After two cycles on Clomid, I got pregnant, but miscarried. Now I am on Clomid again and have not conceived for two months. My doctor wants to give me a hCG injection close to ovulation. How will this help me? Will this increase my chances of multiples if I conceive?

Erin

First, let's consider why clomiphene is being used in the first place. We often use clomiphene to correct an ovulation defect. In such a case, we recommend no more than three or four months of use before trying other medication to restore normal ovulation. If you already ovulate regularly, I don't think that the use of clomiphene is likely to increase your odds of pregnancy. Unfortunately, many less experienced doctors will try clomiphene after incomplete testing or failure to find a cause for fertility problems. However, when clomiphene is combined with intrauterine insemination, there is often a slight improvement over expected fertility rates.

An injection of hCG, like the surge of the hormone LH that normally occurs in the body, can trigger release of the egg from the ovarian follicle. It can be administered when an ultrasound examination indicates both that the uterine lining has developed to a level sufficient to support implantation and that the ovarian follicle is at least 18-20mm in size. Will it help? That depends on whether you have an LH surge on your own. I ask my patients to monitor an LH surge through urine tests, and if no surge is seen by cycle day 15 or 16, an ultrasound can determine whether the hCG shot might help. Again, many physicians arbitrarily schedule the timing of the hCG shot. If this is the plan your physician suggests, you may be getting less than ideal care.

The incidence of multiple pregnancies is about 10 percent after clomiphene is used. About 1 in 200 pregnancies following clomiphene will involve three or more gestational sacs. The use of hCG does not appear to increase this risk.