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For those who are curious, we had our appointment with Dr. Gentry, our Reproductive Endocrinologist, today. We have to get another SA (semen analysis) done, and with my next period in January we will begin Clomid pills and Novarel injections. Please pray for us! I honestly can't wait just to get the process started! It feels good.........now here's to waiting one more month! In case anyone is curious about those meds, I am including some information! Happy Reading!
I am double-posting this on myspace and here for those who are truly interested!
Clomid Use and Abuse by Gary S. Berger, M.D.
Some women can't get pregnant because they don't secrete enough LH and FSH at the right time during the cycle and, as a result, they don't ovulate. For these women, the first drug doctors often prescribe is clomiphene citrate (Clomid, Serophene). This synthetic drug stimulates the hypothalamus to release more GnRH, which then prompts the pituitary to release more LH and FSH, and thus increases the stimulation of the ovary to begin to produce a mature egg.
Clomiphene is a good first choice drug when a woman's ovaries are capable of functioning normally and when her hypothalamus and pituitary are also capable of producing their hormones. In short, the woman's reproductive engine is in working order, but needs some revving up.
Structurally like estrogen, clomiphene binds to the sites in the brain where estrogen normally attaches, called estrogen receptors. Once these receptor sites are filled up with clomiphene, they can't bind with natural estrogen circulating in the blood and they are fooled into thinking that the amount of estrogen in the blood is too low. In response, the hypothalamus releases more GnRH, causing the pituitary to pump out more FSH, which then causes a follicle to grow to produce more estrogen and start maturing an egg to prepare for ovulation. Typically, a woman taking clomiphene produces double or triple the amount of estrogen in that cycle compared to pretreatment cycles
If a woman is menstruating, even if irregularly, clomiphene is usually effective, particularly if she develops follicles that aren't reaching normal size. Usually, a mature follicle is about 20 millimeters in diameter, or about the size of a small grape, just before it ruptures and releases its egg. Clomiphene may help small, immature follicles grow to maturity.
A low estradiol level in a woman's blood correlates with an inadequately stimulated, small follicle. A woman having a spontaneous ovulation cycle (that is, ovulating without the aid of fertility drugs) generally has peak estradiol levels ranging from 100 to 300 picograms (one trillionth of a gram)/ml. A woman may have enough hormones to produce an egg, but if her estradiol production by the follicles is low (less than 100 pg/ml), she may not adequately stimulate her cervix to produce fertile mucus or stimulate her endometrium to get ready to accept a fertilized egg for implantation. Clomiphene could boost the weak signals from the hypothalamus to the pituitary to the ovaries.
"A woman who ovulates infrequently, say at six-week intervals or less often, is also a good candidate for clomiphene therapy, since clomiphene will induce ovulation more frequently. The more a woman ovulates, the more opportunities her mature eggs have to be exposed to her husband's sperm and, therefore, the greater her chance to become pregnant.
Clomiphene is also often effective for a woman with luteal phase defect (LPD). A woman with LPD may begin the ovulation process properly, but her ovarian function becomes disrupted, resulting in low production of the hormone progesterone in the luteal phase of the menstrual cycle. Following ovulation, the ovary produces progesterone, the hormone needed to prepare the uterine lining for implantation of the fertilized egg, which has divided and entered the uterine cavity. A fall in progesterone levels in the blood during this critical time can interfere with early embryo implantation or, even if a fertilized egg has already implanted, cause a woman to menstruate too early and end a pregnancy within a few days after implantation.
Using an LH-urine detector kit or keeping a basal body temperature (BBT) chart can help a woman taking clomiphene determine whether the luteal phase of her cycle is shorter than the normal fourteen days. The luteal phase of the cycle, the length of time from ovulation until she menstruates, has a normal range of thirteen to fifteen days. Clomiphene can often "tune up" the hypothalamus and pituitary so they keep producing the hormones the ovary needs to manufacture progesterone throughout the luteal phase.
"Of women whose only fertility problem is irregular or no ovulation at all, about 80 percent will ovulate and about 50 percent will become pregnant within six months of clomiphene treatments. About three percent of women on clomiphene have a multiple pregnancy, usually twins, compared with about one percent in the general population.
If a woman responds to clomiphene and develops a mature follicle (determined by adequate estrogen production and ultrasound examination), but has no LH surge by cycle day 15, then injection of the hormone human chorionic gonadotropin (HCG), which actslike LH, can be given to stimulate final egg maturation and follicle rupture, releasing the egg. The woman tends to ovulate about 36 hours after the LH surge or HCG injection, which can be confirmed by further ultrasound scans.
"Clomiphene is a relatively inexpensive drug, and is taken orally for only five days each month. The doctor attempts to initiate clomiphene therapy so that the woman ovulates on or around day 14 of a regular 28-day cycle. The simplest, most widely used dose starts with one daily 50 mg. tablet for five days starting on cycle day three or five. If a woman ovulates at this dose, there is no advantage to her increasing the dosage. In other words, more of the drug isn't necessarily better. In fact, more may be worse, producing multiple ovulation, causing side effects such as an ovarian cyst or hot flashes, and most commonly, interfering with her fertile mucus production (Emphasis is Theresa Venet Grant's.)
If a woman doesn't ovulate after taking one clomiphene tablet for five days, then her doctor will usually double the daily dose to two tablets (100 mg) in her next cycle, and if she still doesn't respond, then triple the daily dose to 150 mg, or add another fertility medication such as human menopausal gonadotropin (Pergonal) in the next cycle. Some doctors increase the dose up to 250 mg. a day, but this is NOT recommended by either of the drug's two manufacturers. Women tend to have side effects much more frequently at higher doses.
If the dose of clomiphene is too high, the uterine lining may not respond completely to estrogen and progesterone stimulation, and may not develop properly. As a result, a woman's fertilized egg may not be able to implant in her uterus.
Side Effects
Because Clomiphene binds to estrogen receptors, including the estrogen receptors in the cervix, it can interfere with the ability of the cervical mucus glands to be stimulated by estrogen to produce fertile mucus. Only "hostile" or dry cervical mucus may develop in the days preceding ovulation. If this occurs, adding a small amount of estrogen beginning on cycle day 10 and continuing until the LH surge may enhance cervical mucus production.
Some women taking clomiphene experience hot flashes and premenstrual-type symptoms, such as migraines and breast discomfort (particularly if they have fibrocystic disease of the breasts). Visual symptoms such as spots, flashes or blurry vision are less common and indicate that treatment should stop.
Clomiphene is a very safe medication with relatively few contraindications. Preexisting liver disease is one contraindication since clomiphene is metabolized by the liver. Enlarged ovaries are also a contraindication since clomiphene may occasionally produce hyperstimulation of the ovaries.
The hot flashes are just like the hot flashes women experience at menopause when the level of estrogen circulating in the blood is low. The clomiphene fools the brain into thinking that blood estrogen levels are low.
Novarel
What is human chorionic gonadotropin injection?
HUMAN CHORIONIC GONADOTROPIN (also known as 'HCG', brands include A.P.L.®, Chorex®, Novarel®, Ovidrel®, Pregnyl®, Profasi®) is a hormone that is used for different reasons in men and women. HCG has actions similar to a hormone produced by the pituitary gland in both sexes, called LH, or luteinizing hormone. HCG can help women with fertility problems. To increase a woman's chance of getting pregnant, HCG is used in combination with other fertility drugs. For some men or adolescent males, HCG helps to stimulate the production of testosterone (male sex hormone) and sperm. HCG may also be used in select male children with cryptorchidism, a specific birth problem of the testes (male sex part). Human chorionic gonadotropin injections are available from many manufacturers; not all brands are interchangeable. Ovidrel® is the only recombinant (lab-derived) HCG product currently available.
How should I use this medicine? HCG is usually for injection into a muscle, like the thigh or buttocks. Occasionally the injection is given under the skin instead.
For women receiving infertility treatments: The HCG injection will be given by a health care professional during the day indicated by the doctor during the fertility treatment cycle. It will be given as one dose per cycle under the direction of a doctor with experience in managing fertility disorders. You may be taught how to give this medicine to yourself. Your fertility specialist will explain the needed procedures.
What side effects may I notice from receiving HCG?
Side effects that you should report to your prescriber or health care professional as soon as possible:
Any symptoms of rare allergic reactions:
•difficulty breathing or shortness of breath
•itching
•skin rash or hives
•swelling of the areas of the mouth or throat
For women on fertility treatments:
•indigestion
•nausea, vomiting
•passing small amounts of urine
•shortness of breath
•stomach area or pelvic pain or bloating
•swelling
•rapid weight gain
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
•headache
•mood changes, such as irritability, restless feelings, or anger
•pain, irritation or inflammation at the injection site
•tiredness
What should I watch for while taking HCG?
For women on HCG for fertility treatments:
Your prescriber or health care professional must closely monitor you.
If you are a woman receiving HCG to help you get pregnant, it is important to keep all records required by your health care professional on body temperature and intercourse, and to carefully follow any directions for urine or blood testing or ultrasound exams. If you think you have become pregnant, contact your prescriber at once.
Certain fertility treatments increase your chances of having multiple babies, like twins or triplets.
Drinking alcoholic beverages or smoking tobacco may decrease some person's chances of becoming pregnant. Talk with your health care professional about not drinking alcohol and decreasing tobacco use during your fertility treatments.
I am double-posting this on myspace and here for those who are truly interested!
Clomid Use and Abuse by Gary S. Berger, M.D.
Some women can't get pregnant because they don't secrete enough LH and FSH at the right time during the cycle and, as a result, they don't ovulate. For these women, the first drug doctors often prescribe is clomiphene citrate (Clomid, Serophene). This synthetic drug stimulates the hypothalamus to release more GnRH, which then prompts the pituitary to release more LH and FSH, and thus increases the stimulation of the ovary to begin to produce a mature egg.
Clomiphene is a good first choice drug when a woman's ovaries are capable of functioning normally and when her hypothalamus and pituitary are also capable of producing their hormones. In short, the woman's reproductive engine is in working order, but needs some revving up.
Structurally like estrogen, clomiphene binds to the sites in the brain where estrogen normally attaches, called estrogen receptors. Once these receptor sites are filled up with clomiphene, they can't bind with natural estrogen circulating in the blood and they are fooled into thinking that the amount of estrogen in the blood is too low. In response, the hypothalamus releases more GnRH, causing the pituitary to pump out more FSH, which then causes a follicle to grow to produce more estrogen and start maturing an egg to prepare for ovulation. Typically, a woman taking clomiphene produces double or triple the amount of estrogen in that cycle compared to pretreatment cycles
If a woman is menstruating, even if irregularly, clomiphene is usually effective, particularly if she develops follicles that aren't reaching normal size. Usually, a mature follicle is about 20 millimeters in diameter, or about the size of a small grape, just before it ruptures and releases its egg. Clomiphene may help small, immature follicles grow to maturity.
A low estradiol level in a woman's blood correlates with an inadequately stimulated, small follicle. A woman having a spontaneous ovulation cycle (that is, ovulating without the aid of fertility drugs) generally has peak estradiol levels ranging from 100 to 300 picograms (one trillionth of a gram)/ml. A woman may have enough hormones to produce an egg, but if her estradiol production by the follicles is low (less than 100 pg/ml), she may not adequately stimulate her cervix to produce fertile mucus or stimulate her endometrium to get ready to accept a fertilized egg for implantation. Clomiphene could boost the weak signals from the hypothalamus to the pituitary to the ovaries.
"A woman who ovulates infrequently, say at six-week intervals or less often, is also a good candidate for clomiphene therapy, since clomiphene will induce ovulation more frequently. The more a woman ovulates, the more opportunities her mature eggs have to be exposed to her husband's sperm and, therefore, the greater her chance to become pregnant.
Clomiphene is also often effective for a woman with luteal phase defect (LPD). A woman with LPD may begin the ovulation process properly, but her ovarian function becomes disrupted, resulting in low production of the hormone progesterone in the luteal phase of the menstrual cycle. Following ovulation, the ovary produces progesterone, the hormone needed to prepare the uterine lining for implantation of the fertilized egg, which has divided and entered the uterine cavity. A fall in progesterone levels in the blood during this critical time can interfere with early embryo implantation or, even if a fertilized egg has already implanted, cause a woman to menstruate too early and end a pregnancy within a few days after implantation.
Using an LH-urine detector kit or keeping a basal body temperature (BBT) chart can help a woman taking clomiphene determine whether the luteal phase of her cycle is shorter than the normal fourteen days. The luteal phase of the cycle, the length of time from ovulation until she menstruates, has a normal range of thirteen to fifteen days. Clomiphene can often "tune up" the hypothalamus and pituitary so they keep producing the hormones the ovary needs to manufacture progesterone throughout the luteal phase.
"Of women whose only fertility problem is irregular or no ovulation at all, about 80 percent will ovulate and about 50 percent will become pregnant within six months of clomiphene treatments. About three percent of women on clomiphene have a multiple pregnancy, usually twins, compared with about one percent in the general population.
If a woman responds to clomiphene and develops a mature follicle (determined by adequate estrogen production and ultrasound examination), but has no LH surge by cycle day 15, then injection of the hormone human chorionic gonadotropin (HCG), which actslike LH, can be given to stimulate final egg maturation and follicle rupture, releasing the egg. The woman tends to ovulate about 36 hours after the LH surge or HCG injection, which can be confirmed by further ultrasound scans.
"Clomiphene is a relatively inexpensive drug, and is taken orally for only five days each month. The doctor attempts to initiate clomiphene therapy so that the woman ovulates on or around day 14 of a regular 28-day cycle. The simplest, most widely used dose starts with one daily 50 mg. tablet for five days starting on cycle day three or five. If a woman ovulates at this dose, there is no advantage to her increasing the dosage. In other words, more of the drug isn't necessarily better. In fact, more may be worse, producing multiple ovulation, causing side effects such as an ovarian cyst or hot flashes, and most commonly, interfering with her fertile mucus production (Emphasis is Theresa Venet Grant's.)
If a woman doesn't ovulate after taking one clomiphene tablet for five days, then her doctor will usually double the daily dose to two tablets (100 mg) in her next cycle, and if she still doesn't respond, then triple the daily dose to 150 mg, or add another fertility medication such as human menopausal gonadotropin (Pergonal) in the next cycle. Some doctors increase the dose up to 250 mg. a day, but this is NOT recommended by either of the drug's two manufacturers. Women tend to have side effects much more frequently at higher doses.
If the dose of clomiphene is too high, the uterine lining may not respond completely to estrogen and progesterone stimulation, and may not develop properly. As a result, a woman's fertilized egg may not be able to implant in her uterus.
Side Effects
Because Clomiphene binds to estrogen receptors, including the estrogen receptors in the cervix, it can interfere with the ability of the cervical mucus glands to be stimulated by estrogen to produce fertile mucus. Only "hostile" or dry cervical mucus may develop in the days preceding ovulation. If this occurs, adding a small amount of estrogen beginning on cycle day 10 and continuing until the LH surge may enhance cervical mucus production.
Some women taking clomiphene experience hot flashes and premenstrual-type symptoms, such as migraines and breast discomfort (particularly if they have fibrocystic disease of the breasts). Visual symptoms such as spots, flashes or blurry vision are less common and indicate that treatment should stop.
Clomiphene is a very safe medication with relatively few contraindications. Preexisting liver disease is one contraindication since clomiphene is metabolized by the liver. Enlarged ovaries are also a contraindication since clomiphene may occasionally produce hyperstimulation of the ovaries.
The hot flashes are just like the hot flashes women experience at menopause when the level of estrogen circulating in the blood is low. The clomiphene fools the brain into thinking that blood estrogen levels are low.
Novarel
What is human chorionic gonadotropin injection?
HUMAN CHORIONIC GONADOTROPIN (also known as 'HCG', brands include A.P.L.®, Chorex®, Novarel®, Ovidrel®, Pregnyl®, Profasi®) is a hormone that is used for different reasons in men and women. HCG has actions similar to a hormone produced by the pituitary gland in both sexes, called LH, or luteinizing hormone. HCG can help women with fertility problems. To increase a woman's chance of getting pregnant, HCG is used in combination with other fertility drugs. For some men or adolescent males, HCG helps to stimulate the production of testosterone (male sex hormone) and sperm. HCG may also be used in select male children with cryptorchidism, a specific birth problem of the testes (male sex part). Human chorionic gonadotropin injections are available from many manufacturers; not all brands are interchangeable. Ovidrel® is the only recombinant (lab-derived) HCG product currently available.
How should I use this medicine? HCG is usually for injection into a muscle, like the thigh or buttocks. Occasionally the injection is given under the skin instead.
For women receiving infertility treatments: The HCG injection will be given by a health care professional during the day indicated by the doctor during the fertility treatment cycle. It will be given as one dose per cycle under the direction of a doctor with experience in managing fertility disorders. You may be taught how to give this medicine to yourself. Your fertility specialist will explain the needed procedures.
What side effects may I notice from receiving HCG?
Side effects that you should report to your prescriber or health care professional as soon as possible:
Any symptoms of rare allergic reactions:
•difficulty breathing or shortness of breath
•itching
•skin rash or hives
•swelling of the areas of the mouth or throat
For women on fertility treatments:
•indigestion
•nausea, vomiting
•passing small amounts of urine
•shortness of breath
•stomach area or pelvic pain or bloating
•swelling
•rapid weight gain
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
•headache
•mood changes, such as irritability, restless feelings, or anger
•pain, irritation or inflammation at the injection site
•tiredness
What should I watch for while taking HCG?
For women on HCG for fertility treatments:
Your prescriber or health care professional must closely monitor you.
If you are a woman receiving HCG to help you get pregnant, it is important to keep all records required by your health care professional on body temperature and intercourse, and to carefully follow any directions for urine or blood testing or ultrasound exams. If you think you have become pregnant, contact your prescriber at once.
Certain fertility treatments increase your chances of having multiple babies, like twins or triplets.
Drinking alcoholic beverages or smoking tobacco may decrease some person's chances of becoming pregnant. Talk with your health care professional about not drinking alcohol and decreasing tobacco use during your fertility treatments.
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