To Clomid or Not To Clomid?

GizmoKallah · July 2010

I just got the results from a progesterone blood test taken 7DPO (on CD 25, 2 days before CD1) and the number was low (1.75). This is no huge suprise to me, with my short luteal phase. I had the same test taken on CD20 last cycle which happened to be day of O and the number was the same. The next step is more blood work CD3/FSH and SA.

That's all well and good, but my Dr is ready to move right into Clomid because she seems convinced I'm either not O'ing or O'ing very weakly. She also offered to refer me to a RE right now if I want.

I know a lot of you have opinions about under what circumstances a Clomid regiment should begin. I want to hear those opinions. I can't begin it for a few months anyhow, even if I wanted to, due to business travel.

So: assuming, 3 months from now, that the CD3/FSH and SA tests come back fine, would you begin Clomid? Is there another step to take first? Would you have the patience to wait several months of natural TTC? My tendency is to avoid medication when I can--especially a drug that *can* have unpleasant side effects and that requires vigilant observation (but I will obviously go for it if it is the most tried and true method).

Thanks for any insight/perspectives you might have.

LnR70707 · July 2010

Take the referral to see an RE. You need an HSG and an SHG done before starting any medications. You could also ask if you can try progesterone suppositories in the 2ww first.

goodgollie · July 2010

I'm no expert but it does appear that you are O'ing according to your chart. Did she say anything about trying to supplement with progesterone first? Then again, if you are O'ing "weakly" progesterone may not help. Good luck with you other tests and making a decision. My progesterone was 7.9 last cycle and I am trying to convince my ob to put me on some progesterone supplements.

GizmoKallah · July 2010

Thanks--HSG and SHG before *any* medication including progesterone suppositories too, right? SHG is a new one to me, I appreciate the tip.

cantalopes24 · July 2010

I'm sorry, I'm confused about the term "Oing weakly". You either do or you don't right?

GizmoKallah · July 2010

goodgollie:
I'm no expert but it does appear that you are O'ing according to your chart. Did she say anything about trying to supplement with progesterone first? Then again, if you are O'ing "weakly" progesterone may not help. Good luck with you other tests and making a decision. My progesterone was 7.9 last cycle and I am trying to convince my ob to put me on some progesterone supplements.

Yeah, I pretty much *know* I am O'ing. That makes you think progesterone is worth trying first (seems less harmful/full of side-effects to me)? But with the short luteal phase, something is definitely not right and low-prog could be it.

LauraOTR · July 2010

cantalopes24:
I'm sorry, I'm confused about the term "Oing weakly". You either do or you don't right?

This is what I was wondering also..

GizmoKallah · July 2010

On "you either O or you don't" comment:

That's what I thought, too. But I've read a bit about it, and basically the situation could be where you O but your endometrium/lining isn't at the right level of a possible implantation due to lack of progesterone (or something else?). This is known as a weak O, because if it were stronger (stronger egg, stronger chemical reaction caused by the corpus luteum?) the lining would be better for implantation. Someone correct me if I am wrong, please.

cantalopes24 · July 2010

GizmoKallah:
On "you either O or you don't" comment:
That's what I thought, too. But I've read a bit about it, and basically the situation could be where you O but your endometrium/lining isn't at the right level of a possible implantation due to lack of progesterone (or something else?). This is known as a weak O, because if it were stronger (stronger egg, stronger chemical reaction caused by the corpus luteum?) the lining would be better for implantation. Someone correct me if I am wrong, please.

That makes sense, but I would think it would be refered to as a thin lining. The term weak O just makes me thing of "a little bit pregnant" lol. It seems like its one or the other. I hope you get some answers. If you are Oing Clomid would be a bad choice. I am with you on not taking medications unless unavoidable.

Kris_Merc · July 2010

I could be in this same boat in a month or two. I had 7 DPO bloodwork done last cycle and it was 10.7. My LP is fine, but I have spotting starting at 7 or 8 DPO that last for about a week along with very light periods. My doctor knows I'm O'ing but also said it may be a weak egg, which doesn't produce a strong enough corpus luteum to maintain implantation. I have CD 3 bloodwork Wednesday and go back to see her the end of August after charting two full cycles after my c/p. She mentioned Clomid during my last appt. as a possibility if b/w shows a weak "O."

GizmoKallah · July 2010

Kris_Merc:
I could be in this same boat in a month or two. I had 7 DPO bloodwork done last cycle and it was 10.7. My LP is fine, but I have spotting starting at 7 or 8 DPO that last for about a week along with very light periods. My doctor knows I'm O'ing but also said it may be a weak egg, which doesn't produce a strong enough corpus luteum to maintain implantation. I have CD 3 bloodwork Wednesday and go back to see her the end of August after charting two full cycles after my c/p. She mentioned Clomid during my last appt. as a possibility if b/w shows a weak "O."

I thought that right there is what is meant by "weak O." I think it is basically a week chemical reaction. Also--I DON'T think this is the same thing as "thin lining." It is more like "wrong chemicals hanging out in the lining." --makes fertilized egg not able stick around.

cantalopes24 · July 2010

GizmoKallah:

Kris_Merc:
I could be in this same boat in a month or two. I had 7 DPO bloodwork done last cycle and it was 10.7. My LP is fine, but I have spotting starting at 7 or 8 DPO that last for about a week along with very light periods. My doctor knows I'm O'ing but also said it may be a weak egg, which doesn't produce a strong enough corpus luteum to maintain implantation. I have CD 3 bloodwork Wednesday and go back to see her the end of August after charting two full cycles after my c/p. She mentioned Clomid during my last appt. as a possibility if b/w shows a weak "O."

I thought that right there is what is meant by "weak O." I think it is basically a week chemical reaction. Also--I DON'T think this is the same thing as "thin lining." It is more like "wrong chemicals hanging out in the lining." --makes fertilized egg not able stick around.

That makes sense. Thank you for explaining that!

MrsGoody · July 2010

I'm not sure what advice to give you, but I did have very low progesterone when I first got PG with DD and DS (less than 10). I actually did take Clomid to get pregnant with my DD (I had what I think was "weak" ovulation, because my charting indicated I was O'ing, but I had spotting in my LP and a shorter LP. I also had very long cycles, like O'ing around day 30 or so). We TTC'd for a year before deciding to go with Clomid. DH had an SA and I had the appropriate B/W done to ensure it was the right step. Unfortunately, I wasn't as educated on Clomid risks then as I am now and I didn't have much monitoring or really know what I was getting myself into (I didn't see an RE, my OB prescribed it). Luckily, I got pregnant with no complications on my first round of Clomid and had a very normal pregnancy.

That was five years ago, and we've been TTC#3 for the last few months. I've had spotting in my LP starting around 8 DPO, lastting for 2-3 days. I guess if I were you I would wait a few more months and maybe go on progesterone supplements to see if that helps. I agree with not wanting to take unnecessary medication - I feel the same way this time around. (I was lucky enough to get pregnant with DS my first try and with no meds). Thanks for posting this - I wanted to respond so I could use this post as a reference.

Good luck with whatever you decide to do!

GizmoKallah · July 2010

kdodge423:
cantalopes24:
GizmoKallah:
On "you either O or you don't" comment:
That's what I thought, too. But I've read a bit about it, and basically the situation could be where you O but your endometrium/lining isn't at the right level of a possible implantation due to lack of progesterone (or something else?). This is known as a weak O, because if it were stronger (stronger egg, stronger chemical reaction caused by the corpus luteum?) the lining would be better for implantation. Someone correct me if I am wrong, please.

That makes sense, but I would think it would be refered to as a thin lining. The term weak O just makes me thing of "a little bit pregnant" lol. It seems like its one or the other. I hope you get some answers. If you are Oing Clomid would be a bad choice. I am with you on not taking medications unless unavoidable.

Weak O is a proper term (in general it is considered a low quality egg, whcih can lead to a low quality corpus luteum, which would cause progesterone issues). Clomid is sometimes used to strengthen ovulation for this reason. Thinned lining is a product of low estrogen and is not directly related to ovulation strength. It is possible for the changes post O to be incorrect due to low progesterone from a weak O, but that is improperly aged lining, not thin lining.

Provided that b/w, HSG, and SA all come back good, Clomid is an excellent choice.

OP, on top of those things, please make sure that your doctor intends to monitor. Thinned lining is a very common side effect because Clomid works by blocking estrogen (which as I covered, is what causes the lining to grow). I was immediately pulled off it because my last u/s before IUI my lining was at 3.8 mm. Minimum acceptable is 6 mm, prefered is above 8.

If you do the testing and everything comes back fine, then it is still your choice about taking any kind of medication. If you are not comfortable taking it, then there is nothing that says you have to.

This is exactly why this drug is so high-maintenance, but of course if I choose to go for it, this is the only responsible way to do so.

I would love to avoid Clomid but so far I haven't heard of any other alternative therapies (besides B6 complex which will likely have no effect, though I'm giving it another month).

Thanks for the wisdom.

cantalopes24 · July 2010

kdodge423:
cantalopes24:
GizmoKallah:
On "you either O or you don't" comment:
That's what I thought, too. But I've read a bit about it, and basically the situation could be where you O but your endometrium/lining isn't at the right level of a possible implantation due to lack of progesterone (or something else?). This is known as a weak O, because if it were stronger (stronger egg, stronger chemical reaction caused by the corpus luteum?) the lining would be better for implantation. Someone correct me if I am wrong, please.

That makes sense, but I would think it would be refered to as a thin lining. The term weak O just makes me thing of "a little bit pregnant" lol. It seems like its one or the other. I hope you get some answers. If you are Oing Clomid would be a bad choice. I am with you on not taking medications unless unavoidable.

Weak O is a proper term (in general it is considered a low quality egg, whcih can lead to a low quality corpus luteum, which would cause progesterone issues). Clomid is sometimes used to strengthen ovulation for this reason. Thinned lining is a product of low estrogen and is not directly related to ovulation strength. It is possible for the changes post O to be incorrect due to low progesterone from a weak O, but that is improperly aged lining, not thin lining.

Provided that b/w, HSG, and SA all come back good, Clomid is an excellent choice.

OP, on top of those things, please make sure that your doctor intends to monitor. Thinned lining is a very common side effect because Clomid works by blocking estrogen (which as I covered, is what causes the lining to grow). I was immediately pulled off it because my last u/s before IUI my lining was at 3.8 mm. Minimum acceptable is 6 mm, prefered is above 8.

If you do the testing and everything comes back fine, then it is still your choice about taking any kind of medication. If you are not comfortable taking it, then there is nothing that says you have to.

That is interesting, thanks for the information! I didn't realize Clomid did all that!

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