Sunday, November 15, 2009

Clomid Protocol Not Working



First of all, thank you for being available to answer questions for all of us. I have taken Clomid twice now. The first month I took it I was on 50mg 5-9 and I ovulated on cd 21 with a progesterone level of 19. I have 33 day cycles. The second cycle I was on 100mg 5-9 and I used my Clear Blue Easy monitor and it never peaked just stayed on high. Then I had my progesterone test and it was only 7. But then my OB gave me 100mg again for the next month. Shouldn't I still be on 50mg if that worked better??
I am also thinking about taking the 50mg days 3-7 instead of 5-9 since it is my last month being able to take it according to my OB. On top of the Clomid, she also gave me Estrace (not sure if that is spelled right) to take days 8-12 and Prochieve to take days 16-28. So if I take the Clomid days 3-7 do I take the other meds on different days?? Also, a little background, I have one child conceived naturally, I am overweight but don't have PCOS and don't have blocked tubes (I was tested for both). If there is any way you can help me with my situation it would be very helpful!

Thanks again!



Although the Clomid worked the first cycle, I too would have increased it to 100mg to get your cycles more normal and shorter. It is possible that the Clomid at 50mg was barely effective, and worked by luck only. That would explain why the 100mg did not work.

I also do not advocate the method your doctor is using. I am a firm believer in the ultrasound surveillance to evaluate whether or not the medication is working, how many follicles there are and to time ovulation. That is a lot more information that your doctor is getting. I also automatically use progesterone with my Clomid cycles to help implantation and support the pregnancy. Sometimes, Clomid can also cause the uterine lining to be thinned, however, your doctor should be checking this with an ultrasound rather than treating empirically, as I've mentioned before.

Finally, whether you take Clomid on days 3-7 or 5-9 does not make any difference in stimulation.

My protocol is as follows with Clomid:

1. Cycle day 2-5: Baseline ultrasound to rule out residual ovarian cyst, give Clomid calendar and prescription.

2. Stop recreational intercourse on CD #10.

3. Start ultrasound surveillance on CD #11 and continue as frequently as needed to determine when the follicle is appropriate size for ovulation. This also rules out a super-multiple (three or more) pregnancy potential. If there are more than three follicles, we cancel the cycle and prevent pregnancy.

4. When the lead follicle reaches 20-22mms, HCG (Ovidrel) is given to stimulate ovulation.

5. Have intercourse daily, once per day, one ejaculation per day beginning the day after HCG, for four consecutive days.

6. Start progesterone five days after HCG and take daily until the pregnancy test.

7. Do pregnancy test (serum) in two weeks.

I hope this helps. Please discuss your situation with your OB and get a second opinion if necessary.

Edward J. Ramirez, M.D.,FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

Check me out on Facebook and Twitter with me at @montereybayivf

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