Infertility/Fertility/period

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Question
Hi

I am a 42 years old female,I am writing from the US.My husband and I have been trying to conceive for the past 2 years. I had a miscarriage at 8 weeks on May 2011 and a second one on May 2012. The first pregnancy was normal, for the second one lab testing revealed chromosome 13 abnormality.My FSH level was too high.On November 2012 I took Clomid 100 mg day 5 to 9 and i ovulated on day 15, got my period on day 21. I guess it didn't work. Today, I got my period and i think its too early, its just 12 days from my previous cycle. I am wondering could that be a side effect of Clomid. or i am just going through menopause and my cycle is changing.
Thank you for your answer

Answer
Hello Samira from the U.S. (New Jersey),

The shortened cycle can be a side effect of Clomid (called a luteal phase defect) and for that reason, we usually will add progesterone supplementation to Clomid cycles (by we I an referring to infertility subspecialists and NOT general Ob/Gyn's).  In terms of the shortened cyce off Clomid, that is not a Clomid effect because it does not remain in the system that long.

Based on your age, and elevated FSH, it is certainly possible that you are starting to go through the change, or peri-menopause.  In that case, the ovaries start to dysfunction and that would not be good for your fertility.  You would then have to move to donor eggs in conjunction with IVF.  Also, keeping your age in mind and your history of getting pregnant, the main problem you are facing is an "egg quality" issue.  You certainly have shown that you can get pregnant.  I think that if you want a genetic child, I would strongly encourage you to move to IVF, which has a higher chance of pregnancy than IUI or trying naturally, because time is of the essence.  You would still have the risk of a genetic abnormality, since that is an age and egg related problem, but your chances with each cycle would be higher because there is usually a higher number of embryos to transfer or implant.  The better alternative, which eliminates the age issue, is to move to donor eggs.  You would have up to a 73% chance of pregnancy per cycle attempt.  That can be your backup plan.  Since you have gotten pregnant, you certainly could consider 1-2 attempts of IVF using your own eggs.

Good Luck,

Dr. 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 twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.

Infertility/Fertility

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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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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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