Clomifene

Clomifene (or Clomid) is a fertility drug given to stimulate the release of an egg (or eggs) in women with suspected ovulatory problems. It is a relatively early intervention and is used because it's pretty useful in a lot of cases where you have irregular cycles. If it works (makes you ovulate) it's easier to predict your fertile days, time intercourse to match those days and increase the chances of sperm meeting egg in the right place at the right time.

As far as I understand (and I have done *quite* a lot of reading on the subject) the best time to have sex is in the four days coming up to ovulation, although regular intercourse is important as well. The reason that having sex just on the day you think you ovulate isn't the recommendation is that a) you might have miscalculated your dates, b) your cycle might be a couple of days out in this particular month and c) sperm can take a while to get to where they need to meet the egg.

a) It's very easy to miscalculate dates. Firstly, day one of the cycle is generally accepted to be the first day of your period. This is not the first day you get a little bit of spotting. Day one is the first day you see red blood. If your period starts in the evening, day one is calculated as the first full day of bleeding (i.e. the first morning when you have bleeding). Secondly, with a complicated and busy life, it is actually really easy to forget exactly which day your period started. A lot of women who are trying to have a baby will track their cycles using a fertility app, this does all the calculations for you as long as you input your day 1.

b) Your cycle starts on the first day of your period, i.e the shedding of the previous month's unfertilised egg. This means that you know how long last month's cycle was. You can look back and calculate when you ovulated within that cycle, because in most cases you ovulated about 14 days before the start of your period. However, you can't see into the future, so you might ovulate on day 14 of your cycle this month, or on day 16, or on day 12. Therefore it is best to have 'baby-making' sex regularly, beginning a few days before the predicted middle of your cycle and for a few days after. You're more likely to catch ovulation that way.

c) I didn't know this at all! Sperm takes time. An ejaculation takes (as I'm sure most people know) a matter of moments. When the sperm is in there... well surely it's in the right place? Remember, sperm is microscopic, as in seriously teeeeeeny tiny. For sperm, the journey to meet the egg is a really long way. Also, the egg and the sperm need to meet up in the fallopian tubes ideally, to fertilise, start multiplying cells and then to travel down into the womb and implant. So timing is pretty important. If the egg has descended through the tubes and into the womb: it's too late. If the sperm runs out of energy before it has reached the tubes: it's too late. Also, you have no idea when any of this is happening, some women say that they can feel ovulation, that's fine, but it's not like your body sends you a text message to say 'just so you know, I'm planning on releasing an egg from the left ovary on Tuesday at 4.51pm' and even if it did, you can't instruct the sperm to head left.

But all of that is totally irrelevant if you are not ovulating in any kind of predictable manner. It's really emotionally wearing to take pregnancy tests every two weeks *just in case*. There's always a shred of hope, even when I know my cycles could be anywhere from five weeks to five months. But because the egg comes first, then the period, there's always a tiny chance I *might* have ovulated and fallen pregnant. Of course, it never happened. Not for me anyway. That's why we are where we are.

So, clomifene. After the blood tests and the HSG, the semen analysis and the Provera, we were given the go ahead to try clomifene. I honestly thought this would be our magic bullet. I thought, great, obviously I'm not ovulating, clomifene will make me ovulate and then I will get pregnant. There's nothing wrong with the mechanics of my reproductive system, just for some reason, my body neglects to mature and release an egg. So, the solution seems pretty obvious: chemically encourage my ovaries to mature and release one or more eggs.

I had to take provera to kickstart my cycle and get a day one. I took clomifene (50mgs) from day 2 to day 6 of my cycle. The clomifene is designed to trick your body into producing the hormones to stimulate follicle growth and then release the matured egg.

Side note: Follicles are the sacs where the eggs grow. Eggs are microscopic however, follicles can be around 2 centimetres big)

The first cycle on clomifene was eventful. Clomifene stimulates your body in a way that (especially with irregular cycles) you are just not used to. There are hormones flying around that I just don't know how to deal with because I haven't had to do it on a regular basis, ever. The most disruptive side effects were:

the hot flushes: at night waking up feeling red hot and absolutely drenched in sweat is really not fun.

the swinging emotions: One minute, I would feel optimistic and like I was walking on air, the next moment I would be crying for no reason. It was hard for us, my husband never knew what to say to me as I would either cry or scream at him. Thankfully, he has plenty of experience dealing with me as an irrational being and has developed coping mechanisms. Many coping mechanisms involve chocolate.

(partly leading on from the coping mechanisms mentioned above) the weight gain. I gained weight. It is very easy for me to gain weight, however, I could gain upwards of 3lbs in a week at certain points of taking the clomifene. I'm trying very hard to lose weight, as being at a healthy weight helps you get pregnant and can make pregnancy more comfortable.

thrush: changes in hormones can lead to all sorts of lovely imbalances, which can seriously upset the foof. My nether regions reacted badly to this and thrush is uncomfortable at the best of times. With the clomifene induced thrush and hot sweats, I was not sleeping well which then makes the mood swings worse.

It really was such fun.

I didn't even ovulate on cycle 1! That was a massive blow. I thought, having been so strongly affected by the drug, I must have ovulated. How could I get these side effects if it hadn't even worked?! So, I had to wait another two weeks after my cycle day 28 *just in case* I was pregnant. Testing obsessively every other day (Ok, pretty much every day) and getting negatives every time is really disheartening, but I just couldn't risk taking provera and inducing a bleed if there was any chance, no matter how tiny, that there might actually be a little fertilised egg nestling in there. By the time you get to cycle day 40+ and you're still getting negative tests, it's a pretty definite no. So I got to take Provera again.

Lather, Rinse, Repeat. Side effects again. Not as strong as on the first cycle, which is a plus but also made me feel that the drugs must not be working. In Cycle 2, I had a day 21 blood test, which shows the hormone level and indicates whether or not ovulation has taken place. I don't know what the blood test showed, but bang on day 28, I got my period. This means that I DID ovulate- Hooray! It also means that, even though I ovulated, I am NOT pregnant - boo. But, it means, I have eggs, they are able to be released from my ovaries. When I ovulate, my body is able to do what it is supposed to do and shed the lining of my uterus when that egg is not fertilised. This is, actually quite reassuring.

Cycle 3 is the same as cycle 2, blood test at day 21 and a period. The period was day 32 though, not day 28. From day 28 I was cautiously optimistic one moment (it made me ovulate last time, my period is late...) and down in the dumps the next (why would it work one month and not the next?) Testing pretty much every day from day 28 and getting negatives is really disheartening. There are no answers as to why it's not working or what's even happening. But obviously, day 32 arrived and so did my period.

Cycle 4: same again.

Clomifene made me ovulate in three consecutive cycles. If it was going to help me get pregnant I should have got pregnant within those three cycles. There's no point carrying on or increasing the dose. It appears it's not purely an ovulation issue; there's something else going on.

At this point, IVF is our next step.