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Dr. Pfeiffer
Dr. Pfeiffer, Doctor
Category: OB GYN
Satisfied Customers: 5987
Experience:  Ob/Gyn Doctor
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I have mild PCOS & was placed on clomid to try and increase

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I have mild PCOS & was placed on clomid to try and increase ovulation (which occurred every 3 months without medication). I ovulated on day 22 first cycle, then day 24 second cycle. On my second cycle I thought I wasn't going to ovulate & asked my dr about what I should do - he said increase to 100mg next cycle. But I did then end up ovulating.

My question is - should I still increase to 100mg to try and ovulate closer to day 14, as I have read that the egg is healthier if you ovulate around day 14? Or, does this not matter and I should stick to the 50mg as it has started to make me ovulate? Today is the 2nd day of my cycle and I need to start taking the clomid today. Please help!

Dr. Pfeiffer :

hello

Dr. Pfeiffer :

there's a couple of things

Dr. Pfeiffer :

I'm assuming you are doing a predictor kit to determine when you are ovulating?

Customer:

yes, i have a clear blue fertility monitor

Dr. Pfeiffer :

ok

Dr. Pfeiffer :

those can be a bit tricky

Dr. Pfeiffer :

because they measure an LH surge, which is required to ovulate..but doesn't necessarily mean you did ovulate

Customer:

what should I use?

Dr. Pfeiffer :

ovulation is normally confirmed with a progesterone level

Dr. Pfeiffer :

a blood test that is best on cycle day 21

Dr. Pfeiffer :

now...that said, that's my personal choice and how I determine if the dose needs to go up or not

Customer:

i can go to my doctor to get that - i can do that for this cycle then

Dr. Pfeiffer :

another thing I do with my PCOS patients is add a medication called metformin

Dr. Pfeiffer :

it helps make the clomid more effective

Dr. Pfeiffer :

you can go about it either way..

Customer:

yes, i have read about it - was planning to ask my consultant when i see him next

Dr. Pfeiffer :

increasing the dose of clomid to 100 on days 3-7 or 5-9

Dr. Pfeiffer :

or add the metformin and stay at the 50 mg dose

Dr. Pfeiffer :

bumping your dose to 100 for this cycle is reasonable as he suggested...

Dr. Pfeiffer :

but, going forward those are some other tips for you

Customer:

ok - thank you. He initially told me day 2-6 for 50mg but if I do 100mg you thnk I should start on day 3?

Dr. Pfeiffer :

I think day 3 is fine

Dr. Pfeiffer :

I usually have my patient do days 5-9

Dr. Pfeiffer :

but they are both described in the literature...

Customer:

ok. Is the aim to ovulate as near to day 14 as possible to get the egg healthiest?

Dr. Pfeiffer :

I think it's more of a doctor's personal preference.

Dr. Pfeiffer :

well....sort of

Dr. Pfeiffer :

you have to realize that a woman has a period 14 days after ovulating

Dr. Pfeiffer :

and the 'perfect' cycle is 28 days

Dr. Pfeiffer :

that makes timing much easier to conceive......so you can identify which days to have sex.

Dr. Pfeiffer :

as long as you ovulate the egg is fine...

Dr. Pfeiffer :

the eggs have been in you since you were a fetus in your mom's belly

Customer:

ok, that's interesting. And reassuring! In your opinion then, as I seem to be ovulating now (22 & 24) would you advise me to start on 50mg or to increase to 100mg, if I was your patient?

Dr. Pfeiffer :

as long as you were ovulating I wouldn't increase the dose

Dr. Pfeiffer :

because the medicine is doing it's job...and too much of the clomid can over stimulate the ovaries

Customer:

ok - I will stay on 50 but make sure I get a proper blood test to check if it is really happening

Dr. Pfeiffer :

sounds good...

Dr. Pfeiffer :

and you might talk about the metformin too

Customer:

yes, I definitely will. one last question - can you have a period after a LH surge instead of proper ovulation?

Dr. Pfeiffer :

not usually

Dr. Pfeiffer :

because when the egg is release the progesterone level increases..

Dr. Pfeiffer :

and if conception doesn't occur, a period doesn't happen....

Customer:

Ok - so i have my period now, so that would suggest I am ovulating rather than just a LH surge

Dr. Pfeiffer :

usually it ends up with a heavy and clotty period every couple to every few months

Dr. Pfeiffer :

yes...you are correct

Customer:

and it is exactly 2 weeks after the monitor showed ovulation

Customer:

so it looks hopeful!

Dr. Pfeiffer :

yep...so get an idea of your cycles and start having sex a couple days before you expect to ovulate for 5 straight days

Customer:

is the main problem with PCOS that it reduced chances of getting pregnant due to reduced ovulation? Or does the condition make reduce chances of conception in other ways?

Dr. Pfeiffer :

no..it's reduced ovulation

Customer:

ok - thank you very much for your help

Dr. Pfeiffer :

sure..you're welcome

Dr. Pfeiffer :

good luck

Customer:

Thanks!

Dr. Pfeiffer :

please take the time to rate my service..

Dr. Pfeiffer :

thanks

Dr. Pfeiffer :

Dr. Pfeiffer

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