Friday, May 20, 2011

Canadian Needs To Know: Frequent Blood Draws Are NOT Necessary For Clomid Induction Cycle

Hello Dr. Ramirez,

I'm currently undergoing cycle monitoring and my RE has not yet been able to pinpoint a reason for our 18 months of infertility (hubby checked out okay and my initial tests - ultrasounds, blood work, saline hysterosonogram - show no problems other than possibly my age being a factor - 35).

I am on my second month now of ovulation induction cycle monitoring. At the clinic I go to (and it appears any of the ones that I have looked into here), they want to do cycle monitoring every single month regardless of whether it is a medicated or natural cycle. He said after this month, we will likely try something like Clomid to produce more eggs and continue with the cycle monitoring.

I could handle the ultrasounds, but the blood work has become such an issue for me I may not be able to continue with treatment. I have to go on CD3 and then daily starting again on CD10 until I ovulate which usually isn't until CD17-19 and then for a progesterone test 7 days post ovulation.

The problem is I have always had small veins that are difficult to get blood from. I've had several of the technicians try and they often try for more than 10 minutes with multiple pokes. I develop massive bruises so the subsequent tests are even worse. They told me I have almost no surface veins and even when they hit one, sometimes no blood comes out of it. They've tried my hand too which is very painful and the last time I was there, they talked to my RE and then they used my foot which also hurt a lot. One of the technicians today said they may have to move onto my groin or neck (but she laughed so I hope she was joking)! I've tried drinking lots of water as well as soaking my hands and arms in hot water without any success.

I talked to my RE and asked if the daily blood work is absolutely necessary each and every cycle and every visit and he said it is required because they need to closely monitor levels. I asked if I could go for the ultrasounds and monitor my LH surge using urine OPK tests and he said they require the blood work because they need to monitor things other than just LH and blood work is a requirement each day an ultrasound is done.

In your opinion is there any other option than all this blood work? I'm almost having panic attacks each day on the way to the clinic (and I've never had panic attacks before) because it gets worse everyday and I don't know how many more months I can deal with this. I'm concerned about future routine blood work as these daily tests are no doubt making my veins worse. At this point I don't want to tell many people about our fertility issues, but my arms make me look like a drug addict as they are covered in bruises.

I'm D. from Ontario, Canada.Thank you for your input.


Hello D. from Canada,

I have never heard of such a ridiculous thing! Blood work is not required for simple ovulation induction whether by natural ovulation, Clomid ovulation or even low dose Follistim ovulation. The blood work that is done with IVF is done because the ovaries are being stimulated so strong that we need to make sure that overstimulation or hyperstimulation does not occur. It is NOT required for monitoring. The key to ovulation induction is NOT the blood test results but the number and size of the follicles as seen by ultrasound. Ovulation is timed by the size of the follicle NOT the blood test, and a midluteal progesterone is NOT needed if progeterone supplementation is given and/or ovulation is determined by ultrasound (which is a better method than the progesterone anyways).

I think your doctor, and this clinic, is treating you inappropriately and in essence, torturing you. I would strongly recommend that you change clinics immediately. I find this clinic abhorrent! If you review my blog where I discuss how I do ovulation induction, you will see that there is no mention of any blood tests except for a pregnancy test at the end of the cycle!

In terms of why you are not getting pregnant, if you have not had a laparoscopy then I would recommend that you have one. I often find that in patients that don't seem to have an obvious reason for infertility, that is, the basic workup has been normal, that they often have endometriosis in the pelvis. Endometriosis does not have to be symptomatic to cause infertility.

If you can't find a fertility clinic in Canada that will do the ovulation induction without blood tests, then you should come to my clinic in California. At least I can save you from being tortured. Please seek out the appropriate level and standard of care!

Good Luck,

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

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