In times like these I feel powerless if I don't at least half understand what my body is doing or should be doing, so I search - or research rather. Here are some of the questions I have surrounding this issue.
Should you be monitored on Clomid, or not?
While I am getting this ultrasound, I often hear that a lot of women going to their OBGYN don't get monitored. I wondered if this was a valid practice, or just bad practice on some physicians part. I've read a lot that seems to very much stress monitoring, but I came across a blog written by a full-time Southern California Reproductive Endocrinologist that seems to show both sides. It basically says not doing so is cheaper, but the more ways you have to monitor your progress, the better informed you and your doctor will be in making a "next step" decision.
They go on to list several clear advantages of monitoring while on Clomid
1) Ability to avoid cysts 2) Assurance of follicular growth 3) Optimal timing of intercourse and/or insemination 4) Assurance of ovulation
For me, #1 (the ability to avoid cysts) is enough of a reason to do it, given the fact that I am working with only one ovary. I found it interesting that while most doctors check progestone as a way to tell if you've ovulated successfuly or not due to the Clomid, it doesn't sound like that is always a sure-fire way to tell. That some people show all the signs of ovulation (temp change, positive OPKs, pain, rise in progesterone levls), but the follicles don't actually burst, and the egg simply remains trapped inside until it's too late to be fertilized.
The blog points out that an ultrasound will pick this up, if this happens to be the case. The other points liste in detail are also really very helpful, but those are the two that seem to best apply to my situation at this time.
When do you ovulate while on clomid?
I was curious as to when I can expect to ovulate while on Clomid. I found a handy Clomid Ovulation Calculator by babymed.com that told me this:
If you take Clomid for 5 days from 9/15/2008 to 9/19/2008, you would expect to ovulate between 9/24/2008 and 9/29/2008. You can start LH testing for ovulation on 9/22/2008. Optimally you would start making love every 1-2 days starting on 9/22/2008.
I checked out what FertilityFriend had to say about it and they said "In most cases, you can expect ovulation within 5-9 days of your last dose of Clomid, but the doctor who prescribed the medication for you should be able to give you a good indication of when to expect ovulation based on your own situation. He or she can also help you plan when to have intercourse based on when you are expecting ovulation.
You may notice that your temperatures are higher on the days you take the pills, but they should level out enough for ovulation to be detected on your chart when it occurs. Some women also notice that cervical fluid is not as abundant when taking Clomid."
What if I don't ovulate on Clomid the first time - what's next?
I came across one site with replies from Dr. Amos, medical director of the WebMD Fertility Center, who says "... if 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."
TheFertilityExperts.com fertility institute had to say this... "If you fail to have a period, but your pregnancy test is negative, you are not pregnant. We will induce a period with medroxyprogesterone acetate. During your next cycle, we will increase the clomid to 100 mg. to be taken days 5-9 of your cycle. We will continue to increase the dose if you do not ovulate when taking the lower dosage."