Clomid. GP not v helpful and I have loads of questions. Can anyone shed any light please?

[cloudwine]

I have have one child, now 4, and after a difficult birth was advised to wait 3 years to TTC. I sadly miscarried in Oct '09 and have been trying since with no success. GP asked me to come for Day 21 bloods- these showed all my hormone levels are fine, except Progesterone (2.3) which suggests I didn't ovulate this month. He sent me away with a prescription for Clomid, very little info and said if I wasn't pregnant in 3 months, to make another appointment to see him.

Is this normal at 37? Is it conclusive that I don't ovulate from one blood test? (I have 34 day cycles and don't usually show signs of ovulation till day 20 anyway) Should I be monitored when taking Clomid, or referred? Should my husband have any tests? What happens if Clomid doesn't work for me? GP mentioned IVF briefly and I can't get it out of my head.

Does anyone have any experience of this or can offer any advise? I feel really emotional and confused. Thanks.

cloudwine,

You should be referred to a subfertility unit by the GP. These types of issues are outside the GPS general remit anyway.
Given your history too you need a referral.

Day 21 is used usually to only measure progesterone; other hormone levels like LH and FSH should be measured early on in the cycle around day 2. LH and FSH are important as they kickstart the ovulation process; if these two levels are awry (which may well be why your progesterone level was ultiamtely so low) then ovulation will be affected. Your man should also be tested to see if there are any male factor problems.

If you have a 34 day cycle it does not follow that you ovulate on the 20th day. Ovulation can occur earlier, later or not at all in any given cycle. It may be that you are not ovulating regularly if at all.

Also you should be monitored whilst on clomid as it is possible to become clomid resistant whilst on it. Apart from anything else no monitoring means you have no idea whether its doing its job or not.

You need a specialist to discuss treatment options with. GP is not being at all helpful here. If GP is like this anyway I would look into changing GP practices.

You will need to be persistant in order to get answers. You need a diagnosis first and foremost, not just a script for clomid and being sent on your way!.

Thank you Attila.
GP did say that my LH and FSH levels and other hormones were ok (can't remember the figures as my mind was on the Progesterone by that point!) I have asked to see a female GP in the same practice, so hope she will echo what you've said and get the ball rolling, so to speak. Does a referral happen through the NHS, or do I need to go privately?

Does anyone have any experience of being on Clomid themselves? From what I've read, it can dry up CM, which I've been checking to help find most fertile times (if I ovulate in any given cycle). I've also started charting, but will this give an accurate picture with the Clomid?

Thanks in advance.

Your LH and FSH may be "okay" if within the normal ranges and looked at separately - but these need to be compared against each other early on in the cycle. This is when an abnormality is seen (these hormone levels should be about the same normally). They are not usually tested on day 21 either.

TBH if there are any potential ovulatory problems I would not bother with charting.

See what the other GP says and push for a referral that way. Initially at least you are safer going under the NHS.

Attila, when I see the next GP, I should ask for Day 2 bloods, semen analysis and a referral- is that right?

Does anyone know if OPK's work on Clomid? I just want to feel proactive as much as I can.

I would be just asking for a referral.

OPK's and clomid are uneasy bedfellows, would not use the two together.

Thanks [Attila] you've been really helpful. My GP has always been brilliant in the past, I just feel let down this time.