please help! on clomid & no eggs I don't understand

Question: I am on day 12 of my 1st clomid (100mg) cycle. I have always ovulated normally, I assume (7pregnancies in 8 months of trying). I went in for an ultrasound this morning and was told that I have no eggs in the right size and there was no point in another u/s in 2 days because they were so small. He said I would not ovulate this month and to call when AF came for a new higher Rx. I am so confuesd; how can he tell I won't ovulate at all? Can't I just be ovulating late this month? If I did TTC this month and happened to ovulate and succeed, would I be more likely to miscarry (that is my problem)? I am so confused; anyone with any ideas, please help!!!

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Name: Lena | Date: September 14, 2005, 18:51

Answer: How big were your follicles?

Name: Michelle | Date: September 14, 2005, 20:28

Answer: There were about 5-6 on my right ovary (from what I could see) which were all under 1 centimeter. There were none on my left. He said they should have been over 1 c. minimum. His nurse said after he left that I should try not to get pregnant this month. It seems counterintuitive; I 'm trying to get pregnant, why not try this month?

Name: Lena | Date: September 15, 2005, 0:06

Answer: Your follicle's size is more indicitive of non-ovulatory cysts as opposed to ovum-producing follicles. Bascially it just means that your 5-6 follicles don't have eggs.

Name: Kerri | Date: September 15, 2005, 8:56

Answer: I'm not an expert...but I'll share my story. I took 50 mg of Clomid this cycle---went it on day 12 with only one follicle about 8mm on right side...went back again on day 15 to see if it grew and it had regressed so I had NO follicles mature just a whole bunch of little ones. We had to cancel the IUI--it was depressing. However--here's the good news. I'm now on cd 35 and I'm 4 dpo. My body didn't respond to Clomid within the "normal" time period, but I DID ovulate on cd 31. Judge by your cm--if it's watery or eggwhite use OPK to see if you get a +---that's what I kept doing and finally it turned +. Also track your BBT to confirm if there is a temp shift. If you do Ovulate later this cycle---ask your doctor for a P4 test(progesterone bloodwork done 7dpo) maybe the reason you're miscarrying is because of low progesterone. Hope this helps and good luck!

Name: Michelle | Date: September 15, 2005, 12:36

Answer: Lena & Kerri, thank you both for your input. Kerri, progesterone injections are part of the plan. I was supposed to take an HCg shot sometime soon after yesterdays u/s then start progesterone daily injections until AF or 10-12 weeks. Yesterday my endometrium looked good but he said I wouldn't o. Last month I o'd (no clomid) but my endometrium was too thin. I can't win. I was wondering how he knew I wouldn't o at all instead of oing late like you. I've having some cramping today & yesterday that I don't understand. Lena, when you say cysts are you talking about the cysts they warn you about on clomid? Will I have to wait until they go away to try again? Do you think they will go away in a month's time? Sorry for all the questions. Thank you both again!

Name: Michelle | Date: September 15, 2005, 14:00

Answer: Kerri, I forgot to ask, were you able to reschedule your IUI after you found you were about to ovulate?

Name: Lena | Date: September 15, 2005, 14:39

Answer: Michelle, A cyst is simply a term to describe a fluid-filled, nonvascular sac. They can be simple or complex. For example, the follicles we produce each month to emit eggs are actually cysts, so really aren't always a scary thing. Clomid doesn't produce a particular type of cyst, say a "clomid cyst". Instead clomid merely encourages a cyst (or follicle to grow. This cyst could or could not contain an egg. With hyperstimulation there can be an increase of nonfollicular cyst on the ovary because of the very nature of hyperstimulation. Imagine an assembly line where the workers are asked to increase their productivity of placing chocolates into tiny paper cups. As the conveyor belt increases, the workers are bound to miss placing some chocolates into the paper. The same thing can happen to our ovaries. Clomid can also cause existing cysts to grow even larger. You have 5-6 10mm cysts right now, but if they don't reabsorb and you took more clomid, they could grow even bigger because clomid encourages them to do so. In a nutshell, at this stage of growth your cysts are not too large to be of a concern. Just a nuisance to your conception plans. hCG + progesterone is a standard procuedure for the treatment of cyst. The hCG your dr wants to administer should cause the cysts to regress. The progesterone will then be used to regulate your cycle to assist with your conception plans.

Name: Michelle | Date: September 15, 2005, 15:24

Answer: Lena, my RE won't use the progesterone and hcg this cycle because the follicles are too small. Her never called them cysts, not that I doubt what you said. To be honest, I'm not really sure why I'm on clomid at all. I seem to ovulate normally (with the apparent exception of this month) and my cycles are always regular so that's not it. At one point he said that clomid can help prevent miscarriage, however, I read quite the opposite on-line. The hcg is intended to cause the egg to release which he feels will not happen this month even with hcg due to follicle size. The progesterone would then be used to support the hopeful pregnancy until the placenta kicks in at about 10-12 weeks. With out the aid of progesterone and hcg, will these cysts resolve? By the way, they were all significantly under 1 cm.

Name: Kerri | Date: September 15, 2005, 22:57

Answer: No I could not reschedule the IUI---I got my + OPk on Saturday and Sunday....which worked out good for lots of bd. If we don't get preggo this time we for sure need IUI b/c we did everything right!

Name: Michelle | Date: September 15, 2005, 23:11

Answer: Kerri, well at least you had fun last weekend : ). I hope that that's all it took. Your attitude seems so good. I was just devastated when he said this cycle wouldn't work. I wish you lots of luck and would love to know how things turn out for you!

Name: Lena | Date: September 16, 2005, 11:21

Answer: Let me clarify a few things. :) This will help clarify what I mentioned earlier from what your doctor told you: (1) A follicle is a cyst, or more precisely a follicle is a type of cyst. It common to refer to them as a follicles because patients can readily understand what they are and the word "cyst" can cause unnecessary fear as we always think of cysts as bad things. (2) hCG can regress cysts including follicular cysts. (Though the intention of an hCG injection at the time of ovulation is to release an egg, one side effect/problem with administering hCG for ovulatory purposes is that it can cause a follicle to regress instead of releasing that egg.) hCG + progesterone is the easiest and quickest way to regress nonfollicular cysts, however its common to let them regress naturally without any aids. The follicles will eventually resolve themselves without artificial aids. Progesterone is used to maintain pregnancy if the natural balance of progesterone is low, but progesterone can also be used to regulate a cycle. (3) The presence of a monthly flow, even a regular monthly flow, is not an indicator of regular ovulation. Only a progesterone test or ultrasound can confirm that someone has ovulated.

Name: Lena | Date: September 16, 2005, 11:38

Answer: Forgot to mention about clomid: (1) Clomid can increase follicular production. The more ovulatory follicles you produce each month, the better your chances of becoming pregnant. (2) I have to agree with your doctor, there is no research to support that clomid causes an increase of m/c. There are some sites that claim clomid causes an increase of m/c but they don't provide the research info or supporting statistics in total. Its easy to extract and misinterpret research data. We've had several discussion on this board recently where people have misread or misinterpreted information to support their bias against clomid. I prefer more concrete evidence. I've been doing this for 20 yrs. Clomid has been around for 50+. I've never seen research to suppport the m/c claims.

Name: Michelle | Date: September 16, 2005, 13:41

Answer: Lena, you are obviously very knowledgeable, can I assume you are in the medical profession or is this knowledge from life experience? I hope you're not getting impatient with me and all of my questions. Thank you ! P.S. the reason I assume I ovulate regularly is that we have conceived 7 times and have only tried 8 months. It would seem like too much of a coincidence that we ovulated 7 of the months we tried if I don't ovulate regularly.I suppose it's possible though. It's just so odd to go to a specialist thinking that I am very fertile but miscarry, only to then think that I may have fertility issues too. No one who knows me would ever think of me as infertile (not all of my pregnancies have ended in miscarriage). Thanks

Name: Lena | Date: September 16, 2005, 16:33

Answer: I work in repro research right now. I've gone back and forth during my career from actively practising theriology to research. You mentioned that you'd been pg 7 of 8 months so yeah that would indicate that you able to conceive. Sorry, I didn't reread your original post when I responded. As you can see from the many threads here, Clomid can make people act very different from their normal cycle. I too had multiple cyst my first month and now, pg from a clomid cycle, I have two 2.5 inch cysts on my left ovary. Has you dr tested your post ovulatory progesterone levels or do they feel your m/c are low integrity conceptus?

Name: Michelle | Date: September 16, 2005, 17:54

Answer: I will give a little more background on my situation. I had had several miscarriages before, and most recently a live birth, when we decided to try again. Due to a gynocological problem I required an hysteroscopy, during which it was discovered that I had a mullerian anomaly. I was then referred to my RE. We decided to wait on the referral and were rewarded with another miscarriage, so we went to the RE. He ordered an MRI which showed that what I had was a sub-septate uterus. He also ordered many blood tests and cultures and all was normal. I do not believe that any was a post ovulatory progesterone level since all were on day 2-3 of my cycle. He believed that the septum was too slight to be the cause of the miscarriages, especially since I had carried pregnancies to term and then some. He felt at that point that the problem was a leutal phase defect. One of the miscarriages is almost certainly do to chromosomal defect (one half of a twin pregnancy lost very early). The others we are assuming were due to a leutal phase defect although we can't really know as there were never any chromosomal tests run on the products of conception. We started on his plan of action just this cycle and I am on day 14. I am new to all of this and a little overwhelmed. I always thought I knew my body and the septum, possible l-p defect, and now maybe an ovulatory problem are rather jarring. I almost wish we had gone on on our own and risked another miscarriage. Then we would still be blissfully unaware and believe all was due to problems with the embryo. I know that another miscarriage would have been just too devastating. So I feel that if we want another child we need to stay the course with my RE. I only wish he would concentrate on keeping me pregnant rather than getting me pregnant : ) but I guess the clomid is intended to support the pregnancy. I know that I go on and on but I hate to bother my RE's office with all of these questions. I like having an available expert to ask : ). Thank you!!!!

Name: Michelle | Date: September 16, 2005, 22:31

Answer: Lena, I'm being so self absorbed, How far along are you? Have you been trying long? Was it just divine luck that this was your field and you had fertility issues or the other way around? I suppose that it's unlikely that you have been trying to conceive for over 20 years though!