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Clomid. Progesterone. Bloodwork. Oh My!

August 5, 2009

My doctor called today with the results of the panel of tests my maternal fetal specialist ordered to investigate my lupus anticoagulant disorder. The results were funky. The lupus anticoagulant test came back normal which confused my doctor and me. Her theory is that either I’m borderline and the test got me on a good day, or the aspirin is helping fix that issue. Four tests came back bad and I wish I knew the names but they were so convoluted I got confused, however those four clotting disorders that were present increase the risk of miscarriage. My next step is to see a hematologist and go over the results with them and see if they recommend anything above and beyond lovenox or heparin and if this will affect me beyond just getting and staying pregnant. She can’t refer me to a hematologist since I’m no longer pregnant so now I get to go through some insurance fun to figure out my recommendation. Fun times!

As much as I know I should avoid Dr. Google, he’s just always there for me. I’ve been doing some research on the link between PCOS and low progesterone and the results seem to be mixed. Some say that PCOS causes low progesterone which can cause miscarriages. Some say this theory is rubbish. My progesterone levels at 5 weeks pregnant were 9.5 which my doctor said was low. However, the question is: Did the low progesterone cause the miscarriage, or was the pregnancy doomed hence the progesterone low? The reason I’m researching is because I’m considering taking Clomid next cycle. Until now I’ve gotten pregnant twice on Metformin alone but my ovulations happened on crazy cycle days like CD29 and CD40. To be effective progesterone supplements must be taken immediately upon ovulation. Clomid would help us predict ovulation and thus when to take progesterone supplements. So my goal with Clomid is to be able to time my progesterone supplements.

In my OB’s opinion she didn’t think progesterone supplements did anything but it never hurts to take them so she fully supports a Clomid/progesterone cycle if it will ease my worries. She encouraged me to talk to the RE in September to get a more informed opinion.

I’m already taking more pills than an 84 year old grandmother so the thought of adding more pills if I don’t have to is causing me confusion. There are side effects to clomid I’ve read such as decreased EWCM and occasional implantation issues, so if I dont have to take it then I don’t want to [though my ovulation is so unpredictable there is a huge thought of comfort that with Clomid at least I’d most likely ovulate]. I’m just so confused about whether or not progesterone does in fact save pregnancies, or if my issue is just the clotting issue which lovenox could resolve.

Have you used Clomid? Or had low progesterone but successful pregnancies via Lovenox? Any thoughts or advice on any of this that you might have would be much appreciated.

**And by the way- My boobs are aching. I feel ready to sleep at 9pm and have to drag myself out at 8am. I have waves of nausea! Is this normal post-miscarriage? I thought all this stuff should be going away, not to mention I didn’t have them when I was actually pregnant!

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19 comments

  1. Hi Kate! I wish I had wisdom to share (re: low progesterone and PCOS), but I’m fresh out. =)

    I’m glad that you had all of these tests run, and are beginning to get closer to solving the puzzle.

    Have you considering waiting on TTC again until you see the RE? These doctors deal with complex IF issues day in and day out….and they may be able to *really* shed some light on what’s going on and give you the best chance at achieving a healthy pregnancy.

    I’m sorry that you’ve initially been denied access to a hematologist. =-/ That’s uber frustrating!


  2. i was on clomid for five months, it definitely helped me in the egg production department. i never had any ovulation problems, but before i had my laparoscopy they didn’t know what was wrong with me so they put me on clomid, which is usually the first thing they do. i ovulated normally every month, but when i was on clomid instead of one egg i had like four or five. i still didn’t get pregnant, but that is most likely due to the fact that i had/have stage III endometriosis. the clomid also had a negative effect on my uterine lining, it was very thin which is a common side effect for clomid users. my second iui was actually canceled because my lining was too thin, and that’s when they decided to do the surgery and everything. after my surgery and several months of suppression, when we were finally able to start trying again, they switched me to gonal f, an injectable fsh drug that doesn’t have the same side effects as clomid (i had the thin uterine lining and also hot flashes and night sweats while on clomid). it is more expensive, i think it would have been around $280/cycle but our insurance covered it for some strange reason. i produced less eggs with the gonal f than the clomid, two both times as oppossed to the four to five with clomid, but it does only take one, and i got pregnant on my second gonal f/iui cycle. so, ask your doctor about the thin lining thing, you can produce all the eggs in the world, but if the clomid fucks with your lining it won’t matter. it doesn’t effect everyone that way though, there are plenty of people who have success with clomid, i just wasn’t one of them.


  3. Meg, thanks for your support πŸ™‚ We are definitely going to wait on TTC until we see the RE. This should not be an issue because i wont be getting a period until September anyways and my RE appt is 9/1/09. At this point I’m also going to wait until I can see the hematologist as well. Even if it takes a little longer if I can have a successful ending to pregnancy #3 it will be worth it.

    Kate, thanks so much for explaining. I didn’t realize there were even any other options besides Clomid to do the same work. So, dumb question alert, but if Clomid releases that many eggs is there also the chance that all of them could implant and you could end up with quintuplets?


  4. well, everyone reacts differently to drugs, just because i ended up making that many eggs doesn’t mean you will. if however, you do, it is possible that all of them could be fertilized and implant, then you might be looking at selective reduction. i’m not sure what drugs that kate from jon and kate plus eight was on, some sort of injectable fsh drug i think, but her multiples were from an iui, not from ivf.


  5. aaaahhhh! i just wrote a long comment and then accidentally went “back” which then erased it. bummer. i was saying that i don’t know anything about clomid…but i understand the urge to consult with dr. google.

    i’ll be interested to read what you decide and what ends up working for you…as katery said, everyone reacts differently to drugs…we all need to pay attention to our bodies and especially our intuition about what is best for us…that isn’t alway easy, that’s for sure! πŸ™‚


  6. I took prog with my pregnancies (but I used injectibles not Clomid to ovulte). I used the pill form twice a day until I was 16w. (Then I switched to P17 shots to prevent preterm labor.) There are no harmful side effects to the prog supplementation, so I say go for it! It cant hurt!


  7. I used Clomid to get pregnant, and it did thin my lining and dry up my CM like the Sahara. We counteracted the dryness by using Pre-Seed, and the lining didn’t thin enough that we needed to correct. However, the thining of the lining is the reason my RE switched me to Femara.

    There are a few options in the ovarian stimulation category. Here’s a list of the ones I’m aware of with the info provided by my RE:

    – Clomid: Pros- Cheap ($25-$30 per cycle), Typically effective for women with PCOS, Did I mention cheap?; Cons-Thins lining, dries up CM, increases risk of cysts

    – Femara: Pros- Cheap (my insurance paid for it, because it is a breast cancer drug being used off label for infertility), Often more effective than Clomid for women with PCOS, Does not effect lining or CM, some data shows lower chance of chromosomal early m/c; Cons- Some data shows increased risk of chromosomal early m/c

    – Injectibles (like Gonal-F): Pros- Very effective; Cons- Expensive

    Obviously, I’m not a doctor, this is just the info I was given as I understand it.

    That said, we have a lot of the same issues with PCOS, the anti-coagulant disorders and the less than perfect progesterone. Also, the details of our miscarriages are pretty similar (late 1st trimester, baby was developing, heart was beating etc…). So, I’m going to share the protocol that my RE and rheumatologist are suggesting for our next cycle (which is our current cycle). Maybe it will be of value to you, maybe not.

    To start with everyday, regardless of cycling, I take (the drugs started after the m/c are labeled “(new)”):
    Metformin: 2000mg
    Actos (new): 30mg
    Prenatal Vitamin
    Prednisone: 5mg
    Asprin: 81mg
    Cinnamon (new): 1000mg
    Iron
    Vitamin D3
    Plaquenil (new): ?? not sure of the dose, this is new as of yesterday

    Every week I also take an Enbrel shot. Also new as of yesterday

    The get pregnant plan is:
    Femara (new): 2 pills (15mg, I believe) Days 3-7
    Ovidrel Shot: Day 14’ish (determined by u/s)
    Ovidrel Booster (New): Day 28’ish (if positive hpt)

    The stay pregnant plan is (after postivie hpt, in addition to med’s above):
    Heparin shot: 25 units 2x daily for at least the first trimester
    Progesterone vaginal suppository (new): 1 a day, for at least the first trimester

    Sorry for the book. Hope the info is helpful. I also hope that your RE can get you on the right track.


  8. Hi Kate!

    I have a bit of experience with Clomid- I did it for three months with trigger shots but it made my CM go away entirely, so I failed a post coital test. Then we did IUI’s but moved to IVF quickly. I think that Clomid can be an amazing drug for so many but I would as for a post coital test.

    Thanks again for the support on my blog. I am thinking of you, too, and hoping the docs and you figure out the miracle cocktail!


  9. It took me a couple of months for everything to return to normal after my first miscarriage, so you are probably experiencing leftover hormonal mess.

    I was suffering from really late ovulation, too–always CD21 or later. My OB wasn’t concerned, but when I finally went to the RE (a renowned miscarriage specialist), he told me that routinely ovulating after CD18 means poor egg quality, which means more miscarriages. For me, my BMI wasn’t in the “prime” range to get pregnant, and it was a matter of adjusting my weight so I had a “normal” BMI. That moved my ovulation up to CD17, and I got pregnant the 3rd cycle it had moved up. But, I also used Clo.mid the 2nd and 3rd cycles. My RE was firmly convinced that Clo.mid wouldn’t do anything in my particular case, though, and I tend to agree with him, since my progesterone levels always came back normal. By the way, he puts all his patients on progesterone supplementation if they’ve had a history of m/c.


  10. PS The Clomid was prescribed by my OB, who throws it at every patient who can’t get pregnant, without doing any tests or anything. I only went to see the RE after my 3rd cycle was already underway. I’d already taken the Clomid, which he told me was useless. I had been working on the BMI issue on my own, after something I’d read. It was fascinating to me that this was his conclusion, too, before I even told him that I was working on it!


  11. And another PS: I don’t have PCOS, so I was dealing with totally different problems, by the way.


  12. Kate thanks for the insight. There is so much to think about.

    Lilly, Are you taking anything to help make sure this pregnancy is stable, etc? I know like me you’ve gone through the pain of loss twice, did they do any tests or come up with any ideas?

    Michele, did you ever try Clomid or they just went straight to injectibles? the way the plan has been laid out its 3 cycles clomid, then 3 cycles IUI then Injectables.

    Arminta, WOW that is a lot of medication. I’d never heard of Cinnamon for treatment. I’m going to write these down for my appointment with the RE thanks. I’m overwhelmed by all the meds required to get and stay pregnant but I’m sure we’d take these and thirty more if it meant a happy ending in nine months. thanks for taking the time out to explain.

    Carrie, thanks for checking in and giving insight during your own tough time. (hugs)

    Queenie, thanks for your perspective. So did the lowering of the BMI just on its own without anything else get you to ovulate sooner? I’ve also heard that late ovulation pregnancies can lead to miscarriage due to poorer egg quality. I am currently 7 pounds from my “healthy BMI” I’m working like hell to get into the healthy range but its so confusing since many people of all shapes and sizes ovulate normally so I don’t understand how its just about my weight.


  13. I have my master’s degree from Google U. I don’t know how not to google things.

    My OB said that since I had regular cycles and positive OPK’s that I should not need Clomid, which makes me wonder why some people say they are given it from their OB without even having any testing done. I did try soy isoflavones, which are supposedly a natural alternative to Clomid, but I didn’t put much faith into that and it didn’t work anyway.

    Sorry I am no help, but I did learn a lot from reading your comments. I’m glad others were more help than I am!


  14. Hey there. No great words of wisdom, but I just wanted to share about my clotting history. . . when I was pregnant and hospitalized with HELLP Syndrome, my blood tests came back as positive for lupus anticoagulant (and a few other things) – and my MFM declared that the LA was at the root of it all. It took months to recover, my blood was a mess – then I retested – and the LA test came back negative! My hematologist said sometimes these things are “transient.” I have no idea what that means, and his accent make him very hard to understand :), but bottom line is they treat me as positive for the purposes of pregnancy just to be safe. Hope this makes you feel a little better about the wacky results – I know its confusing!


  15. Birdless, my first OB was ready to give me Clomid on the spot when I told him I’d TTC for a year. I shudder at this since he didn’t even consider checking me for PCOS which was the underlying major issue! I guess each doctor is different. I’m glad the comments were helpful for you.

    LittleBlueBirdsFly, I’m glad to hear that your doctor decided on the same approach (i.e. lets play it safe and stick with the lovenox) despite the conflicting results. It makes me feel better for sure. So it seems like the hematologist just looked at the results and gave you an opinion? Did they do further bloodwork?


  16. I’ve fortunately not had to take medications so far, so can’t help much on that. But i bet the low EWCM could be helped by PreSeed – it worked for DH and I the first month we tried it. Although as you know that pregnancy didn’t end well. I often wonder whether the PreSeed helped a little mutated chromosomally messed up sperm get to my egg when it otherwise wouldn’t have been able to and that’s why i’ve lost a year of my life to beta hell.

    Anyway, regarding your symptoms, has your HCG gone down to zero? If they stopped testing you and you’re still getting symptoms I’d ask ’em to follow you to zero (you can also take HPTs). So you’ll have peace of mind that at least you don’t have what I might have had – the persistent trophoblastic tissue catastrophy thing. All my symptoms went away a couple days after my D&C except my skin kept breaking out uncontrollably until the HCG hit stone cold zero. So it’s possible that small amounts can continue to wreak havoc.


  17. Hi, Just wanted to let you know I’m going through something similar. I had “0” pregnancy symptoms but now that I’ve miscarried (had d&c last Friday) all of a sudden I have morning sickness and other pregnancy symptoms, it’s like a cruel joke. So I guess it must be normal. My progesterone was also low and its left me wondering if it was low due to the failing pregnancy or is that why it failed. I was on prometrium but I wonder if it was too little too late. Guess I’ll never know. My husband refuses to try again. I wish you well and hope you find solutions and have a happy ending. πŸ™‚


  18. Astrid, I’ve heard of pre-seed, thanx for the reminder! My HCG was 60 last Friday, I’m supposed to go in next Thursday for my next beta draw. They said it should be zero by then. I’ve stopped bleeding today so hopefully my symptoms will start going away too.

    Terri, I am SO sorry for your loss *hugs* Sounds like we both have a lot of questions about progesterone levels… and I’m sorry the symptoms are coming on to you as well like some sort of cruel joke. Is your husband against TTC forever now or just for some time? I hope he will come around soon.


  19. I am on my first cycle of clomid and after spending dar too long reading scare stories on google i found it surprisingly great – only first cycle so far but had no side effects other than one moment when it felt like everything I was seeing shifted before my eyes. It was odd but not entirely unpleasant, then back to normal. I had a scan after and appeared to have had good results from it in terms of knowing when ovulation was due and assurances it will also help my progesterone levels get to the right levels. had some tests on Friday to confirm this but not had them back yet.
    Still i have high hopes, at this stage anything is worth a try xxx



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