CD2: Down the Drug Addled Path, I go

Day two means start taking the clomid tablets. Or clomifene citrate 50mg to be exact. These tablets start on day 2 and there are 5 of them.

I took it at about 7am this morning.

Over 12 hours later and I don’t think I’ve noticed anything significantly different about me.

The rest of this blog is about the drug, my interpretations of what I’ve been told and read. I’m not a doctor. I may have a degree in the Biological Sciences where I studied whole units on the reproductive system, knowing certain things that most women don’t realise or learn about whilst trying to conceive. I already knew lots of the terms without needing to trust in google. Day two, however, is maybe a bit of a biology lesson.

Are we all sitting comfortably?

So, clomid is an ovarian stimulant, which means that it stimulates the ovaries, which produce the eggs that we want to be released so they can be fertilised by sperm. In my case (both for IUI and IVF), clomid is actually more intended to hyper stimulate the ovaries. In women that do not ovulate or have problems in doing so (irregularity, perhaps), clomid is given to simply stimulate – I don’t mean simply in a patronising way. For those that have another problem (or it’s unidentified), hyper stimulation will lead to more than one egg being released which is the aim.

During a normal cycle, FSH (Follicle Stimulating Hormone) increases, peaking on just day 3, causing a few follicles to start developing. Of these follicles, one will become dominant and, over the cycle, grow to between 18 and 30mm before being ovulated.

But I’m getting ahead of myself.

So FSH peaks on day 3 normally and the follicles it’s stimulated begin producing oestrogen (I’m British!) which eventually gets to a level where it inhibits FSH and LH (Luteinizing Hormone). This is a form of negative feedback. Substance A produces Substance B which, in turn, stops production of Substance A.

For IUI and IVF, this is not what is wanted because whilst multiple follicles start to develop in a normal cycle, usually only one becomes dominant with the other follicles dying. of course, this isn’t always the case because you get non-identical twins without scientific intervention. For fertility treatments, multiple follicles need to mature to the point of ovulation.

This is where clomid comes in first, working by inhibiting the oestrogen (British!) receptors up in the hypothalamus. In turn, this inhibits the negative feedback from FSH. Without the feedback loop, oestrogen from the follicles cannot stop the production and release of FSH. FSH levels continue rising past day 3 and more follicles than normal continue developing.

All make sense?

The most important potential consequence of over stimulating the ovaries is that they can become hyper stimulated. This can be painful if the, usually walnut sized, ovaries grow to the size of apples in your abdomen!

Just one more day (two sleeps) to go before the first hospital appointment, the scan and first FSH injection. From what I can gather it isn’t enough that the clomid helps natural FSH production to stimulate follicle growth, you also need extra FSH to really make sure there’s enough!

So far my brain has not become too drug addled!

~ Persephone M

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