Question:
Hi. I am 26 years old and have been trying to conceive for 2 years now. So far my infertility is unexplained. All tests have yielded normal results. My husband's sperm analysis was normal in all categories. Count was 170mil although he did have moderate sperm aggregation (clumping) which I was told should not be an issue since its moderate and there were plenty more sperm doing the right thing. While I do ovulate and have a period on a frequent basis it is not on a 28 day cycle, in fact my cycle lengths range from 26 days to 35 and go up and down from month to month.
I just finished my first round of Clomid. Ultrasound at day 12 indicated one good follicle, my lining was good. At day 21 my progesterone was 22.5. I did ovulate. However, my period was only 1 day in length with a 2nd day of spotting. Normally, I have 2 days of moderate bleeding and then 1-2 days of spotting. Is it normal to have a shorter menses with Clomid?
Also, my cycle was only 27 days. I had a confirmed sugar at day 14. I believe I ovulated on day 16. It has apparently also caused a shorter luteal phase. Is that normal? I was under the impression it would lengthen my cycle. My menses came 6 days after my 21 day progesterone showed 22.5. Is that too sudden of a drop in hormone?
Answer:
Hello. Yes, very often Clomid will shorten a cycle. I am concerned, however, that you had a short luteal phase. This should not be the case, but can happen with Clomid. We call it a "luteal phase defect". If this is the case, it could impair implantation leading to failure or loss of the pregnancy. For this reason, I always add and recommend adding progesterone from day 16. It is an easy thing to do and does not have side effects. The only problem is that it will inhibit a spontaneous period if you don't get pregnant, so a pregnancy test will need to be scheduled.
I also recommend ultrasound surveillance when doing Clomid cycles. Most non-fertility specialists will not do this, as in your cycle. It is the best way to monitor progress and lets you know how many follicles are about to be ovulated. HCG can be given to stimulate ovulation (which also helps with the luteal phase) and helps to time your intercourse best. You should ask your doctor to do this. If he/she looks at you curiously, and without understanding, then you need to find a real fertility specialist. Also, only 4-6 cycles of Clomid are recommended by ASRM and reproductive specialists, after that you need to look at other options.
I hope this answers your question.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.
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