Trying to Conceive: Clomid Questions

WebMD Live Events Transcript

Clomid is the first line of attack against infertility for many women who have problems with ovulation. Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us for a look at what Clomid can, and can't, do to help you conceive. He answered our questions on WebMD Live on Sept. 27, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
I just got off the birth control pill 5.5 months ago. I always had irregular periods before I ever went on the pill. Now I am still irregular. I have had three periods since I got off the pill. We have been having relations regularly. Should I be concerned yet and consider Clomid, or just wait it out? I am 29 years old.

DR. AMOS:
Regularity of the cycle depends on when and if you ovulate. So the first step is establishing the answer to that question. Doing a fertility chart will quickly answer this issue about ovulation. Once you have an ovulation chart you should be able to decide on the next steps. If you ovulate then a sperm test is the next test.

MEMBER QUESTION:
What is the difference between Clomid and Provera, and is it true that both of these drugs have strong side effects, including dramatic mood swings and anger?

DR. AMOS:
These are both totally, totally different drugs. Clomid induces ovulation, while Provera makes you bleed but has no influence on ovulation. Their side effects may be similar.

MEMBER QUESTION:
Is Clomid appropriate to restore ovulation after discontinuing birth control pills or shots?

DR. AMOS:
If you haven' ovulated three to four months after stopping BCP then the first step is to find out why. Clomid is not necessarily the first answer because you first must find out why you don't ovulate. If, for example, you don't ovulate because the eggs are not good enough or you are menopausal then Clomid won't help get you pregnant.

MEMBER QUESTION:
I am ovulating according to OPKs but my cycles vary from 26-35 days. My ob-gyn says that Clomid might restore some regularity -- should I try it?

DR. AMOS:
An OPK is not a good enough indicator of ovulation, especially with such irregular cycles. So the first step is to do a temperature chart and find out exactly when you ovulate. This information should tell you why your cycles are irregular and help figure out the right treatment.

"If you haven't ovulated three to four months after stopping BCP then the first step is to find out why. Clomid is not necessarily the first answer because you first must find out why you don't ovulate."

MEMBER QUESTION:
I have been told to take progesterone suppositories starting the day after I ovulate. They first gave me Clomid, but I still spot a couple of days before my period and I also have a shorter LP (10-12) days. Is progesterone the way to deal with this? We've both been tested and there seems to be no other problem. Do I need to lie down for half an hour after taking these? Also, do they have to be taken exactly 12 hours apart?

DR. AMOS:
The question about progesterone supplementation is best answered by your doctor. He knows your medical history best and can decide on the best treatment. A short LP is usually not treated by progesterone, but Clomid, which improves the quality of ovulation and the corpus luteum.

MEMBER:
She wrote me a prescription for the progesterone. I just want to know if I need to lie down after taking it vaginally.

DR. AMOS:
Most women lie down afterwards to ensure that they dissolve without falling out.

MEMBER QUESTION:
My RE said that I could take Clomid if I want to. I usually ovulate on my own, but I don't have a lot of mucus. If I take Clomid, will it help my mucus as well? If not what can I do to increase my mucus? Maybe take alfalfa tablets or primrose oil?

DR. AMOS:
Clomid is an antiestrogen and thus will in effect decrease the amount of cervical fluid, and if that happens it likely decreases chances getting pregnant.

There are no studies showing alfalfa or primrose help when you take Clomid. In fact, I suggest you never, ever take additional herbs and other medication without letting your doctor know.

MEMBER QUESTION:
I went off BCP December 2003. My periods are very irregular and only consist of spotting about every other week. My doctor tells me that I will have to go on Clomid to get pregnant (he did blood work and everything came back within normal limits). Since I don't have a real period will I have to go on something to have a "real" period before starting Clomid?

DR. AMOS:
Before starting a new dose of Clomid most doctors will give medication to make you bleed, yes.

MEMBER QUESTION:
I am in round one of 100 milligrams of Clomid. Negative OPK days 11-16. Today is day 29 and no period, with negative pregnancy test. What is a "normal" Clomid cycle length and when should I worry that I didn't ovulate?

DR. AMOS:
Ovulation normally comes five to nine days after the last pill of Clomid. If you did not ovulate then AF isn't likely to come, and if your pregnancy test is negative then most doctors will induce bleeding then start a higher dose of Clomid in the next cycle.

MEMBER QUESTION:
Would using a product such as Preseed help while taking Clomid?

DR. AMOS:
No it won't. Preseed is likely to not affect sperms, but no studies have shown it improves fertility.

MEMBER QUESTION:
I have been trying for more than a year to get pregnant, and I have been on Clomid for six months, but it doesn't seem to help. Do you have any suggestions?

DR. AMOS:
I am always concerned about certain statements made, like Clomid "didn't help." As Clomid is given to induce ovulation can I assume that you did not ovulate on 200-250 milligrams of Clomid?

MEMBER:
It hasn't seemed to help for six months. She has only given me 50 milligrams, nothing higher.

DR. AMOS:
And did you ovulate?

MEMBER:
The first time I went and had an ultrasound they saw five on each ovary, but nothing since then.

DR. AMOS:
So you did not ovulate, I assume.

MEMBER:
As far as I know, no.

DR. AMOS:
I suggest you see another doctor immediately. Clomid is given to induce ovulation. You start at 50 milligrams and monitor for ovulation with a temperature chart or progesterone. If you do not ovulate the first month then Clomid is increased by 50 milligrams a day until you ovulate. It's not good medical practice to keep you on the same Clomid dose if you don't ovulate, and to not adequately monitor to see if it induced ovulation. Keeping you for six months on the same dose is wrong.

"A sperm count should be done on all men before their wives take Clomid to ensure that the Clomid isn't taken when in fact the man has the problem."

MEMBER QUESTION:
I am starting round two of 50 milligrams of Clomid. I have been told to have intercourse on days nine through 16 of the cycle. From one of your previous responses I should wait for days 15-18. Is that right?

DR. AMOS:
No. Ovulation happens five to nine days after the last pill of Clomid, and you should start making love two to three days before you are first expected to ovulate. So if you take Clomid on CD 5-9 (do you?), then you should start making love on CD 12 and continue daily until CD 18-19.

MEMBER QUESTION:
Are there any potential risks of taking Clomid (such as side effects, etc.)? I am not taking it now, but I do not think I am ovulating, and I researching my options.

DR. AMOS:
There are many potential risks. First of all, it's NOT a fertility medication that improves your chances getting pregnant. It's a drug for inducing ovulation. But it can also decrease fertility by decreasing cervical mucus and preventing sperm from entering the cervix. In addition, a sperm count should be done on all men before their wives take Clomid to ensure that the Clomid isn't taken when in fact the man has the problem.

MEMBER QUESTION:
Are you saying if the husband has a low count Clomid is useless?

DR. AMOS:
I'm saying if his sperm count is too low that even Clomid will not improve your chances of getting pregnant.

MODERATOR:
In other words, you can have the best, most well-oiled gun in the West, but without bullets you ain't going to shoot nothin'.

DR. AMOS:
You may shoot but not hit ...

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