First round of clomid...is this normal?

daileym · December 2012

This is my first round of clomid. My cycles are typically between 40-65 days long. On CD 20 I got a positive OPK in the afternoon, but then a negative that evening and every day until today (CD 25) where I got another positive this afternoon. I'm not having any symptoms of ovulation. I usually have a temp drop two days before, and lots of EWCM which I have had none at all. I figured if I hadn't ovulated by day 21 or so, that the clomid had just failed. I have been using the clearblue digital and the wondfo cheapy strips from Amazon, and got positives on both of them. I have been using them for over a year as we have been ttc, and they have never had a false positive, let alone two in five days. Is this a normal symptom of clomid? TIA!

monimu13 · December 2012

First off, doesnt sound like you are being monitored appropriately on Clomid to me.

daileym · December 2012

That is another concern. My friend who was on clomid a few years ago was surprised my doctor wasn't going to do ultrasounds. He is my family doctor, but he delivers all the baby at my clinic. Should I be running for the hills? I live in a small town and don't have many options, unless I want to drive. How does your doc monitor you?

megs3084 · December 2012

When i was on clomid, i had ultrasounds approx. Cd1216 and they monitored my lh e2 levels.

Unknown · December 2012

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MrsSmith414 · December 2012

daileym:
That is another concern. My friend who was on clomid a few years ago was surprised my doctor wasn't going to do ultrasounds. He is my family doctor, but he delivers all the baby at my clinic. Should I be running for the hills? I live in a small town and don't have many options, unless I want to drive. How does your doc monitor you?

Um.. yes you should. Have you had any testing done? I am assuming no but you should NEVER be on Clomid unmonitored! Exp without previous testing... HSG, BW/US, Semen Analysis.

Please.. do some research and find a RE

TheHensonWedding · December 2012

MrsSmith414:
Um.. yes you should. Have you had any testing done? I am assuming no but you should NEVER be on Clomid unmonitored! Exp without previous testing... HSG, BW/US, Semen Analysis.
Please.. do some research and find a RE

THIS!

daileym · December 2012

I'm going to call the other OB/GYN in town and see if they monitor more closely and make the switch tomorrow. I have had testing and we have a healthy child that was conceived naturally, and this MD delivered him, so that is why I trusted him. I've had ultrasounds, blood and urine work multiple times in the past year and they can't find anything wrong. I did ask if he should be monitoring me and he said no because it was a small dose. Sounds like that is WRONG! Thank you for the feedback, I'm glad that I asked!

DebateThis · December 2012

Sigh. I'm just going to copy/paste this from my multitudes of other posts about unmonitored Clomid. Some of it won't apply to you because it's a C&P but 99% of it will.

What's dangerous about this is that you're clearly not being monitored while taking a drug that can have some serious, even life threatening side effects. The fact that you've blindly taken a drug from a doctor that can have deleterious consequences without so much as reading the package insert is concerning, for a variety of reasons.

Secondarily - you need to have at minimum CD3 ultrasound and bloodwork, CD10-12 ultrasound and bloodwork, and 7dpo (NOT cd21) bloodwork to see if the clomid is even working and not thinning your lining too much or creating too many follicles or creating OHSS, among other things.

And finally - why are you even taking clomid in the first place? What's your diagnosis? Has your husband had an SA? Have you had an HSG? These are all questions that need to be answered and tests that need to be run before you take this drug.

For specific monitoring requests you need CD3, where cycle day 1 is the first day of full flow of your period. You should have a panel of bloodwork for hormone levels plus an ultrasound to determine resting follicles and lining thickness at this state.

Then midcycle (cycle day 10-12) you should have more bloodwork and another ultrasound to see how many follicles you've produced, where your estrogen levels are (to indicate if you're about to ovulate) and if Clomid has had any negative impacts on your uterine lining.

Then 7 days past ovulation (7dpo) you should go back for more bloodwork (progesterone) to check how well the clomid worked - if your progesterone levels are good, it means your ovulation was strong and clomid did its job.

ACOG might not "require" it but the three most widely known, oldest, and well respected groups of infertility experts ALL recommend no clomid or other fertility meds until a complete infertility workup.

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.

And if you don't believe me, this is what can happen when you aren't monitored:

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

daileym · December 2012

Sorry that this has come up a lot, but I do appreciate that info. Thanks.

deelopi9 · December 2012

daileym:
Sorry that this has come up a lot, but I do appreciate that info. Thanks.

It's not your fault the pharmaceutical companies provide the drugs to OB's. It's the OB's responsibility to make sure he has the patients best interest at heart and knows the full effects of each drug. OB's are experts in delivery and keeping you pregnant. RE are the experts in getting you pregnant. Even if you have to drive, the trip will be worth it. Remember you only have one set of fallopian tubes and one uterus-adding all those hormones into your system can cause a multitude of complications. One being you could have a Kate +8 situation. If you develop too many follicles under clomid you have a higher risk of multiples or it could thin out our lining to the point where you could never sustain a pregnancy. GL

IBackBevo · December 2012

I'm going to interject here only because I think some of the posts may freak you out a little unnecessarily.

I think some of this extensive monitoring people may be mentioning may be because they are on a different protocal (i.e. they may be triggering) or may be more profit driven than truly necessary...at least at an early stage in the IF battle. I went to one of the top clinics in the country (with an RE who has been named one of the top docs in the country) and I did not have any ultrasounds other than the CD 3 ultrasound to check for cysts. I also didn't have bloodwork to determine if I had ovulated. Do you now how we determined when to do my IUI? With OPK's. I had the IUI the day after getting my first positive OPK. And I got pregnant even with horrible numbers. This is standard practice for them and they see thousands of women every year.

Now they do do more extensive monitoring with injectable meds where there is a high risk for high order multiples. And if a woman is being triggered, more monitoring is warranted. But that doesn't sound like your situation. And OHSS caused by a low dose of Clomid is exceedingly rare. I even brought this up with my RE (when I asked about so little monitoring) and he pretty much laughed at me.

I would however agree that you definately need to have a CD 3 ultrasound to make sure you don't have any cysts because Clomid can make those grow.

And I also agree that if the Clomid doesn't work in a cycle or two that it is probably a good idea to get an HSG to make sure your tubes are open because (obviously) the Clomid isn't going to help if your tubes are blocked. Additionally, if the Clomid doesn't work in a couple of cycles, it would be a good idea for your DH to get an SA as well.

I just wanted to add my two cents so that you didn't freak out or think your doctor was the worst doctor ever. Every RE's office or OB's office does things a little different. Some are more cost concious than others. It sounds like to me that your doctor is just trying to see if maybe this works before giving you the million dollar work up...a work up that insurance may not cover. And, trust me, having a doctor who is willing to try less expensive methods first could be a good thing--take if from someone who knows because I have thousands of dollars of bills from medical bills the insurance said they would cover and then later decided to reject. Again, the only thing I would be truly leary of would be not having the CD 3 u/s to check for cysts.

Good luck to you!

EDIT: Let me add - High order multiples on Clomid is very rare. OHSS on Clomid is exceedingly rare. I think John and Kate did injectable meds (much stronger) AND had an IUI. This does pose a much greater risk for high order multiples and does require closer monitoring to make sure you aren't developing too many follicles. But that is a totally different situation.

IBackBevo · December 2012

Also, Clomid can dry up EWCM. It is one of the negative side effects. I would guess that you probably did O if the OPK's were positive. You could have also O'd twice and released two eggs. I had 3 days of positive OPK's when I was on Clomid.

OPK's can also be affected by the time of day you take them and how well you are hydrated or if your urine is diluted because you have been drinking alot of water. Generally, I have been told that the second pee of the morning is the most reliable time to test because LH tends to surge at it its highest between 10 and noon. But this is just a general statement. Everyone is different.

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First round of clomid...is this normal?

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