Three months ago I had my initial consultation with an infertility doctor, who diagnosed me with polycystic ovary disorder. At that time, I expressed my concerns about taking Clomid. My OB/GYN had already put me on Clomid for three months, and the side effects were awful (mood swings, depression). I am still not ovulating. The nurse says I should increase the Clomid to 150mg. When I expressed concern, she suggested I make an appointment to see the doctor again. I cannot get in to see her for another two months. Either I don't do anything till then, or I listen to the nurse and increase my dosage to 150mg. I hate just sitting and doing nothing. Is there any other way to induce ovulation? Should I be concerned with increasing my dosage of Clomid to 150mg?

Tracy

While traditionally clomiphene has been used to treat polycystic ovarian syndrome (PCOS), I do not believe it is the best approach. PCOS appears to be associated with abnormal insulin function. It is hard to diagnose this condition by measuring a particular blood hormone level, such as an elevated insulin level. Rather, if you have irregular menses and elevated male hormone levels or excess hair growth, you may benefit from using an insulin-lowering medication. By treating the underlying cause of PCOS rather than the individual symptoms, you allow the body to get back to normal. Such treatment can lower blood pressure, normalize blood lipids, promote weight loss and regulate menstrual cycles. This approach to managing PCOS-related infertility also avoids the risk of multiple births associated with ovulation induction treatments.

As far as clomiphene is concerned, I do not use doses higher than the FDA-approved dose of 100mg per day. Clomiphene, an anti-estrogen, works to increase LH and FSH stimulation to the ovary to promote development of an ovarian follicle (the structure that holds and releases an egg). If the ovary responds, the next step is to trigger ovulation with a pituitary LH surge. Quite often the clomiphene can stimulate the egg to develop, but an LH surge does not occur and the egg is not released. Without an ultrasound, your doctor has no way of knowing what is going on and how to advise you.

I usually recommend that my patients begin with 50mg of clomiphene for five days. We also begin monitoring of LH levels in their urine about four days after the last clomiphene tablet. If the tests do not show a surge during the next five days, an ultrasound is performed to see if a follicle has developed. If it has, and the only problem is a lack of an LH surge, an injection of the hormone hCG will stimulate ovulation.

If no follicle is seen, we induce a period with progesterone, and we start over again at the higher dose of clomiphene daily for five days. If no follicle is seen at this higher dose, rarely is giving more clomiphene helpful. For those who have failed to develop follicles on the higher dose, injectable therapy may be useful.