Clomid for LPD and Miscarriage

[Bun]

Hi guys,

I am not sure what section to put this in, so have put in both the AC thread and TTCAML thread. Mods, please move/delete if in the wrong place.

I am not sure if anyone here can help me, but I would love to hear from anyone who has been given clomid to help a possible luteal phase defect and/or to prevent a miscarriage.

My history is falling pg easily, but then losing my pregnancies, quite early on. The first was a missed m/c that was discovered at 8.5wks, but the baby had stopped growing at 7 wks. The second was very early at 5.3wks, but I knew my HCG level was dropping from when I was 4.6wks.

My specialist has done almost all the repeat loss tests, and everything has come back normal. All that hasn't been done is an endometrial biopsy for possible elevated levels of natural killer cells, but he seems certain this is not the problem, and in any event, is a v controversial area.

The only abnormal thing is that my cycles, ever since coming off the pill 18 mths ago, have been erratic. I went from having perfect 28 day cycles before the pill, to waiting 4 months just to get my cycle back after the pill, and ever since then my cycles have been long (from 32 to 52 days), but have lately stabilised to about 32 to 37 days. I also O late in my cycle, anywhere from CD20 to 26, and I have identified an LP of only 11 days on at least 2 cycles. I do not have PCOS, and no reason can be found for these cycles. I have just had cycle monitoring.

My specialist has now decided that I have a slight O dysfunction, so has prescribed clomid. My understanding is that this should hopefully bring O forward and help by boosting all my hormones so that a better egg is released, and should also hopefully help with my short LP, and therefore result in that ever elusive baby!

I would love to hear anyone's experiences on clomid, and reasons for it to be prescribed. I started my first tablet last night (50mg) and feel fine so far, but I am a little worried about the potential side-effects!

Does this sound like a good solution to the problem? How did you find taking clomid? Has anyone had a cycle cancelled due to too many follies and what is the chance of this? Did you have success with clomid?

Sorry for so many questions - I am just keen to find out as much as I can and my specialist, although good, always seems too rushed for questions.

TIA,

Bun xx

[Willow]

Bun, there were quite a few of us who were on clomid following a loss and possible LPD - we actually had our own thread for a while but the mods eventually closed it.

Unfortunately, clomid didn't work for me (I did 5 cycles and it really is not bad at all) and we eventually moved on to IVF, but Michelle71 and Deb (Flowerchild) have both had success with clomid - I'm hoping one of them will pop in very soon to answer your questions - they are both very knowledgeable women!!

[Inanna]

HI Bun,
I have successfully used clomid to rectify a LP defect. Did you have a cd21 test done? If so was it within normal limits?
A luteal phase defect will not cause a loss as late as the ones you have suffered. A LP defect can cause problems in that implantation can occur up to 10 days after you ovulate (this is the late end of the scale but it can...) if your LP is only 11 days the dip in progesterone that occurs will interrupt the development of the pregnancy and you will have a chemical pregnancy. I have had 3 chemical pregnancies - all without clomid and all with an 11 day LP. If you implant earlier (each pregnancy will implant at a different time for each woman) say on 6 dpo then the pregnancy has time to implant and the the progesterone production isn't interrupted. So, this is why some women with shorter LP chave successful pregnancies.

The Clomid can be a very effective treatment for LP defect and personally it has been so for me. Clomid tricks your body into making more hormones (very basically) so all levels will be increased. This can cause hot flushes and mood swings (think she devil!!!) but I personally think it's a small price to pay for conceiving.
It is unusual to produce enough follies for a cycle to be cancelled on clomid. Usually you will begin on 5omgs - on this most women will produce 1 or 2 mature follies. I was on 150mgs of clomid the cycle I conceived my recent pregnancy on and I had 3 mature follies... My obs only cancels above 3 in a woman my age...(39)

Be aware though that on the first round of clomid your cycle may not be shorter. I am a late ovulator also and on my first round I ovulated on cd22. My subsequent cycles did shorten but never to 14days at ovulation. You will hear many stories similar to mine too. Conversley though you will hear many where women ovulate on cd14. It's just not a given...

I hope that has helped.

As for the NK theory. Yes it's controversial but it's certainly been a proven cause of many women suffering recurrent miscarriage. Dr S is a Sydney obsteric immunologist who deals with this. He will do phone interviews.
He does endometrial biopsies but they have to be done in his lab as he uses specialised testing that can only be done there.

If you have had 2 early losses it is HIGHLY likely that your next pregnancy will stick. However, I am a great believer in intuition. If you feel there is more to this - be like a pit bull and dont' let up. If you need any more information and I can help I would be more than happy. Good luck Bun

[Inanna]

We posted at the same time Willow

[Willow]

Ooh, good girl Deb, I knew you'd be able to help her!

And Bun, I can second Deb's recommendation about Dr S - he's my FS/surgeon and a wonderful man!

A very dear friend of mine has recently had a consult with him and if she gets no joy from her next ivf cycle, she will be having the biopsy and NK testing done with Dr S.

[Bun]

Salt, Willow, Deb thank you so much for posting, it is great to get some more info on this.

Deb - my specialist does definitely believe that elevated NK cells could be a problem, but he thinks it is only necessary for women who have had three m/cs to go ahead with this testing, and at this stage he doesn't put me in the recurrent loss category. If I were to have another loss, then I will definitely be going down this path. I have had A CD21 BT done (although in my case it needs to be done on more like CD27-32) and my prog levels and everything else were really good. I also had a chem pg my second last cycle, so I am not sure if maybe this is one of the reasons my specialist thinks a LPD could be the problem. He has defined it as a 'slight ovulatory dysfunction', whatever that is supposed to mean.

Thanks for the info re follies - as I O on my own, I was a bit worried that the clomid may make my hormone levels go too high and produce too many follies, and I certainly don't want to have to cancel a cycle! I hope I manage to O closer to CD14, but it looks like maybe this won't be the case. Oh well, time will tell.

What do you think my chances are of having a successful pg with this treatment? My biggest trouble atm is losing hope with it all and fighting off depression. I need hope that this has a good chance of working, as DH are getting more than a little sick of this rollercoaster. I know that we have not been TTC nearly as long as a lot of people here, but we have been finding it hard coping with the fact that it has been 18 months since I went off the pill, and in that time we have had to endure 2 m/cs and the birth of his family's first grandchild right in between them.

I don't feel like there is something wrong that I need to push the drs to find, I am more just scared, and the more info I have, the easier I find it going down this path. I have always been really healthy, I am young, a healthy weight, don't drink or smoke and I eat healthily, so I just have no idea why this has happened to me not once, but twice.

[Inanna]

Hi Bun,
If your specialist believes nk cells could be the problem I personally - and I am going out on a limb here - would get testing before you embark on another pregnancy. That decision is yours though of course and that may not feel right for you. The endometrial biopsy isn't a biggy and the biopsy can be sent to Dr S for testing. You would have the result in about 7 days. If it is clear you can embark on another pregnancy with a new optimisim. If it isn't than it will probably just be a matter of taking steroids for the first part of your pregnancy. If your specialsit feels this could be an issue with you perhaps you could discuss taking the steroidal treatment as a precaution...

The clomid won't protect you against miscarriage. It will help your body to produce more hormones and the increase in progesterone will likely increase your LP. If you are ovulating on your own it probably won't increase your chance of conception greatly. If your cd21 progesterone level was good without clomid that's great. Because you will likely be monitored you will likely be able to time intercourse well and this will optimise your conception chances.

I am sorry for the losses of your little ones Bun and I hope that you can get some answers and hold that Earth Baby in your arms.

Even though it's painful it isn't unusual for a woman to have 2 miscarriages and then go on to have a healthy pregnancy.

Ensure you are taking prenatal vitamins and that your partner is taking zinc for healthy sperm and folate too.

Good luck again Bun...

[Lynn]

Bun, I am so sorry for your losses and I just wanted to wish you well on your TTC journey. It is a hard and emotional journey which unfortunately there are many of us travelling.

My biggest trouble atm is losing hope with it all and fighting off depression.

I can understand how you feel. We struggled for two year to have a baby and evenutally conceive Cooper on Clomid. However, we heartbreakingly lost Cooper to a cord accident (nothing to do with Clomid). I am again on the struggling TTC journey but this time Clomid has not worked for me so I am on FSH injections/IUI. Basically I just wanted to give you hope that you can fall pg on Clomid and I hope so much that you get to hold that precious earth bubba in your arms very soon. I too find that I am losing hope but I have surrounded myself with wonderful support people who help me through my darkest days and somehow make me believe that there is hope and that it will happen for me one day. It WILL happen for you one day too. I know it is very hard to be patient because I am the most impatient person, I want my baby yesterday and I am sure that is how you feel.

Wishing you the best of luck. Take care and best wishes.

luv & hugs
Lynn
xxxxxxxxxxx

[Bun]

Deb - sorry, I didn't mean that my dr thinks it is NK cells. He mentioned NK cells at my first appointment when he went through all the possible causes of m/c generally, but he doesn't think this is my problem, and I have no reason to believe it is the problem. After getting all the tests done, at my last appointment he ruled it out completely and said he doesn't think that is the cause and that I didn't need to have the test done at this stage.

I did ask if I could be on prednisone anyway as a precaution and he said no. He seems confident that is not the cause of my m/cs, and said he doesn't want to prescribe drugs unless it is really necessary, and at this stage it isn't. Of course, if I were to m/c again, I would get the endo biopsy done and he would treat me accordingly should this turn out to be the problem, but he seems certain this is not an issue with me.

Now I am feeling really discouraged about clomid. I was really hoping that it would *fix* whatever is wrong and make my next pg last, but I am feeling so down about everything. Basically, if clomid isn't going to help me not miscarry, then is there any point? I was hoping, and thought from what my specialist said, that it would help to boost all the hormone levels up, so a better egg is released, and for further support in the LP, thus reducing the likelihood of another m/c.

I am having my cycle monitored, so will know exactly when to BD, which is good. I am taking a megaB vit in addition to my folate, and DH takes multi-vits with zinc.

Thanks for your comments about it not being unusual to go on and have a healthy baby at this point. I need that hope to keep going on with this journey.

Lynn - I am so sorry about your dear son Cooper. I have read your story and check out the TTCALL thread to see how you are going often. I am sorry that clomid hasn't worked for you this time and that you have had such a long hard road. I think you are a very strong woman and I am sure it will work for you. Thank you for your understanding. I am the same as you - wanted my baby yesterday!

[Inanna]

Bun, Clomid does just that. It boosts your hormones but I don't know that you get a "better egg".

If you have a LP defect than clomid will likely help you. For that reason alone I think it's a good idea and as I said I used it to effectively lengthen my LP.
I had 4 rounds before I conceived this baby. It's not a magical cure and it will not decrease your overall miscarriage rate. It will decrease the liklihood of a chemical miscarriage caused by a short luteal phase though.

I am sorry if I have deflated you. Bun, the great thing is you are ovulating well - the clomid will give a boost to those hormones that will hopefully lengthen your LP - thus increasing your chance of conceiving.

I will pop back again later to post more - I have to go out...

[Bun]

Deb - I suppose from what you have said, it is probably worthwhile taking clomid to prevent a chem pg since I do definitely seem to have a LPD, and I suppose there is also a slightly increased chance of conception, so maybe it will do the trick and get me pg soon and my next bub will stick! I don't know, I guess I am just trying to be positive,

Bun xx

[Inanna]

Bun that is why I am sure your specialist has recommended it. What I wanted to point out is that clomid doesn't give you protection from the type of miscarriage you have endured.

You should feel positive - it's an effective treatment for LPD - it has worked for me and many others... As I said without clomid I have had 3 chemical pregnancies... Likely (of course it can never be known) due to my short LP.

Sending you a big big hug my love - you are doing all the right things to get that Earth Baby...

I hope that this month brings you that beautiful with a sticky sticky baby...

[Bun]

Deb & Salt - thank you so much for your support and your kind words. It helps me so much to have such wonderful women to *talk* to about this and offer your support.

I am taking my last clomid tablet tonight, so I guess we will just have to wait and see and hope for the best. At least I know we have done everything we can do to try and bring a healthy bub into the world, and as you have said Deb, we have a good chance of the next one being ok.

Salt - thank you. I know you're not trying to gloss over anything, and I certainly hope that I have used up all my bad luck! It helps me to hear that you feel it will be positive next time, and I know that it will be positive for you next time too!

Thank you again, I don't know what I would do without your help.

Bun xx