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Re: use of clomidFrom: annette lee (aleeoc@rocketmail.com)Thu Dec 3 07:21:36 1998
In our RE practice we start with 100 mg clomiphene on day 3, 4 or 5. The only randomized study that I know of comparing start days was done by Chung Wu in the 1980's and showed no difference in efficacy or multiple rate between starting on cycle day 2,3,4 or 5. We then do our first scan 4 days after the last pill and then scan every other day, administering hCG when the lead follicles are 20 mm or more. We trigger with hCG to facilitate the timing of IUI and then we check progesterone levels 7 days after ovulation, supplementing if levels are < 15 ng/ml. We have done over 2000 cycles this way and have rarely found ovulation to fail to occur. After 3 unsucessful clomid cycles, we move on to gonadotropin and IUI. We find it useful to do a clomid challange test the first cycle, measuring FSH on days 3 and 10 with CC given days 5-9. Any FSH>13 in our lab indicates diminished ovarian reserve and a poor prognosis. I also check fasting insulin and glucose levels for ALL anovulatory patients and start Metformin if glucose/insulin is less than 5. PS - I passed the boards as well last week. What a relief! Annette Lee MD IVF New Jersey
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