I haven't been here in a while as you can see. I have been working and I am extremely tired. I use my off days for physical therapy and recovery. I thought however that when I have time it would be great to post some patient education material that I have been working on. I would then like to have an open discussion with questions and answers. I close friend of mine has recommend me to start writing a book. I just don't know hat direction to go, so maybe i can get input here. I know I need a website, but I don't know how to go about getting one. here's a copy of the lastest material I have been working on.
CLOMID
Clomid or clomiphene citrate or Serophene is a medication that is commonly used for the treatment of infertility. It is often used to attempt to induce ovulation in women that do not develop and release an egg (ovulate) on their own. Women who do not ovulate without medications are said to have a condition called anovulation. Women that do not ovulate regularly, such as those with polycystic ovaries, PCOS, will often ovulate after taking Clomid. However, this is quite variable and some anovulatory women will not respond to Clomid and ovulate at all. In general, about three fourths of women that are not ovulating on their own will ovulate on Clomid at some dosing level. Unfortunately, only about 50% of those women that do ovulate with Clomid will get pregnant with it.
How does Clomid work?
Clomid works as an ‘anti-estrogen’ that tricks the brain into thinking that estrogen levels in the body are very low. It does this by binding to estrogen receptors in the brain and blocking the ability of estrogen to bind to those receptors. The brain then thinks that estrogen levels are very low so a process begins that increases release of follicle stimulating hormone (FSH). FSH is the hormone involved with stimulating development of mature follicles (egg containing structures) in the ovary.
Many women will have side effects when taking Clomid. Many of the side effects and adverse effects of clomiphene are brought about by its anti-estrogenic properties.
Clomid side effects
Clomid treatment has some potential for adverse effects. Side effects are definite "cons" of clomiphene use. Adverse effects are seen in some, but not all women using the drug.
Mood swings, psychological / emotional side effects
Hot flashes
Abdominal discomfort
Visual disturbances
Ovarian cyst formation
Nausea
Thinning of the uterine endometrial lining
Reduced production of cervical mucous - this can lower fertility (bypassed by insemination)
Increased risks for twins and multiple pregnancy (this is sometimes a desired outcome)
92% singletons, 7% twins, 0.5% triplets. Very rarely higher than triplets
How long does it take to ovulate using Clomid?
For women that do not ovulate on their own, the average day that ovulation occurs about 8-10 days after completing a course of Clomid pills. That means that a woman taking Clomid on days 5-9 will often ovulate on about day 16-19 of the cycle. However, there is significant variation in how long it takes to ovulate using Clomid. Some women will ovulate much later - even as late as two or three weeks after the last clomiphene tablet.
What is the process or protocol for taking Clomid for women that do not ovulate?
Clomid is generally started early in the menstrual cycle and is usually taken for five days either from day 3 through 7 or from day 5 through day 9. Day one is counted as the first day of menstrual bleeding. The period can be from a spontaneous menstrual period or from a period induced with a medication called Provera (medroxyprogesterone acetate).
In order to induce a period, Provera is usually given for 5 to 10 days at a dose of 5mg to 10mg per day. The period usually starts within 2-7 days after the last Provera pill is taken.
Clomid is usually started at a dose of one tablet, or 50mg daily (taken any time of day).
If the patient does not ovulate on the starting dose, Provera is often given to induce a period and then a 100mg dose of Clomid is tried.
If she does not ovulate on the 100 mg dose, then 150mg would often be tried.(This is when I will send you out to a specialist).
Clomid dosing
Clomid works best when the lowest dose that results in ovulation is used. If a woman ovulates on 50mg then increasing to 100mg is probably of no benefit and may result in increased side effects. Many women will ovulate on 50 or 100mg and some will require 150 mg in order to get an ovulatory response. Some pregnancies can be seen on clomiphene doses higher than 150mg. However, increasing the dosage to 200mg or more results in very few pregnancies. Even at the 150mg dose, success rates are lower than at 50 or 100mg.
How many cycles of Clomid should be tried before moving on to other treatment options?
There is no set number of cycles of Clomid that should be done before moving on to other fertility treatment options. Several important variables are involved:
If the woman is not ovulating on Clomid then the dose should be increased and if not ovulating at 150 mg then other therapies should be attempted.
Female age is an issue. Relatively fewer cycles should be done with an older female partner. Clomid probably should not be used at all if the female age is 40 or older because of the significantly reduced fertility potential. Women 38 or older should probably start fertility treatment with a fertility specialist doctor, rather than with their gynecologist.
If the female is under 38 years old and the sperm is good then usually about 3-6 months of clomiphene cycles (with good ovulation) are tried.
The patient's own sense of urgency, financial considerations and other personal factors will often be part of their decision about when to move on to more aggressive therapy.
Timing intercourse after Clomid treatment
There is no perfect “ovulation calculator” to use with Clomid. It is best to have intercourse on the day of ovulation if possible. The trick is to figure out what day that is. Some women will prefer to use ovulation predictor kits with Clomid cycles to time their sex. These kits are available at drugstores and supermarkets and are urine tests that the woman does at home. These ovulation predictor kits, also referred to as OPKs, are designed to detect the presence of the woman's LH surge. The LH surge in the bloodstream begins approximately 36 hours prior to ovulation. The ovulation prediction kit test is usually done once daily and when it turns positive then sex either the same day or the next morning are the best for fertility. Couples often ask “when should we have intercourse, and how often” in order to get pregnant.
Sex once on the day of ovulation should be good enough, however if the ovulation day is not certain then intercourse every other day (or every day) around the time of ovulation is another good option.
If sperm is normal it should live in the reproductive tract of the female for 3 to 5 days. However, the egg has a life span of only 12 to 24 hours. Therefore, intercourse a day or two before ovulation should be fine, but if the first recent sex is more than 24 hours after ovulation then the egg has already degenerated.Ovulation generally occurs about 14 days prior to the onset of the next menstrual period. Therefore, when the menstrual cycle length is known for the woman’s typical Clomid cycle, then intercourse can be timed to fall about 12 to 16 days prior to the ‘expected’ date for the next period. For example, if the woman has a 32 day cycle length on Clomid, then she is probably ovulating on about day 18. A good plan for having intercourse would be to have sex on about days 16, 18 and 20.
so let me kow if you have any questions
