INFERTILITY INFORMATION
Everything is based on the first day of your last menstrual cycle (FDLMP). This is Cycle Day (CD) number one. Any bleeding is considered a period. If you are having irregular cycles occurring less than 24 days and/or greater than 35, please contact our office.
Normal office hours are Monday 9am through Friday 1pm for all test results, labs and refills of medication. These can not be done when office is closed so please plan so that a cycle is not missed.
To check for ovulation:
Progesterone level – This is a laboratory test. You need to obtain on CD #21 or #22 (this is if you are having cycles Q26-32 days). If your cycle is not regular, please use an ovulation predictor kit (we prefer the Clear Blue Easy Digital NOT Advanced since there are less false positives) and time your blood test for 9 days after a positive ovulation predictor for what day you are going into the lab if you don’t already have your lab slip. Labs can not be ordered when the office is closed. If you do not get a positive surge, please contact the office during normal business hours to discuss next step.
Basal Body Temperature – Need to obtain your temperature at first wakening. This is even before you go to bathroom, roll over and kiss your husband, etc. A normal basal body temperature chart will show a rise in the temperature AFTER ovulation. This should only be done to track cycles initially to approximate when you will ovulate to narrow down when to use your ovulation predictor kit.
Ovulation Predictor Test (Clear Blue Easy) – Please start your ovulation kit on CD#10. Once it is positive x 2 days, stop any further testing and keep strips for next month.
To check your husband/partner:
Semen Analysis (SA) – This requires an appointment at the lab. This is not done in our office. You will get an instruction sheet with a kit for collection. Please read that sheet. Your husband needs to abstain from all sexual contact resulting in ejaculation for 3 days before collection. He needs to collect at home without artificial lubrication (ie-no ky jelly, astroglide, etc) OR saliva. May use glycerin lubricant available at drug stores if necessary. This has to be at the lab within 30 minutes. So if appointment is at 10am, collection needs to be done at 9:30am. Keep the specimen at body temperature (put collection in pants against skin, inside bra against skin until you get to lab and then put in container in paper bag to bring into lab).
If your husband/partner has already had SA, please get a copy for us.
To check patency of your fallopian tubes:
Hysterosalpingogram (HSG) – This is a timed test. Has to be done between CD 3-10. Please call our office at the start of your period during normal business hours to arrange. You will need to know your FDLMP in order to schedule. This is done at the hospital or surgery center. You need to arrive at least 30 minutes ahead of your appointment time to allow for preregistration. Please take some ibuprofen 800mg 1 hour before your procedure time as long as you are not allergic to this or have issues which make this contraindicated (ie-peptic ulcer).
MEDICAL THERAPY:
Clomid:
The normal timing of clomid is to start of CD 5-9. Incidence of most common side effects for clomid can be abdominal pain/cramping in the area of the ovary about 5-13%(since the medication is stimulating the ovaries to produce an egg), hot flashes about 10%, nausea/vomiting about 2%, breast discomfort about 2%, headache about 1% and irregular bleeding about 1%.
The success rate for clomid (ie-to get you to produce an egg) for patients who are not ovulating is about 80%. 90% of time, this results in a singleton pregnancy. 10% of the time, this results in a multiple pregnancy (90% twin or overall rate of 9%).
Please pay cash for clomid (at Walmart 50mg dose of clomid is $12); otherwise, your insurance may see this as treatment for infertility and they will not pay for any further tests/procedures that may have to be done.
Progesterone:
This medication is responsible for the support of the lining of the uterus (endometrium) in holding a pregnancy for the first 10-12 weeks of pregnancy. Your natural progesterone comes from the ovary after ovulation. For those women who are having difficulty making an egg or who may have had multiple miscarriages, may need to be on progesterone.
Incidence of most common side effects for progesterone can be headache 30%, breast tenderness 27%, mood changes 19%, abdominal bloating 12%, vaginal discharge 10%, , nausea/vomiting 8%.
This timing of starting progesterone is critical. If you start too early, you can blunt the ovaries ability to ovulate.
So if this is ordered for you, progesterone supplementation is started 4 days after your positive ovulation predictor test.
If you are taking progesterone and not pregnant, progesterone levels as stated above, are not taken since they will be falsely altered by the medication. You physician will determine any changes on monitoring.
As always, if you have any questions, please call the office to clarify.
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