Expert: Scott Roseff, MD, FACOG - 3/25/2004

Question
My situation is as follows (with some history).

I am 33 years old. I have wanted a baby for as long as I can remember. When I was 25 and in my first marriage, I sought the assistance of an RE from the Cleveland Clinic because my husband was unable to have normal coitus due to a traumatic injury. The RE recommended IUI by donor. Although he established that I was ovulating, he prescribed Clomid with an profasi trigger. I underwent two rounds of IUI (each with 2 inseminations and follicle monitoring) without success. I became concerned and I had just about every possible fertility test including endo-biopsy, blood work, internal ultrasounds, HSG and laproscopic surgery. The doctor asserted that everything was fine and I resumed trying with another IUI (again 50 mg Clomid and trigger) without success. I quit trying as the doctor wanted to get more aggressive and we were not financially prepared (especially after paying for all that testing!).

Since that time, my marriage ended and I began a new relationship with my current partner of 6 years. For the first year of our relationship we used barrier contraception. From years 2 to 4 1/2 we used the withdrawl method. For the past 2 years we have used no method at all. We average intercourse about 5 to 8 times per month. I feel that we should have had an "accident" by now.

Last year (May 2003) we started actually "trying" to conceive. Again, I am 33 and realize that my chances are lessening each year. I charted my cycles for several months. My partner had a semen analysis. My cycles run between 29 and 32 days. I do have a cycle every month although I do notice that they are lighter the last few years than they were in my early 20's. My temps are lower than average (imho) but I have had new bloodwork by my regular OB and everything is in order with the exception of a very slightly raised testosterone level (very slight...one number above high normal).

This last month I took 100 mg of clomid from days 3 to 7 and appear to have ovulated on cd 19 or 20. I did not have a progesterone test to confirm or internal sonograms. We had intercourse on those days.

I was late starting and on CD 32 I engaged in intercourse and directly after this I experienced light brown spotting. This continued throughout the day and was only lightly apparent when I wiped. I assumed that my cycle was starting and didn't think much of it. I did not spot the next day...and the day after I began spotting lightly.  It is now CD 38 and I am still only experiencing this very light spotting. Sorry if this is too much information...but it is brown in color, not enough to get on my underware, and only visable as a light brown/dusty rose color when I wipe with white toilet paper.

I have suffered disappointment so much in TTC... and I refuse to start taking HPTs and going through the pain of another failure. I have had slight cramping and all the symptoms of PMS which are maddeningly similar to early pregnancy symptoms. I don't want to test for pregnancy unless I actually have a good chance for something other than disappointment. I have given myself CD 40 as a date I can begin to become hopeful.

So, my question is this: Does Clomid cause period disturbance?  Is it likely that this "spotting" is my period? Is brown spotting a normal side-effect at the 100 mg dose? Can you explain to me what OTHER THAN PREGNANCY can be causing this? Should I just consider this spotting as my period this month... is this a typical period on this level of meds?   

Thank you so much for your time... and I am sorry if this is way too long!

Answer
Hi,

It could be pregnancy, and you should approach this head-on and assure you're not pregnant.  If you are, you should be monitored in early pregnancy (IF it's a tubal pregnancy, you need to know immediately!).  I urge you to test for pregnancy sooner rather than later.

It could be a cyst.

It could be a disturbance from the Clomid - You should read the Clomid portion of a Newsletter I wrote on Fertility Drugs; You can view it at:
www.inciid.org/newsletter/october/2003/RoseffMeds.html

Consider seeing a board certified reproductive endocrinologist rather than an Ob/Gyn....

Good luck,
Dr. Roseff - Director of W.E. C.A.R.E. in West Orange, NJ
Personalized/Individualized Successful care by a solo practice specialist
in a warm and caring setting....
www.reproendo.com
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