Clomid failure - what next?

  Hi.  My first cycle of clomid failed (50 mg d5-9). I usually o pretty regularly without clomid (confirmed with opk and temps) but was on clomid for short luteal phase.  On clomid I o'd d19 (late for me). Sonogram d13 showed only one mature folicle of 3.1cm and lining of .78 cm.  Dr puzzled why I o'd so late. OPK showed weak + result (I usually get a strong result).
  Temps rose slowly then took off as follows:
       only 3/10 day after o
       1/10 each day for 2 days
       down 1/10 day 4
       up 4/10 day 5
       steady days 6-9  (progesterone 7dpo was 17.1 - no supplements given)
       up 2/10 day 10  (thought I was getting a second rise upon implantation)
       up 1/10 day 11  (started spotting)
       down 5/10 day 12 (got period)
  This charting is very unusual for me.  I usually get almost a degree rise after o but high temps only last for 11 days - even without clomid.  I think if I o'd sooner my luteal phase would have been longer.  She wants to give me hcg shot next month if I don't o by d14 and sono's show good.
  My question is  - should I up the clomid to 100mg since 50 mg didn't help my luteal phase? Will taking a larger dose help my luteal phase more or will o'ing via hcg shot help?  I want to be prepared when I talk to my doc on Monday.
  Also, I only have one good tube - confirmed via HSG.
  Thanks,
  Maryann

[hfhs.md.db]

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The diagnosis and management of luteal phase "insufficiency" is somewhat controversial. Those who advocate clomiphene citrate use propose that the increased FSH due to the clomiphene results in better development of the follicle and improved production of progesterone in the luteal phase. Others would hold that supplementing with progesterone during the luteal phase directly adds to the support of the endometrium with the hormone felt to be deficient.
It may be difficult to fully evaluate your individual response after only one ovulatory cycle on 50 mg clomiphene. However, as you have noted, the luteal phase length was not different on the medication as compared to your spontaneous cycles. Either increasing the dose of clomiphene or monitoring several cycles on the present 50mg dose would be acceptable alternatives. The hCG injection proposed would also likely be of benefit by promoting improved luteinization of the follicle (and hopefully better progesterone production).

[Jennifer389]

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