Sunday, October 17, 2010

Trying To Conceive For One Year: Clomid Vs. Laparoscopy?

(If the blog radio program comes on, you can pause it by going to my Oct. 1st post. I will be keeping the show up for the month of October.)


Hi. I've been trying to conceive for about a year and my doctor and I are ready to take a more aggressive approach. We have generally discussed both clomid and laparoscopy as next steps in the coming months. I am wondering if you can give some advice as to the order of trying clomid first or having a laparoscopy first.

My sister and aunt both had endometriosis so I expect that could be the culprit. I personally lean towards having the laparoscopy first, but I want to understand which is usually recommended. Thank you. V. from the U.S.


Hello V. from the U.S.,

In order for you to achieve pregnancy, if you have been having trouble, you have to find the reason so that you can get the appropriate treatment. The term "fertility treatment" or "fertility drug" is a misnomer. The treatment has to treat the problem. There is nothing that makes your more "fertile" no matter what the problem.

Clomid is a fertility medication only in that it is used to treat infertility. In actuality, it is an ovulation inducing drug. That is, it gets the ovary to ovulate if the ovary is not already ovulating. Doctors use this medication in women that ovulate also to increase the number of eggs they ovulate so that there is a higher chance for one of the eggs to reach and enter the tube (because that does not happen every time).

Laparoscopy is a surgical procedure that is used as an infertility test. It is part of the infertility evaluation because it is the only method to assess if there are any pelvic abnormalities. This is important because the third step of the body's process to achieve pregnancy (brains sends FSH/LH to ovary > ovary grows follicle and matures an egg > ovary ovulates and egg enters pelvis > egg has to get to tube . . .) is for the ovulated egg to pass through the pelvis and get into the tube. If there is anything within the pelvis, like scar tissue or an inflammatory disease like endometriosis, then then egg may not make it to the tube (endometriosis causes inflammation that can destroy the egg).

I presume that you have had a complete infertility evaluation prior to your doctor's recommendation to use Clomid or do laparoscopy? I dislike it when general Ob/Gyn doctors jump to unnecessary conclusions such as go directly to Clomid or laparoscopy without making sure that is what is needed. Clomid is used for ovulation problems or in conjunction with IUI (if there is a sperm problem). Laparoscopy is done if all the other preliminary tests are normal, or if there is an increased chance of having endometriosis such as severe menstrual cramping or pelvic pain or pain with intercourse. It is usually one of the last tests to be done. Is that where you are?

These are the things that need to be considered and if you see the right fertility specialist, it is more likely that the appropriate things will be done to help you to become pregnant. If you see the wrong person, then you might just be wasting your time.

If you give me more detailed and specific information (such as your age and what tests have been done), then I would be able to give you my recommendations on what needs to be done next.

Good Luck,

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


  1. i dont know if you will receive this czuse its bn a long time since anybody has been on but i leave it to God to see to it you get it.I have been struggling to have a baby for 3years now.I have been put on one round of clomid by one gynae and another round by another and not consecutively cause i moved towns.I was diagnosed with PCOS about a year back.I have recently been referred to another ob/gynae who has me on 500mg metformin,clomid 100mg. I have also been proactive and research about the disease on my own which has recently led to me taking Vitamin D and Omega 3 and 6.My periods are very irregular ,I have been known to go for more than a year without seeing a period.I have been put on the pill and on primolut N to try and regulate the period.

    1. Hello,

      You don't ask a question so there is no specific answer to give. I would recommend that you read the second on PCO in this blog as I have covered it very extensively. Just a couple of thoughts for you to bear in mind:
      1. PCO is a difficult problem and it is very important that you see the right doctor, otherwise, you will be wasting time. Most general Ob/Gyn's doctors do not have the knowledge and skill to treat this problem. You need to see a fertility specialist!
      2. Clomid can be given in dosages from 50-250 mg per day for five days and the determination on how much to give is based on ultrasound monitoring. Most PCO patients either require 250 mg or do not respond to this medication. Alternatives are Femara and injectables. Metformin dosage is 1500 mg per day and should ONLY be used in patients that have been shown to have insulin resistance. It does not work in all PCO patients.

      Just based on the information you have given me, you have not seen and are not seeing the right doctors. Don't let more time pass by. Seek out the correct specialist.

      Good Luck



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