Clomid (But I ovulate naturally?)

[saggymaggie]

Myself and my partner have been undergoing fertility investigations since last year. We were referred to fertility clinic in December 2020.

GP investigations showed everything was OK with me but my husband has a low morphology of 3%. Everything else, normal.

I had bloods with the GP with confirmed ovulation was occurring naturally and this is documented in my patient record.

All further tests of mine with the fertility clinic have been clear- no blocked tubes etc. My husbands results have consistently said morphology 3%, although his other numbers have improved for count etc

Today I had my latest consultation with the fertility doctor. He told me they're putting me on Clomid as i'm not ovulating. I asked for clarification because i've previously been told I am ovulating naturally and I also get positive ovulation tests, with consistent signs of ovulation each month. He said no, tests show no ovulation. I asked which tests as they've only ever done a rubella blood test for me and a HSG to check for blocked tubes whilst i've been under the fertility clinic. Never any further ovulation tests.

He said he was referring to the ones the GP did. The same ones that the GP said showed ovulation. He was adamant, no ovulation. Clomid the only way to go at the moment and he's posting out the prescription tomorrow.

I have looked back at the results myself and numbers are within the normal ranges. Confused, I called my GP and a member of the team (not a GP) compared them to the normal ranges also. They confirmed all is within normal range to suggest ovulation. Not even borderline. They are as confused as me and have suggested a GP consult, which i've booked for Friday.

Does anyone have any experience of similar or Clomid being prescribed even when you are ovulating naturally? Is it standard procedure?

Because i've always been told I was ovulating as expected, i've never read much about or looked into Clomid (but I will now) so any experiences welcome.

You need up to date blood test results. Anything done over 6 months ago should be discounted. Same goes for your man; he also needs up to date test results.

Somebody is wrong here. What results do you have re ovulation tests?. What tests did the GP do to confirm ovulation?. Usually a day 2 test is done to check and compare LH levels against that of FSH. A day 21 is usually done to measure progesterone and a level of 30 or more is ideal. Such tests should ideally be carried out over some months.

Home positive ovulation predictor kits results can be misleading so these would have been disregarded.

Giving you clomid without further clarification on blood test results does not seem right at all. Clomid is also quite powerful stuff and the patient should be monitored if prescribed it; no monitoring is unacceptable as you will then have no idea whether its working or not.

When is your next appointment with this fertility clinic?.

Thanks for the reply @AttilaTheMeerkatAttilaTheMeerkat

The bloods were done in December 2020 and i've had no more since (aside from the Rubella immunity test) this was the bloods which are taken at the beginning and on day 21 of your cycle to compare and confirm ovulation has taken place. These were the ones done by the GP and the results the fertility clinic are using.

My Serum progesterone level was 29 nmol/L and the reference range they used said ovulation was occurring if over 16 nmol/l

I remember the second set being done on day 22 though as day 21 was boxing day and they were closed. My cycles are 27 days on average, if that makes a difference.

My husband has had 3 lots of semen analysis, the most recent was last month. He's been on various supplements and all his other numbers have increased, but morphology has stayed at 3% consistently. He's also had bloods (once) and these were all said to be fine too.

I'm not sure if it's due to covid, or if it's always done this way but we've never seen the consultant in person, we've had 2 "meetings" and both have been on the phone. The first just confirmed our weight/height/how long we've been trying and he also referred me for a HSG during that initial conversation. That was the first time we'd spoken to him. The only people we've ever seen are those taking our blood and I also met the ladies who did my HSG.

We do not have any further appointments with them as yet. The phone call ended with him saying the Clomid prescription would be posted out tomorrow and he told me to start on day 2 of my cycle for 5 days, if it doesn't work, same again the following month, for 6 months, then they'd review.

To confirm, this is all NHS, not private.

Those results need to be discounted. You certainly need up to date bloodwork done and you need both a day 2 and day 21 test. I do not see any indication of you ever having a day 2 test carried out which is key. At some clinics a level of 29 would indicate borderline or no ovulation. At the NHS clinic I saw they wanted to see progesterone levels of 30 or more.

The day 21 test measures progesterone levels, the day 2 test is done to compare the level of LH against that of FSH. The day 2 test is key because if those hormone levels are out of sync (particularly if LH is a lot higher than FSH) then ovulation will be affected.

Have no internal ultrasound scans been performed either?. It appears not and that is not good either. At least they did the HSG but your treatment to date seems really patchy and due to covid services has been cut back. You need to see these people though face to face; it cannot all be done over the phone. I would actually consider asking your GP to refer you to another NHS unit in your nearest city because it is fair to say that some of them work far better than others.

I would not be happy be given clomid either in your circumstances
also because you are not being monitored whilst on it. Clomid makes the ovaries work harder and can affect hormone levels like LH markedly. If say there was an excess of LH to start with the clomid would further increase that. There is also such a thing as clomid resistance and if you are indeed ovulating regularly (this really does need further evaluation and checking) then clomid will have the opposite albeit temporary effect.

@saggymaggie
I can you understand your confusion!! This all sounds very odd! For me, I had 6 months on clomid through the NHS. My progesterone level was 17mnol and they said I wasn't ovulating (despite always getting positive ovulation tests each month). Both GP and consultant wanted a result over 30nmol. I was put on 50mg of clomid and monitored with follicle tracking and subsequent blood tests to check I had ovulated. Obviously I'm not a professional but I would say you've been given clomid on the basis that your progesterone level was 29mnol and they wanted 30 and over. For comparison on my first month on clomid my progesterone level jumped to 54mnol. But I wouldn't be happy in your shoes either to be prescribed it without all the tracking that should go alongside it!!!

Thank you for the replies, i've only just seen them.

I really do feel that I need some more up to date blood work on this. There hasn't been much clarity at all and it seems like a few standard things have been missed or not carried out, which isn't giving me much confidence moving forward.

I have had internal ultrasounds, but that was approx 4 years ago (unrelated to fertility investigations) due to pelvic pain. At the time, all was clear.

We have actually just moved so i've now initiated a switch to a new GP and we can hopefully get the ball rolling with another clinic as it's a different trust area.

Thank you for the info, its been helpful

@saggymaggie I don't know if this will be helpful but we seem to be in a very similar boat.

My DH has 0 morphology. I've got long irregular cycles, so figuring out when my day 21 was for bloods was a guessing game. I've since looked back on my apps and think my bloods were taken before I would have ovulated. So them coming back with low progesterone isn't surprising.

I've done OPKs and temp tracking which show ovulation but obviously not 100% reliable.

I'm on clomid for 6 months too via NHS. I'm not being tracked at all. So no idea if it's working.

I was unsure about it at first, but I think because of the male factor issues it's really a stepping stone to ICSI for us.

I also was happy to try it because my cycles were ridiculous, and I'm hoping the clomid might shorten them if anything. I have other symptoms of low progesterone too so I thought I'd just go with it.

So sorry if that's completely unhelpful. But I read your message and had such similar thoughts myself I didn't want to ignore you.

@seathistle never unhelpful In a way it's reassuring to know others are being offered similar as hopefully that means it's not too far off the mark?

Small update- I managed to get a last minute (telephone) appointment with my new GP today who has reviewed my previous results and agrees that by the parameters they use, they would consider my results normal and would suggest on that basis that I am ovulating naturally. However, she also looked up the parameters used by the next closest trust to us just to see why there may be a discrepancy. It turns out they use 30 as a baseline. So for them, my result of 29 would be borderline and that explains the Clomid prescription.

She has also referred me to a new fertility clinic, I have an actual in person appointment there in 6 weeks. Worst case scenario is we need to go back to the beginning and redo all tests to this point, which feels like a waste of 6 months, but perhaps its not a bad thing as it appears a few things were missed anyway.

GP said ultimately it's up to me whether to take the Clomid in the mean time and she trusts that the consultant would have prescribed it for a reason, although she did say they would usually monitor it. So i'm a bit torn on what to do.

@saggymaggie sorry for such a late reply to this. Did you decide what to do in the end?

I'm feeling so disenfranchised with clomid. It feels like a lot to go through when they don't care if it's working or not and for us probably won't work even if it makes me ovulate. Sorry, ranting!