Expert: Scott Roseff, MD, FACOG - 7/31/2007

Question
I have had 4 miscarriages now and all have happened around the 6th week of pregnancy. We have had all the tests done from HSG, complete panel of blood work, to chromosomal testing with no explanation as to why. My obgyn said that our next step would be to start on Clomid. She says that this increases the amount of progesterone produced during the leutenizing phase of pregnancy. She also says that it makes the uterus amore habitable environment for a growing fetus. Now I have done some reading and some of the literature states that Clomid actually increases the risk of miscarriage. I also know that it increases the risk for multiples, which in turn increases the risk for preterm birth, complicated birth, the need for cesarean section, babies that have to go to the NICU after birth and the list just goes on and on. My question is just this, what does the clinical evidence say about the use of Clomid in women who don't have problems with getting pregnant, but rather maintaining a pregnancy? I don't want to make a choice like this with so many risks lying in the balance without being at least informed on the topic.

Answer
Good for you for questioning this, Jennifer!  Indeed, Clomid CAN be used to increase progesterone levels to help someone get (and possibly stay) pregnant IF, and ONLY IF, someone has a well-documented progesterone deficiency.

If, however, someone doesn't "need" Clomid, but she takes it anyway, it can potentially increase the odds of a miscarriage.

Consider seeing a board certified reproductive endocrinologist who is an expert in and savvy in the diagnosis and treatment of recurrent pregnancy loss.  I find it hard to believe you've had everything looked at having had 4 losses.... [For example, what did your partner's sperm DNA fragmentation analysis show???]

Dr. Roseff, Director - Palm Beach Center for Reproductive Medicine
PERSONALIZED/Individualized Successful care by a Board Certified Reproductive Medicine specialist in a warm and caring setting....  Visit us in Wellington, Florida!
www.reproendo.com/different.htm
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