AboutScott Roseff, MD, FACOG Expertise I can answer questions relating to ALL aspects of female infertility.
Experience I am Board Certified in Reproductive Endocrinology/Infertility.
Organizations Medical Advisory Board, Serono Labs, Inc.
Speaker's Bureau, TAP Pharmaceuticals, Inc.
The American Society for Reproductive Medicine
American Association of Gynecologic Laparoscopists
The International Society for Gynecologic Endoscopy
The Society of Laparoendoscopic Surgeons
The International Federation of Gynaecologic Endoscopists
U.S. International Foundation for Studies in Human Reproduction, Inc.
The Endometriosis Association
Fellow, The American College of Obstetricians & Gynecologists
American Medical Association
The Academy of Medicine of NJ
NJ Obstetrical & Gynecological Society
The NY Reproductive Medicine Society (Steering Committee)
The Society of Reproductive Endocrinologists
Resolve - National Chapter
Resolve - New Jersey - Executive Board
Publications Kettel LM, Roseff SJ, Berga SL, Mortola JF, Yen SSC. Hypothalamic-pituitary-ovarian response to clomiphene citrate in women with polycystic ovary syndrome. Fertil Steril. 1993;59:532-8.
Fischer UG, Wood SH, Bruhn J, Roseff SJ, Mortola JF, Rivier JE, Yen SSC. Effect of human corticotropin-releasing hormone on gonadotropin secretion in cycling and postmenopausal women. Fertil Steril. 1992;58:1108-12.
Kettel LM, Roseff SJ, Bangah M, Burger HG, Yen SSC. Circulating levels of inhibin in pregnant women at term: simultaneous disappearance with oestradiol and progesterone after delivery. Clin Endocrinol. 1991;34:19-23.
Kettel LM, Roseff SJ, Chiu TC, Bangah ML, Vale W, Rivier J, Burger HG, Yen SSC. Follicular arrest during the midfollicular phase of the menstrual cycle: a gonadotropin-releasing hormone antagonist imposed follicular-follicular transition. J Clin Endocrinol Metab. 1991;73:644-9.
Roseff SJ, Kettel LM, Ulmann A, Bangah ML, Rivier J, Burger HG, Baulieu E, Vale W, Yen SSC. Accelerated dissolution of luteal-endometrial integrity by the administration of antagonists of gonadotropin-releasing hormone and progesterone to late-luteal phase women. Fertil Steril. 1990;54:805-10.
Roseff SJ, Murphy AA. Laparoscopy in the diagnosis and therapy of chronic pelvic pain. In Clinical Obstetrics and Gynecology. JB Lippincott Co., Philadelphia. 1990.
Roseff SJ, Murphy AA. Pelviscopy. In Manual of Endoscopy, by the American Association of Gynecologic Laparoscopists, Edited by DC Martin, GL Holtz, M Wenof. Santa Fe Springs. 1989.
Roseff SJ, Bangah M, Kettel LM, Vale W, Rivier J, Burger HG, Yen SSC. Dynamic changes in circulating inhibin levels during the luteal-follicular transition of the human menstrual cycle. J Clin Endocrinol Metab. 1989;69:1033-9.
Roseff SJ, Bernard JM. Seasonal changes in carbohydrate levels in tissues of Carex lacustris. Can. J. Bot. 1979; 57:2140-44.
Education/Credentials Postgraduate Fellowship training in Reproductive Endocrinology & Infertility was done at The University of California, San Diego, School of Medicine.
Awards and Honors Mellon Fellow in Reproductive Endocrinology and Infertility, 1988, awarded for academic excellence in the Reproductive Sciences, for research efforts aimed at development of novel contraceptives.
Wyeth Service Award for Physician Education and Training in Norplant Contraceptive Implants.
Certificates of Service and Appreciation from Our Lady of Mercy Medical Clinic, Guadalajara, Jalisco, México, 1978-1982.
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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Since I don't know your entire history and haven't examined you,
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Therefore, Dr. Roseff and the W.E. C.A.R.E. staff can not be responsible for any actions taken or not due to the information contained within these communications.
These communications are for educational and informational purposes only, and should
never be used to replace the information and care rendered by your own doctor.
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