doc is wrong. 

Progesterone can supplement and make an LP longer, but it's not always a fix all. Clomid can produce mature follicles which in turn their CL cysts produce progesterone. 

OP - Did the doctor test your progesterone levels 7 days past ovulation? Are you being monitored with ultrasounds or just bloodwork? How many follicles did you have last cycle? 

Man oh man Shay, there you go with all that excellent bitter advice and knowledge again.

One thing to clarify: CL = corpus luteum (just for those who don't know) it's the place from which your egg erupted on your ovary and it's primary responsibility is progesterone. 

NicoleD54

Sorry this turned into a post & run, I didn't realize how close I was to having my next class when I posted.

I have a baseline ultrasound done, and a 7 dpo progesterone draw. Now, I realize most on this board believe you need mid cycle ultrasounds also, but I have done my research, and talked to my doctor and there is little to no risk involved in HOM/OHSS on 50 mg of clomid. I have yet to find a reliable source that says otherwise, however, I welcome one if anyone has found something I would be willing to change my decision.

Shayliz

NicoleD54:

Sorry this turned into a post & run, I didn't realize how close I was to having my next class when I posted.

I have a baseline ultrasound done, and a 7 dpo progesterone draw. Now, I realize most on this board believe you need mid cycle ultrasounds also, but I have done my research, and talked to my doctor and there is little to no risk involved in HOM/OHSS on 50 mg of clomid. I have yet to find a reliable source that says otherwise, however, I welcome one if anyone has found something I would be willing to change my decision.

The mid cycle ultrasound would give you the ability to see how many follicles you have (not just for HOM/OHSS but just to even know if you are really responding) and the opportunity for discussion on if 50mg is enough, if a trigger shot would be beneficial, if Clomid is thinning your lining too much and needs to be supplemented with Estrogen, etc.

eta: You can definitely over-respond with 50mg Clomid. I had 3 mature follicles one cycle from just 50mg and had to go through the talk of triplets/HOM. 

Kdbean27

Shayliz:

NicoleD54:

Sorry this turned into a post & run, I didn't realize how close I was to having my next class when I posted.

I have a baseline ultrasound done, and a 7 dpo progesterone draw. Now, I realize most on this board believe you need mid cycle ultrasounds also, but I have done my research, and talked to my doctor and there is little to no risk involved in HOM/OHSS on 50 mg of clomid. I have yet to find a reliable source that says otherwise, however, I welcome one if anyone has found something I would be willing to change my decision.

The mid cycle ultrasound would give you the ability to see how many follicles you have (not just for HOM/OHSS but just to even know if you are really responding) and the opportunity for discussion on if 50mg is enough, if a trigger shot would be beneficial, if Clomid is thinning your lining too much and needs to be supplemented with Estrogen, etc.

eta: You can definitely over-respond with 50mg Clomid. I had 3 mature follicles one cycle from just 50mg and had to go through the talk of triplets/HOM. 

I was on 50mg Clomid this cycle CD5-9. I am now on CD13. On CD 11 I had an ultra sound and found out my follies were still small and my lining was very thin. Without the ultra sound we wouldn't have know that. I go back in tomorrow for another, to see if anything has improved.

NicoleD54

Shayliz:

NicoleD54:

Sorry this turned into a post & run, I didn't realize how close I was to having my next class when I posted.

I have a baseline ultrasound done, and a 7 dpo progesterone draw. Now, I realize most on this board believe you need mid cycle ultrasounds also, but I have done my research, and talked to my doctor and there is little to no risk involved in HOM/OHSS on 50 mg of clomid. I have yet to find a reliable source that says otherwise, however, I welcome one if anyone has found something I would be willing to change my decision.

The mid cycle ultrasound would give you the ability to see how many follicles you have (not just for HOM/OHSS but just to even know if you are really responding) and the opportunity for discussion on if 50mg is enough, if a trigger shot would be beneficial, if Clomid is thinning your lining too much and needs to be supplemented with Estrogen, etc.

eta: You can definitely over-respond with 50mg Clomid. I had 3 mature follicles one cycle from just 50mg and had to go through the talk of triplets/HOM. 

Hmm OK. You're the first person I have heard of with 3 mature follicles on clomid. Maybe I will rethink it next cycle, especially if he increases my dose to 100mg. 

As far as lining goes I have had heavy periods, so I was basing that on having a good lining. Yes, I realize this is not as accurate as an ultrasound, but it's a heck of a lot cheaper. I hadn't given much shot to a trigger since we are doing TI and I have been ovulating.

How many mid cycle ultrasounds do you usually have?

Shayliz

NicoleD54:

Shayliz:

NicoleD54:

Sorry this turned into a post & run, I didn't realize how close I was to having my next class when I posted.

I have a baseline ultrasound done, and a 7 dpo progesterone draw. Now, I realize most on this board believe you need mid cycle ultrasounds also, but I have done my research, and talked to my doctor and there is little to no risk involved in HOM/OHSS on 50 mg of clomid. I have yet to find a reliable source that says otherwise, however, I welcome one if anyone has found something I would be willing to change my decision.

The mid cycle ultrasound would give you the ability to see how many follicles you have (not just for HOM/OHSS but just to even know if you are really responding) and the opportunity for discussion on if 50mg is enough, if a trigger shot would be beneficial, if Clomid is thinning your lining too much and needs to be supplemented with Estrogen, etc.

eta: You can definitely over-respond with 50mg Clomid. I had 3 mature follicles one cycle from just 50mg and had to go through the talk of triplets/HOM. 

Hmm OK. You're the first person I have heard of with 3 mature follicles on clomid. Maybe I will rethink it next cycle, especially if he increases my dose to 100mg. 

As far as lining goes I have had heavy periods, so I was basing that on having a good lining. Yes, I realize this is not as accurate as an ultrasound, but it's a heck of a lot cheaper. I hadn't given much shot to a trigger since we are doing TI and I have been ovulating.

How many mid cycle ultrasounds do you usually have?

I had anywhere from 1-3 mid-cycle ultrasounds a cycle, depending on how I was responding on the first ultrasound.  I was ovulating before Clomid as well, the trigger just helped time TI/IUI (I did 2 TI cycles) and helped "force" the follicles to release. 

NicoleD54

Thanks for the info Shay! I will discuss mid cycle monitoring at my next appointment. As much as I don't want to pay $200/ultrasound, I also really don't want triplets. My body couldn't handle the one baby, and my pregnancy will be high risk enough without adding the risks with multiples.

KdgTeacher

NicoleD54:

Thanks for the info Shay! I will discuss mid cycle monitoring at my next appointment. As much as I don't want to pay $200/ultrasound, I also really don't want triplets. My body couldn't handle the one baby, and my pregnancy will be high risk enough without adding the risks with multiples.

Monitoring isn't just about HOM/OHSS, you need to keep an eye on cysts and your lining as well. 

NicoleD54

I have a baseline ultrasound done to check for cysts before starting a new cycle.

ETA: Sorry that was in response to KDG. I thought I hit the quote button.

KdgTeacher

NicoleD54:

I have a baseline ultrasound done to check for cysts before starting a new cycle.

ETA: Sorry that was in response to KDG. I thought I hit the quote button.

And lining should be checked throughout the cycle...