Clomid, STAT!

Infertility.

I find that patients often approach it in 1 of 2 ways.

A. Denial: “We haven’t used protection since we got married 10 years ago, but we haven’t really been ‘trying’ either. We may start ‘trying’ sometime next year.”

B. Obsession: “We’ve been off protection for 3 months. Here’s my excel spread sheet of my basal body temperatures. The slope of the curve on month two is not quite what it should be. Also here’s a cell phone picture of my cervical mucous. Is it the right consistency? I’ve read on line about natural progesterone. Do I have a luteal phase defect? I want my Clomid…. NOW!”

This is an exaggeration, of course , but I thought I would touch on the medical definition of infertility since we have have several posts about it recently. Infertility is defined as unprotected intercourse for one year without conception. If you have not conceived after one year of ‘trying’ then you should see a gynecologist. Now this applies to healthy women, with regular monthly cycles, under the age 37. If you are greater than 37 then it is recommended you seek treatment after 6 months if you have not conceived. Also if your cycles are irregular and infrequent its most likely that you aren’t ovulating so you would also need to seek treatment sooner. By irregular cycles, I mean cycles every 2 to 6 months, that really have no pattern to them.

As a doctor, when a patient comes to me for infertility, it’s usually a relief to find out that they aren’t ovulating. Ovulation is something that can be ‘fixed.’ Unexplained infertility, when everything is normal, is the most challenging because then there is nothing to ‘fix.’

Medically speaking, clomid is a miracle drug. It takes women whose ovaries are stalled out, whips them into shape and helps them ovulate. 80% of women who don’t ovulate, will do so with clomid. Lack of ovulation is most commonly due to a miss communication between the brain and the ovaries. What clomid does is trick the brain into thinking that there isn’t any estrogen in your system, the brain responds by causing an estrogen surge which then results in ovulation in most women. Now, clomid won’t work if your brain has stopped ovulating due to stress, exercise or weightloss. Sometimes in addition to clomid the fertility specialist will inject the sperm into the uterus at the time of ovulation, in order to get the egg(s) and sperm closer together and bypass any issues that may be going on with cervical mucous.

I wanted to clarify from Jessica's previous post that clomid doesn’t increase the risk of miscarriage. In Jessica’s situation, because of her multiple losses, it is going to be more helpful to monitor her ovaries with ultrasound and get her timing perfect with the HCG shot. She has already passed the simpler treatments.

Clomid is one of the few drugs that people ask for quite regularly. It is inexpensive* and taken as an easy to use pill, so I think sometimes people aren’t aware that it does have risks. The main risk is twins, up to 8% risk. That may not seem like a lot, but the normal rate of twins is less than 1%. Other risks include hot flashes, moodiness and blood clots. Twin pregnancies have an increased rate of preterm labor and several other complication, so clomid, like all medications should be taken only when indicated.

To all those out there ‘trying’ and even those in the ‘practicing’ stage, my hope is that you never need to read this post, and that all your conception will go smoothly and quickly.

*Clomid costs about $20 a month. If you can't afford clomid…. You can’t afford a baby.