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About Edward Joseph Ramirez, MD, FACOG
Expertise
I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience
I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications
American Journal of Obstetrics and Gynecology
Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
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You are here: Experts > Health/Fitness > Women's Health > Infertility/Fertility > Clomid vs injections
Expert: Edward Joseph Ramirez, MD, FACOG - 11/6/2009
Question
Dr. Ramirez,
My husband and I have been trying for 10 mos, both 33 yrs old, we tried clomid for one mos, 50 mg days 3-7 and it had a negative effect on my endometrial lining as seen on the ultrasound taken around day 10. Our doctor has recommended we try the injections as it should not have the same effect on the lining. Do the injections have a higher probability of multiples? I know someone that is now pregnant with quads on the injections. If I am ovulating on my own without medications will the injections over stimulate my ovaries? If the clomid had a negative effect on the lining for one cycle does that translate that clomid will continue to have the same effect on me or could it be different cycle to cycle? Last question, my cycles are normally 24 days and I am now on day 40, no period, not pregnant due to 2 home pregnancy tests and no symptoms, I imagine it's a functional cyst. Do cysts usually delay periods this long? Once my period comes will the next cycle have a decreased likelihood of producing a mature egg? I plan on making a trip to the doctor next week if my period is still absent. Thank you!
Answer
Hello Kim from Thailand,
Yes, the injectables have a higher chance for multiples because they are stronger medications. They have to be used carefully and your doctor needs to do ultrasounds to make sure you are not stimulating too strongly.
Clomid can have a negative affect on the uterine lining because it blocks the estrogen receptors. This does not occur in every cycle, and the experience from one cycle should not deter your from using it again. In addition, supplemental estrogen can be used to help the uterine lining. Finally, a cycle day # 10 ultrasound is not timed appropriately to determine if the lining is adequate. The lining only needs to be adequate at the time of ovulation, which is usually cycle day #12-14. So if your doctor is doing his Clomid cycles correctly, and monitoring you with ultrasound at the mid-cycle, then he should be able to tell when you are going to ovulate and evaluate the lining at that time. The minimum thickness should be 9 mms.
If a thin uterine lining continues to be a problem, then he might want to switch to Femara (2.5-7.5 mg). It is used just like Clomid (1, 2 or 3 tablets on cycle day # 3-7 or 5-9). It has less affect on the endometrial lining but helps to hyperstimulate the ovaries (produce more than one egg to ovulate each month).
Functional cysts can delay menses for 1-2 months. Your doctor should give you provera to induce your menses, then check with the ultrasound for a persistent cyst. If it is there, then you should take the birth control pill for one cycle to suppress the cyst.
Because Clomid can cause the formation of functional cysts, doctors should always do an ultrasound at the beginning of the cycle, prior to starting the Clomid cycle, to confirm that there are no cysts present. These cysts will interfere with the cycle and ovulation will not occur.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
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