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Last Updated:
Jan 3rd, 2010 - 00:09:53
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Question
I have been trying to conceive for a little over a year. My cycle is about 23-27 days long. I have premenstrual spotting before every cycle. Usually 2-3 days long (twice in the last 6 months the spotting has lasted even longer). I am ovulating as evidenced by a spike in my BBT on day 10 or 11 and ovulation predictor kits. I have had 2 ultrasounds confirming that I have no fibroids or cysts, a healthy uterine lining, and good follicular development. They told me my progesterone level was normal (only tested once 7 days after ovulation). My husband's semen analysis was normal. The doctor wants to start me on Clomid 50mg starting cycle day 3 through 7. Should I be asking for another progesterone level, an estrogen level, or more fertility tests? Does clomid sound like the right option for me?
Answer
I think there should be more investigation into why you have not conceived. There are a few concerns that I have. First, premenstrual spotting especially 3 or more days is associated with low overall progesterone levels or an abnormal curve to the progesterone levels in the luteal phase. I have found that a spot check of progesterone at a regular lab does not give you adequate information. This is because the range of normal is so big. What you want to know is what your progesterone (and I would add estrogen and some other tests) levels are over the entire luteal phase and compare that to a standardized normal from Pope Paul VI Institute. Progesterone is key in endometrial development and maintaince of a pregancy.
The next question is what your cervical mucus is like. In the Creighton model, we score the mucus cycle which helps to identify another part of fertility, the cervical mucus. Some people may have an estrogen receptor defect in the cervix which will decrease peak type mucus and make sperm transport less likely. Perhaps a mucus enhancer will be beneficial to increase your fertility. These include some antibiotics, Vitamin B6, Guafenesin, and Prednisone.
Additionally, one would wonder if you wouldn't benefit from Human Chorionic Gonadotropin (HCG) which is given in the luteal phase. It will help the corpus luteum to stimulate more estrogen and progesterone.
You may end up using Clomid which can be a useful tool. I would recommend that you start at a lower dosage of 25mg on day3-5. Then, one can move to 50mg on day 3-5. The maximum dose would be 50mg on day3-7.
In summary, the cause of your infertility has not been established and there is more information to be gathered. This would be through laboratory testing, laparoscopy to look for structural damage and/or microscopic endometriosis, salpingogram, etc.
I sincerely hope that this gives you some help and insight.
Dr. Marsh is a family practioner in Yuba City, CA where she lives with her husband and 5 boys.
She is a Creighton model certified Medical Consultant and a certified Fertility Care Practioner.
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