Active substance: Clomiphene
Everything looked great until week 8 at a routine ultrasound when the heartbeat could no longer be seen.
I could sense surprise on Dr. I initially chose to miscarry naturally, and doctor Allen told me to call him if I changed my mind at any time because natural miscarriage can take weeks to even begin. I did end up changing my mind after walking around for a few weeks with no sign of a miscarriage.
Both were unsuccessful. Allen never pushed me into any kind of treatment. We took the summer off still hoping that I would get pregnant naturally. Now we are in the process of talking about IVF.
I do trust Dr. Allen and his employees.
In fact his med assistant called me last Sunday to give me some lab results.... I often do lab work where I live and they are really good about emailing orders and waiting for results to be faxed.
They are always prompt. Allen will help us get pregnant very soon!
Amenorrheic patients require additional evaluation to determine whether circulating estrogen levels are normal or frankly low. Any attempt at ovulation induction is generally futile in patients with elevated serum FSH levels.
To be effective, CC depends on normal operation of the hypothalamic-pituitary-ovarian feedback mechanism. In patients with low circulating estrogen levels and low or normal FSH concentrations, that feedback mechanism is clearly not operating normally; if it were, FSH levels would be frankly elevated.
Consequently, successful ovulation induction will require exogenous pulsatile GnRH treatment to reestablish normal communication between the hypothalamus and pituitary, or exogenous gonadotropins to stimulate the ovary directly.
Anovulatory women with a long history of oligomenorrhea or amenorrhea merit preliminary evaluation of the endometrium to ensure that they have not developed hyperplasia or neoplasia as a consequence of long-term unopposed estrogen stimulation, regardless of their age.
Endometrial biopsy is diagnostic, but is not always necessary.
Transvaginal ultrasound examination and measurement of endometrial thickness is a useful screening tool for identifying those having an abnormally thickened endometrium.
In the absence of any data to define the thickness that should be regarded as an indication for biopsy in the asymptomatic individual, thickness greater than 10 mm e.
Although successful ovulation induction and cyclic endogenous progesterone production will normalize the hyperplastic endometrium within one to three cycles, preliminary treatment with progestational agents is generally recommended before attempts at ovulation induction with CC begin in earnest.
Before CC treatment begins, other important causes of infertility should be excluded. Ovulation induction will achieve little purpose if significant male, uterine, or tubal factors are also present.
Preliminary semen analysis is always wise.
The test is relatively inexpensive, poses no risk, and when clearly abnormal, often will signal the need for a change in treatment strategy.
Evaluation of uterine and tubal factors, typically accomplished by performing a hysterosalpingogram HSG, should also be considered.