starting clomid/update

Jenibug05

Hi Ladies. I thought I would just share a little update on me. A couple weeks back the doctor wanted me to do some blood tests to determine where my levels were at to see if I was/am ovulating. I have endometriosis and my cycles are kind of all over the place, but are more normal now that I'm not on BC pill or depo shot.

The blood tests showed low levels in pretty much everything he tested in-progesterone, prolactin, thyroid, and I'm not even sure what else. He tested 5-6 things. He determined it doesn't appear I'm ovulating. He put me on clomid 50 mg to take CD 5-9. I'm on CD 6 now so I've taken two dosages so far.

On CD 21 he will do another blood test for progesterone only to determine if I've ovulated. I asked if he does monitoring/u-s after the round of clomid is done, and the nurse said my OBGYN 'doesn't do that.' I remember several of you talking about u/s while on clomid. I'm a little nervous about that. He said when/if I get pg again they'll do another progesterone check and if my levels are low, he'll put me on supplements while pg.

Anyways, that's the update on me. This is our 5th cycle TTCAL. The first full cycle we tried was in May & we got pregnant, so obviously I was ovulating then. I know that's extremely rare since each month you only have a 20% chance of conceiving for healthy couples and perfect timing. I don't understand why I wouldn't be ovulating this time though. It's frustrating. So far with clomid I'm cramping, dizzy, and sick to my stomach. It's not really severe yet though. Hopefully it stays that way.

No questions really. But if anyone has any experience with clomid or not ovulating/low levels I'd be happy to hear your experiences and connect/support one another.

lovelainie

Honestly, I know you didn't really ask for advice here, but I wouldn't be taking clomid, unmonitored, from an OB. There are just too many risks involved, and it doesn't sound like you've had enough testing done, either. 

Have you had an HSG? If you have endometriosis, especially, it's a good idea to at least make sure your tubes are clear before you waste a clomid cycle--you only get six of them in your lifetime.  

RedPhoenix625

lovelainie:

Honestly, I know you didn't really ask for advice here, but I wouldn't be taking clomid, unmonitored, from an OB. There are just too many risks involved, and it doesn't sound like you've had enough testing done, either. 

Have you had an HSG? If you have endometriosis, especially, it's a good idea to at least make sure your tubes are clear before you waste a clomid cycle--you only get six of them in your lifetime.  

I will second this.  I hope you'll consider seeing an RE before deciding to continue with this next cycle, if you don't have luck this time around.  GL though.

ETA to add: Also, if you had questionable blood results for thyroid, prolactin, etc. then that should have been investigated as well.  Is your doctor doing anything in response to those levels?  The thyroid levels especially have me scratching my head as to why he would throw you on clomid.

twotexans

Monitoring is really important on Clomid, and other follicle stimulating drugs.  You are at risk for overstimulation and cysts, and feeding Clomid to a cyst is not a smart idea.  I would seriously consider finding a different doctor if he refuses to monitor you.  It's just not a good practice. 

There are also lifetime caps on the number of Clomid cycles one should do.  There are some studies that link over use of Clomid with increased evidence of ovarian cancer later in life.  There is some room for debate on this, but better safe than sorry.

As for side effects, you can reduce some of them by taking them right before bed.  You can usually sleep through the dizziness and nausea.

 

km_md

I have no advice, just wanted to offer ((Hugs)). I'm sorry that you are dealing with all of this, it must be so frustrating for you

[Deleted User]

The user and all related content has been deleted.

Jenibug05

RedPhoenix625:

lovelainie:

Honestly, I know you didn't really ask for advice here, but I wouldn't be taking clomid, unmonitored, from an OB. There are just too many risks involved, and it doesn't sound like you've had enough testing done, either. 

Have you had an HSG? If you have endometriosis, especially, it's a good idea to at least make sure your tubes are clear before you waste a clomid cycle--you only get six of them in your lifetime.  

I will second this.  I hope you'll consider seeing an RE before deciding to continue with this next cycle, if you don't have luck this time around.  GL though.

ETA to add: Also, if you had questionable blood results for thyroid, prolactin, etc. then that should have been investigated as well.  Is your doctor doing anything in response to those levels?  The thyroid levels especially have me scratching my head as to why he would throw you on clomid.

What is HSG? I'm not sure what this is, but I did have a laproscopy done for endometriosis last June, which cleaned me out and the dr said I shouldn't have any problems conceiving (even before the surgery), he was just concerned that I wasn't ovulating because of my irregular cycles.

When talking with my dr and his nurses it didn't sound like he was considering referring me to a RE at this point. He said if we went further through treatment I would need a RE but that he's treated patients with clomid before and is able to do that. I expressed my concern to the nurse about not having u/s and she just said that the progesterone check would determine if I've ovulated. How would I go about this? When they do an u/s while on clomid, what all do they check for? I'm assuming size/swollen ovaries, how many eggs you have, etc.

Well, with the other low levels like prolactin, thyroid, progesterone, etc. they mentioned they were low but the dr was going to look into if anything needed to be done. I found it odd that my thyroid was low because my family dr checked my thyroid a couple months ago and it was fine. The mentioned 'low/normal', so maybe the level number is in the normal level, but on the lower end of the scale? I asked the nurse if I needed another appointment before starting clomid and to discuss the blood results and she said no. I guess I should push harder on having another appointment?

 

Sorry I realize that this post makes me sound uneducated. I'm trying to ask the dr questions to know more about what's going on and what effects what to make a decision. I appreicate your feedback. I, too was wondering why I wouldn't get u/s while on clomid as I know many of you have had u/s while on it. I found it odd they just said 'dr - doesn't do u/s while on clomid.' I had heard from you ladies you can only take clomid for 6 cycles in a lifetime. But, what do I do if the dr says I don't need a RE at this point (like he did before)? I can't get one without a referral, can I?

On a different note, this dr also delivered my step daughters. Yes, I know that sounds odd. I've gone to the dr for 8 years at this point and he's done several surgeries for me so I didn't want to switch just because my step daughter's mother also goes to him. DH and his ex wife had two miscarriages and both step daughters were high risk pregnancies and Dr did really good with them, so I guess I thought I had a good dr. DH thinks a lot of my dr.

What other testing would they do to determine if I'm not ovulating? I definitely think now that I need to look into clomid further and ask my dr more questions (and not just the nurse on the phone) and ask dr to elaborate.

Thanks for your honesty. We really want two kids (of course at this point I would be happy with one healthy baby), so I don't want to use all 6 cycles at this time in case I need clomid in the future.

twotexans

The ultrasound looks for active cysts on your ovaries on cd3.  If that is clear, you start clomid.  The second will be around cd12.  It will look at the number and size of follicles to see how you are responding.  They will also check to make sure your uterine lining is thick enough.  Clomid can thin your lining, which can lead to implantation issues.

Does your insurance require a referral for specialists?  If not, then you can go with a referral.  If they do require a referral, you need to find another doctor who will either monitor you, or refer you to an RE.

twotexans

I forgot about the HSG.  It is a test to make sure your tubes are clear.  It is an x-ray that runs dye through your uterus and fallopian tubes to look for abnormalities.  It does no good to stimulate your ovaries if the egg cannot make it through the tube.  Any RE will require it before you start medicated cycles.

Jenibug05

twotexans:

The ultrasound looks for active cysts on your ovaries on cd3.  If that is clear, you start clomid.  The second will be around cd12.  It will look at the number and size of follicles to see how you are responding.  They will also check to make sure your uterine lining is thick enough.  Clomid can thin your lining, which can lead to implantation issues.

Does your insurance require a referral for specialists?  If not, then you can go with a referral.  If they do require a referral, you need to find another doctor who will either monitor you, or refer you to an RE.

Thanks. I really wasn't sure the timeline of when the u/s were. I wonder... with endometriosis the uterine lining doesn't shed each month during AF, so I may have some built up. I wonder how clomid effects endometriosis. I feel like I didn't get a lot of questions answered.

I believe my insurance does require a referral for specialists and it also doesn't really pay for any type of 'infertility' treatment. Insurance didn't cover clomid either, so I paid that out of pocket (that still wasn't that expensive though). I work in Human Resources, right next to benefits, so maybe I'll try to swing by there later today and ask them about coverage. I know one girl in benefits has problems conceiving and has gone through IVF, a loss, trigger shots, etc. so she would definitely know.

I think I may talk to DH about if I should see another dr. We talked about it in the past (when I found out my dr was his ex wife's dr) and decided to stay with my dr because he did good for my step daughters in the past and had done well during my surgeries (laproscopy for endo, D&C, and also another surgery I had). I don't know why doctor's would hand out clomid so easily if you need monitoring and can only take it 6 cycles in a lifetime. Seems pretty careless to me.

RedPhoenix625

I really think you need to see an RE.  There are too many unknowns at this point based on all the things you've told us, and they need to be investigated by a specialist.  Honestly, your history of endometriosis and the questionable bloodwork alone should be enough for your OB to refer you.  I hope you figure out a plan you're comfortable with.

lovelainie

Jenibug05:

RedPhoenix625:

lovelainie:

Honestly, I know you didn't really ask for advice here, but I wouldn't be taking clomid, unmonitored, from an OB. There are just too many risks involved, and it doesn't sound like you've had enough testing done, either. 

Have you had an HSG? If you have endometriosis, especially, it's a good idea to at least make sure your tubes are clear before you waste a clomid cycle--you only get six of them in your lifetime.  

I will second this.  I hope you'll consider seeing an RE before deciding to continue with this next cycle, if you don't have luck this time around.  GL though.

ETA to add: Also, if you had questionable blood results for thyroid, prolactin, etc. then that should have been investigated as well.  Is your doctor doing anything in response to those levels?  The thyroid levels especially have me scratching my head as to why he would throw you on clomid.

What is HSG? I'm not sure what this is, but I did have a laproscopy done for endometriosis last June, which cleaned me out and the dr said I shouldn't have any problems conceiving (even before the surgery), he was just concerned that I wasn't ovulating because of my irregular cycles. An HSG is an x-ray test used to check out your ute and make sure your tubes are clear. Did you have your lap done in 2011 or 2012? If it was 2011, I'd probably ask for an HSG just to make sure your tubes are still clear. 

When talking with my dr and his nurses it didn't sound like he was considering referring me to a RE at this point. He said if we went further through treatment I would need a RE but that he's treated patients with clomid before and is able to do that. I expressed my concern to the nurse about not having u/s and she just said that the progesterone check would determine if I've ovulated. How would I go about this? When they do an u/s while on clomid, what all do they check for? I'm assuming size/swollen ovaries, how many eggs you have, etc. For me, a clomid cycle involved an ultrasound on CD3 to check for cysts, and then monitoring through ultrasound and bloodwork from around CD12 until ovulation--which, by the way, they can confirm through ultrasound (my RE would say 'It looks like you ovulated from the left this time,"). 

Yes, they can give you clomid, and it might be successful, but it might also land you in a Jon+Kate situation. Or, if you have a cyst and take clomid on top of that... Not a good situation, either.  

Well, with the other low levels like prolactin, thyroid, progesterone, etc. they mentioned they were low but the dr was going to look into if anything needed to be done. I found it odd that my thyroid was low because my family dr checked my thyroid a couple months ago and it was fine. The mentioned 'low/normal', so maybe the level number is in the normal level, but on the lower end of the scale? I asked the nurse if I needed another appointment before starting clomid and to discuss the blood results and she said no. I guess I should push harder on having another appointment? Honestly, I'd just push for a referral to an RE. 

 

Sorry I realize that this post makes me sound uneducated. I'm trying to ask the dr questions to know more about what's going on and what effects what to make a decision. I appreicate your feedback. I, too was wondering why I wouldn't get u/s while on clomid as I know many of you have had u/s while on it. I found it odd they just said 'dr - doesn't do u/s while on clomid.' I had heard from you ladies you can only take clomid for 6 cycles in a lifetime. But, what do I do if the dr says I don't need a RE at this point (like he did before)? I can't get one without a referral, can I? This depends on your insurance. Mine doesn't require a referral, so I just called and set up an appointment. And, if you don't need an RE at this point, you also shouldn't be taking clomid. 

On a different note, this dr also delivered my step daughters. Yes, I know that sounds odd. I've gone to the dr for 8 years at this point and he's done several surgeries for me so I didn't want to switch just because my step daughter's mother also goes to him. DH and his ex wife had two miscarriages and both step daughters were high risk pregnancies and Dr did really good with them, so I guess I thought I had a good dr. DH thinks a lot of my dr. He probably is a good OB. The thing is, OBs aren't well-trained in fertility procedures. Their job is to help pregnant women and deliver babies, not to get women pregnant.  

What other testing would they do to determine if I'm not ovulating? I definitely think now that I need to look into clomid further and ask my dr more questions (and not just the nurse on the phone) and ask dr to elaborate. My RE has always been able to confirm ovulation on ultrasound... But you could chart, too, which would be cheaper and just as effective. 

Thanks for your honesty. We really want two kids (of course at this point I would be happy with one healthy baby), so I don't want to use all 6 cycles at this time in case I need clomid in the future.

Good luck! I really hope you get some good answers, and your rainbow.  

Jenibug05

twotexans:

I forgot about the HSG.  It is a test to make sure your tubes are clear.  It is an x-ray that runs dye through your uterus and fallopian tubes to look for abnormalities.  It does no good to stimulate your ovaries if the egg cannot make it through the tube.  Any RE will require it before you start medicated cycles.

Hmm... I definitely didn't get a HSG done. Okay I feel silly for asking this, but what does RE stand for? I just asked my doctor if I needed to see a specialist. It's pretty much the same thing, right?

Thanks for sharing your knowledge ladies. It looks like I need to talk to DH and call my dr or find a new one. I'm already on pill 2 of clomid though. I have 3 days left after today. I wonder what I should do about the rest of the clomid round.

Man, doctor's are frustrating for not informing patients properly. Thank goodness for you ladies that can help inform me. I appreciate you.

lovelainie

RE= Reproductive Endocrinologist. 

And yeah, uninformed medical professionals are everywhere.  

twotexans

Jenibug05:

twotexans:

I forgot about the HSG.  It is a test to make sure your tubes are clear.  It is an x-ray that runs dye through your uterus and fallopian tubes to look for abnormalities.  It does no good to stimulate your ovaries if the egg cannot make it through the tube.  Any RE will require it before you start medicated cycles.

Hmm... I definitely didn't get a HSG done. Okay I feel silly for asking this, but what does RE stand for? I just asked my doctor if I needed to see a specialist. It's pretty much the same thing, right?

Thanks for sharing your knowledge ladies. It looks like I need to talk to DH and call my dr or find a new one. I'm already on pill 2 of clomid though. I have 3 days left after today. I wonder what I should do about the rest of the clomid round.

Man, doctor's are frustrating for not informing patients properly. Thank goodness for you ladies that can help inform me. I appreciate you.

RE is a Reproductive Endocrinologist.  They are specially trained to deal with infertility issues.   

Jenibug05

lovelainie:

Jenibug05:

RedPhoenix625:

lovelainie:

Honestly, I know you didn't really ask for advice here, but I wouldn't be taking clomid, unmonitored, from an OB. There are just too many risks involved, and it doesn't sound like you've had enough testing done, either. 

Have you had an HSG? If you have endometriosis, especially, it's a good idea to at least make sure your tubes are clear before you waste a clomid cycle--you only get six of them in your lifetime.  

I will second this.  I hope you'll consider seeing an RE before deciding to continue with this next cycle, if you don't have luck this time around.  GL though.

ETA to add: Also, if you had questionable blood results for thyroid, prolactin, etc. then that should have been investigated as well.  Is your doctor doing anything in response to those levels?  The thyroid levels especially have me scratching my head as to why he would throw you on clomid.

What is HSG? I'm not sure what this is, but I did have a laproscopy done for endometriosis last June, which cleaned me out and the dr said I shouldn't have any problems conceiving (even before the surgery), he was just concerned that I wasn't ovulating because of my irregular cycles. An HSG is an x-ray test used to check out your ute and make sure your tubes are clear. Did you have your lap done in 2011 or 2012? If it was 2011, I'd probably ask for an HSG just to make sure your tubes are still clear. 

When talking with my dr and his nurses it didn't sound like he was considering referring me to a RE at this point. He said if we went further through treatment I would need a RE but that he's treated patients with clomid before and is able to do that. I expressed my concern to the nurse about not having u/s and she just said that the progesterone check would determine if I've ovulated. How would I go about this? When they do an u/s while on clomid, what all do they check for? I'm assuming size/swollen ovaries, how many eggs you have, etc. For me, a clomid cycle involved an ultrasound on CD3 to check for cysts, and then monitoring through ultrasound and bloodwork from around CD12 until ovulation--which, by the way, they can confirm through ultrasound (my RE would say 'It looks like you ovulated from the left this time,"). 

Yes, they can give you clomid, and it might be successful, but it might also land you in a Jon+Kate situation. Or, if you have a cyst and take clomid on top of that... Not a good situation, either.  

Well, with the other low levels like prolactin, thyroid, progesterone, etc. they mentioned they were low but the dr was going to look into if anything needed to be done. I found it odd that my thyroid was low because my family dr checked my thyroid a couple months ago and it was fine. The mentioned 'low/normal', so maybe the level number is in the normal level, but on the lower end of the scale? I asked the nurse if I needed another appointment before starting clomid and to discuss the blood results and she said no. I guess I should push harder on having another appointment? Honestly, I'd just push for a referral to an RE. 

 

Sorry I realize that this post makes me sound uneducated. I'm trying to ask the dr questions to know more about what's going on and what effects what to make a decision. I appreicate your feedback. I, too was wondering why I wouldn't get u/s while on clomid as I know many of you have had u/s while on it. I found it odd they just said 'dr - doesn't do u/s while on clomid.' I had heard from you ladies you can only take clomid for 6 cycles in a lifetime. But, what do I do if the dr says I don't need a RE at this point (like he did before)? I can't get one without a referral, can I? This depends on your insurance. Mine doesn't require a referral, so I just called and set up an appointment. And, if you don't need an RE at this point, you also shouldn't be taking clomid. 

On a different note, this dr also delivered my step daughters. Yes, I know that sounds odd. I've gone to the dr for 8 years at this point and he's done several surgeries for me so I didn't want to switch just because my step daughter's mother also goes to him. DH and his ex wife had two miscarriages and both step daughters were high risk pregnancies and Dr did really good with them, so I guess I thought I had a good dr. DH thinks a lot of my dr. He probably is a good OB. The thing is, OBs aren't well-trained in fertility procedures. Their job is to help pregnant women and deliver babies, not to get women pregnant.  

What other testing would they do to determine if I'm not ovulating? I definitely think now that I need to look into clomid further and ask my dr more questions (and not just the nurse on the phone) and ask dr to elaborate. My RE has always been able to confirm ovulation on ultrasound... But you could chart, too, which would be cheaper and just as effective. 

Thanks for your honesty. We really want two kids (of course at this point I would be happy with one healthy baby), so I don't want to use all 6 cycles at this time in case I need clomid in the future.

Good luck! I really hope you get some good answers, and your rainbow.  

Thank you for all of this information. I have started charting, and am on my fourth cycle charting. The first and the third showed I ovulated based on my temps, the second showed I did not. However the OPK did not show that I ovulated (or perhaps I didn't catch my surge).

RedPhoenix625

Jenibug05:

twotexans:

I forgot about the HSG.  It is a test to make sure your tubes are clear.  It is an x-ray that runs dye through your uterus and fallopian tubes to look for abnormalities.  It does no good to stimulate your ovaries if the egg cannot make it through the tube.  Any RE will require it before you start medicated cycles.

Hmm... I definitely didn't get a HSG done. Okay I feel silly for asking this, but what does RE stand for? I just asked my doctor if I needed to see a specialist. It's pretty much the same thing, right?

Thanks for sharing your knowledge ladies. It looks like I need to talk to DH and call my dr or find a new one. I'm already on pill 2 of clomid though. I have 3 days left after today. I wonder what I should do about the rest of the clomid round.

Man, doctor's are frustrating for not informing patients properly. Thank goodness for you ladies that can help inform me. I appreciate you.

I don't know what to tell you about the clomid now that you've already begun taking it...if you're having second thoughts, best to call your doctor's office and ask if it's safe to stop mid-week.

And yes, doctors can definitely be frustrating.  It seems that many OBs have trouble recognizing and admitting where their expertise ends.  I'm thankful mine was helpful yet honest, and referred me to an RE after a year and initial testing.

Jenibug05

Thank you ladies for your responses. I debated if I wanted to post this, because I felt like I was being an 'attention whore' but I'm sure glad I posted this. You all provided a lot of information and knowledge. I appreciate it.

DebateThis

OK, this is a C&P from a post I wrote months ago and it's going to be long (and some parts might not apply to you), but bear with me. If you are infertile enough for Clomid, you are infertile enough to get a FULL infertility workup and to see an RE:

All of this is why OB's should not be providing clomid and should refer all fertility patients to an RE.

First and foremost 11 mos TTC is still in the range of normal [I have no idea how long you've been TTCAL], so what you're experiencing could very well be nothing worrisome at all with no need for clomid. That said, yes, there are a LOT of things that should fall into place prior to being prescribed a medication like this. Many people have perfectly good luck with it; many people have side effects with it (cysts, thinned lining, etc) that can actually make it harder to conceive.

Your DH should first have an SA. In terms of invasive testing and side effects, the SA is the only one with no side effects (except an orgasm, lol) and no intrusion into your person.  It's estimated that nearly 40% of infertility in couples is MFI (male factor infertility), so it's not like its a small sample of the population that has issues with their sperm. It's a huge deal and is super cheap to test compared to the rest of them so you might as well get it done.

Next, your OB should not be "hypothesizing" that you are not ovulating. You CANNOT know that you didn't ovulate based on CD21 bloodwork - it is completely unreliable. Given that your charts have shown ovulation in two of your last cycles, you should go with that number.  There are very specific tests (with just a simple blood draw and transvaginal ultrasound on specific days of your cycle) that can determine this with near certainty. Second,  if you are having periods somewhat regularly (under 60 days between Day 1 to Day 1 of your cycles) then you ARE ovulating. It might not be regular or strong enough or any host of other reasons, but you are ovulating. It is not impossible to figure out when you're ovulating, either - basal body temperature charting or OPKs can go a long way toward pinpointing ovulation.

The most common diagnosis for lack of ovulation/weak ovulation/ is PCOS. There are a number of criteria that need to be met in order to be diagnosed with that, but again - you need to have the tests run. If PCOS is what is causing your ovulation issues (if you have ovulation issues at all) taking clomid, especially unmonitored, can cause ovarian cysts to grow out of control and potentially even cause irreversible damage to your tubes. This could all be a moot point if you don't have PCOS, but you need to rule that out first.

Last, you need to rule out that you aren't having any structural issues with your ovaries, tubes, and uterus that could be impeding conception. This is done via HSG (hysterosalpingoram - an ultrasound with radioactive dye injected into your uterus). It checks for tubal blockages and uterine abnormalities. All the Clomid in the world won't get you knocked up if your tubes are blocked or if you have a uterus full of fibroids or polyps.

And this is more info on monitoring during Clomid:

This is from INCIID (International Council on Infertility Information Dissemination), and the ASRM and SART recommendations are nearly identical:

If you are not seeing an RE and your OB/GYN does not have the facilities to conduct these routine tests, you should seriously consider switching to a doctor who does. Minimally, a doctor treating fertility patients should have the following:

Availability of staff and technicians seven days per week. If your doctor or clinic does not offer weekend and holiday hours, you are clearly not in the hands of someone whose priority is helping you get pregnant. Transvaginal ultrasound equipment. You should not undergo treatment with Clomid or injectable fertility medications unless this equipment is available for routine monitoring. Though many OBs prescribe Clomid without doing this monitoring, it is in your best interest to have periodic ultrasounds to ensure that the Clomid is indeed stimulating ovulation and that the follicles are releasing the eggs. Under no circumstances should a patient undergo treatment with injectable medications, such as Humegon, Repronex or Follistim, without ultrasound monitoring. If you are using intra-uterine insemination (IUIs), ultrasounds are required for accurately timing insemination with ovulation. An on-site, certified lab to do semen testing and prep for IUIs and post coital tests, as well as facilities to do E-2, blood HCG beta and progesterone tests.
See also: How to Chose a Clinic

 

https://www.inciid.org/printpage.php?cat=infertility101&id=262

And all this, of course, is AFTER OP/DH have been tested. Good luck and feel free to ask any questions you might have.

 

DebateThis

And here's a post on what can happen when you aren't monitored:

https://community.thenest.com/cs/ks/forums/37115533/ShowThread.aspx?MsdVisit=1

And another one on why full monitoring with an RE is important: https://community.thebump.com/cs/ks/forums/thread/64391126.aspx

Jenibug05

DebateThis:

OK, this is a C&P from a post I wrote months ago and it's going to be long (and some parts might not apply to you), but bear with me. If you are infertile enough for Clomid, you are infertile enough to get a FULL infertility workup and to see an RE:

All of this is why OB's should not be providing clomid and should refer all fertility patients to an RE.

First and foremost 11 mos TTC is still in the range of normal [I have no idea how long you've been TTCAL], so what you're experiencing could very well be nothing worrisome at all with no need for clomid. That said, yes, there are a LOT of things that should fall into place prior to being prescribed a medication like this. Many people have perfectly good luck with it; many people have side effects with it (cysts, thinned lining, etc) that can actually make it harder to conceive.

Your DH should first have an SA. In terms of invasive testing and side effects, the SA is the only one with no side effects (except an orgasm, lol) and no intrusion into your person.  It's estimated that nearly 40% of infertility in couples is MFI (male factor infertility), so it's not like its a small sample of the population that has issues with their sperm. It's a huge deal and is super cheap to test compared to the rest of them so you might as well get it done.

Next, your OB should not be "hypothesizing" that you are not ovulating. You CANNOT know that you didn't ovulate based on CD21 bloodwork - it is completely unreliable. Given that your charts have shown ovulation in two of your last cycles, you should go with that number.  There are very specific tests (with just a simple blood draw and transvaginal ultrasound on specific days of your cycle) that can determine this with near certainty. Second,  if you are having periods somewhat regularly (under 60 days between Day 1 to Day 1 of your cycles) then you ARE ovulating. It might not be regular or strong enough or any host of other reasons, but you are ovulating. It is not impossible to figure out when you're ovulating, either - basal body temperature charting or OPKs can go a long way toward pinpointing ovulation.

The most common diagnosis for lack of ovulation/weak ovulation/ is PCOS. There are a number of criteria that need to be met in order to be diagnosed with that, but again - you need to have the tests run. If PCOS is what is causing your ovulation issues (if you have ovulation issues at all) taking clomid, especially unmonitored, can cause ovarian cysts to grow out of control and potentially even cause irreversible damage to your tubes. This could all be a moot point if you don't have PCOS, but you need to rule that out first.

Last, you need to rule out that you aren't having any structural issues with your ovaries, tubes, and uterus that could be impeding conception. This is done via HSG (hysterosalpingoram - an ultrasound with radioactive dye injected into your uterus). It checks for tubal blockages and uterine abnormalities. All the Clomid in the world won't get you knocked up if your tubes are blocked or if you have a uterus full of fibroids or polyps.

And this is more info on monitoring during Clomid:

This is from INCIID (International Council on Infertility Information Dissemination), and the ASRM and SART recommendations are nearly identical:

If you are not seeing an RE and your OB/GYN does not have the facilities to conduct these routine tests, you should seriously consider switching to a doctor who does. Minimally, a doctor treating fertility patients should have the following:

Availability of staff and technicians seven days per week. If your doctor or clinic does not offer weekend and holiday hours, you are clearly not in the hands of someone whose priority is helping you get pregnant. Transvaginal ultrasound equipment. You should not undergo treatment with Clomid or injectable fertility medications unless this equipment is available for routine monitoring. Though many OBs prescribe Clomid without doing this monitoring, it is in your best interest to have periodic ultrasounds to ensure that the Clomid is indeed stimulating ovulation and that the follicles are releasing the eggs. Under no circumstances should a patient undergo treatment with injectable medications, such as Humegon, Repronex or Follistim, without ultrasound monitoring. If you are using intra-uterine insemination (IUIs), ultrasounds are required for accurately timing insemination with ovulation. An on-site, certified lab to do semen testing and prep for IUIs and post coital tests, as well as facilities to do E-2, blood HCG beta and progesterone tests.
See also: How to Chose a Clinic

 

https://www.inciid.org/printpage.php?cat=infertility101&id=262

And all this, of course, is AFTER OP/DH have been tested. Good luck and feel free to ask any questions you might have.

 

Thank you for all of this information. I'll click around all the links you sent as well.

My DH has two girls and his ex also had 2 miscarriages. Tests/SA/etc. have been done before with no problems with DH.

I know that 11 months is in the range of 'normal' however since I have endometriosis my dr didn't see the need to wait until 11 mos before we started doing testing, etc. This is why testing, etc. was done prior to 11 months of TTC. My dr told me that sometimes, patients will have all the signs of ovulation (temperature change, positive ovulation kits, etc), but the follicles themselves do not actually physically burst, and cause the egg to remain trapped inside the follicle until it?s too late to be viably fertilized.

Thanks for all of the information and responses.

twotexans

I agree with DebateThis on all but one part of her post.  It is possible to not ovulate and have a regular cycle.  I've done it often.  Prior to starting progesterone, my cycles we never longer than 30 days- even annovulatory.  You don't get a real period, but it is almost identical.  It's usually caused by a drop in estrogen, much like the bleeding that occurs from taking BCPs.

mayonegg

km_md:

I have no advice, just wanted to offer ((Hugs)). I'm sorry that you are dealing with all of this, it must be so frustrating for you

This ^ so sorry. ((hugs))