clomid

[jluhart]

I just got back from the gynecologist for my annual check up.  Because my periods are getting closer together, I have to get my progesterone level checked on Thursday, Day 21.  If it indicates that I didn't ovulate, she wants to put me on Clomid.  That's fine with me since I really want a baby, and my cycles have been all over the place, ranging from 35 days to 18 days.  My question is, who does it work?  I did some research on it and it says I will take it on Days 5-9.  What then?

[Christie2004]

"Ovulation is essential for your regular menstrual cycle and for pregnancy, is preceded by a chain of events involving several hormones and beginning during your prior menstrual cycle. Clomid works by influencing the interaction of these four hormones:

GnRH (gonotropin releasing hormone)
FSH (follicle stimulating hormone)
LH (luteinizing hormone)
Estradiol


Toward the end of a normal cycle, your body's levels of estrogen and progesterone slowly decrease. During the first days of the next menstrual cycle, the lower levels of those two hormones eventually trigger production of GnRH in the hypothalamus. GnRH then stimulates the pituitary gland to produce FSH and LH, also called gonatropins, which directly affect ovulation: FSH is responsible for the growth of both follicles and eggs and for increasing the size and number of the follicles. The level of LH suddenly increases one to two days before ovulation, which causes the eggs to be released. Estradiol is a hormone produced by the ovaries and the corpus luteum, or tissue left behind in the ovary after ovulation. Among other things, estradiol aids in the development of the uterine lining and the eggs.


If GnRH, LH, or FSH are not produced in the right amount and at the right time, your ovaries won't release eggs. In some medical conditions such as polycystic ovary syndrome, the body produces too much estrogen, which may interfere with the production of GnRH, LH, and FSH and cause anovulation.


Although we still don't quite know a lot about how Clomid works, we do know that it tricks the body into believing that your estrogen level is low. The body then produces more GnRH, causing the pituitary to pump out more of FSH and LH eventually triggering the release of an egg from the ovary.


Clomiphene citrate was approved by the FDA in the U.S. in 1967 to induce ovulation; it's sold under the brand names Clomid, Serophene, and Milophene. It's a very powerful drug, and it induces ovulation in more than 50% of women who take it.


Clomid is usually taken in pill form once a day for five days. The typical starting dosage of is 50 mg/day for the first 5 days, and it can be increased monthly by 50 mg a day. You would generally take the first pill five days after the first day of menstrual bleeding (cycle day two to five); ovulation usually occurs five to nine days after the last dose of Clomid. If you don't menstruate, and pregnancy is excluded, bleeding can be started with medications such as progesterone".

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Be cautious about relying on a single progesterone determination to tell if you are ovulating or not.  Progesterone levels can vary wildly.  Even multiple samples taken on the same day can differ significantly.  To be accurate and sure about what progesterone levels mean, they should be followed serially over several months.  A single progesterone level is not terribly meaningful.