Clomid Resistance and Improving Ovulation Response

 

Letrozole VS. Clomid for ovulation induction?

Video taken from the channel: Dominion Fertility


 

PCOS-evaluation and treatment

Video taken from the channel: Wesley Davis, M.D.


 

Dr Sachin Kulkarni: Letrozole and Clomid

Video taken from the channel: Fertility Courses


 

How to get pregnant fast with ovulation problems

Video taken from the channel: Infertility TV


 

PCOS patient, not responding to ovulation induction

Video taken from the channel: Fertility Courses


 

PCOS case: Improving success

Video taken from the channel: Fertility Courses


 

Trying to Conceive with PCOS: Fertility tips| BOARD CERTIFIED PCOS Expert | InfertilityTV

Video taken from the channel: Infertility TV


Studies have shown that Letrozole may induce ovulation in some women with PCOS who do not respond to Clomid, as well as some women with unexplained infertility and Clomid resistance. In one study, women with Clomid resistance and PCOS were more likely to ovulate when taking the medication Letrozole (79.3% ovulated), than when taking Clomid in combination with two, low dose injections of. Some women with PCOS have been observed to have good response to a drug called Letrozole, known as Femara.

This drug may induce ovulation in some women with PCOS who are Clomid resistant, as well as some who have unexplained infertility. There is a wide variety of infertility treatments available for women experiencing difficulties conceiving. This section deals with many of them. Clomid Resistance and Ways to Improve Ovulation Response to Clomid.

While 75% of women taking Clomid for anovulation will ovulate, 25% will not. Without ovulation, pregnancy achievement is impossible. If you don’t achieve ovulation on Clomid, will you need to move on to stronger drugs or more complex treatments?

Not necessarily. Clomid Resistance. The current first line therapy is the weight loss in the obese group of women, and then induction ovulation with clomiphene (1, 3). Since 20-25% percentage of PCOS women show resistance to clomiphene citrate they are unable to ovulate (4).

An increased level of FSH hormones improves the chances of growing an ovarian follicle that can then trigger ovulation. In women who ovulate irregularly, approximately 80 percent who take clomiphene will ovulate and 30 to 40 percent of all women who take clomiphene become pregnant. Clomiphene Resistant PCOS: Treatment Options. Clomiphene Citrate (Clomid, Serophene) was introduced into clinical medicine for the treatment of anovulation in the 1960’s. Its introduction represented a major breakthrough in the medical management for ovulation induction.

Clomiphene Citrate (Clomid, Serophene) was introduced into clinical medicine for the treatment of anovulation in. Clomid is a 50-milligram pill that is usually taken for five days in a row in the beginning of a woman’s menstrual cycle. Day three, four, or five is typical for a Clomid start date.

In this study clomiphene citrate-resistant patient had different response to letrozole in a way that 44.24% of the cycles had normal follicles and 23.89% of them resulted in pregnancy. Increasing the dosage can improve the chance of ovulation and pregnancy. Yeah, I wouldn’t be pleased with that.

My response to Clomid stunk and my response to Bravelle isn’t that great, either I have PCOS and always have a ton of follicles on Day 3, but I’ve still never triggered with more than one follicle in the end. Clomid (Clomiphene Citrate) Fertility Treatment. Clomid is one of the most popular fertility drugs.

It may be prescribed alone or in conjunction with another treatment, and it’s important to know how it works and what to expect when taking it.

List of related literature:

The majority of anovulatory patients will ovulate in response to 50 mg of Clomid.

“Management of Common Problems in Obstetrics and Gynecology” by T. Murphy Goodwin, Martin N. Montoro, Laila Muderspach, Richard Paulson, Subir Roy
from Management of Common Problems in Obstetrics and Gynecology
by T. Murphy Goodwin, Martin N. Montoro, et. al.
Wiley, 2010

In both women with hypogonadotropic hypogonadism (WHO Group I) and those with clomiphene-resistant anovulation (WHO Group II), initial attempts to induce ovulation generally should begin with a low daily dose (75 IU daily) in a “step-up” treatment regimen designed to define the effective threshold of response.

“Clinical Gynecologic Endocrinology and Infertility” by Marc A. Fritz, Leon Speroff
from Clinical Gynecologic Endocrinology and Infertility
by Marc A. Fritz, Leon Speroff
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011

In both women with hypogonadotropic hypogonadism (WHO Group I) and those with clomiphene-resistant anovulation (WHO Group II) initial attempts to induce ovulation should begin with a low daily dose (75 IU daily) in a “step-up” treatment regimen designed to define the effective threshold of response.

“Clinical Gynecologic Endocrinology and Infertility” by Leon Speroff, Marc A. Fritz
from Clinical Gynecologic Endocrinology and Infertility
by Leon Speroff, Marc A. Fritz
Lippincott Williams & Wilkins, 2005

There is no one ideal regimen for ovulation stimulation in assisted reproduction, but the use of GnRH agonists together with gonadotropins prevents spontaneous endogenous LH surges and improves egg collection rate and subsequent fertilization and implantation.

“Oxford American Handbook of Obstetrics and Gynecology” by Errol R. Norwitz, S. Arulkumaran, I. Symonds, A. Fowlie
from Oxford American Handbook of Obstetrics and Gynecology
by Errol R. Norwitz, S. Arulkumaran, et. al.
Oxford University Press, 2007

Finally, it seems that LH can provide a means of selecting larger follicles and curtailing smaller, less mature follicles, and it can be used to rescue the luteal phase in patients in whom ovulation induction is performed with a-GnRH, a strategy that is used to prevent OHSS (49).

“Textbook of Assisted Reproductive Techniques: Two Volume Set” by David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham
from Textbook of Assisted Reproductive Techniques: Two Volume Set
by David K. Gardner, Ariel Weissman, et. al.
CRC Press, 2017

Unlike ovulation induction, in which the goal is to stimulate the release of a single oocyte in anovulatory women, the explicit goal of superovulation (for non-ART or ART purposes) is to cause more than one egg to be ovulated, thereby increasing the probability of conception in women with unexplained infertility (205).

“Berek & Novak's Gynecology” by Jonathan S. Berek
from Berek & Novak’s Gynecology
by Jonathan S. Berek
Wolters Kluwer Health, 2019

Once ovulation has been documented at a given dose of clomiphene, there is no advantage to increasing the dose in subsequent cycles.

“Obstetrics and Gynecology at a Glance” by Errol R. Norwitz, John O. Schorge
from Obstetrics and Gynecology at a Glance
by Errol R. Norwitz, John O. Schorge
Wiley, 2013

If follicle development is inadequate, an ovulatory stimulant such as Clomid is often used; these drugs help the follicle to mature more appropriately, which has the double benefit of producing a higher quality egg and a better functioning corpus luteum.

“Obstetrics and Gynecology in Chinese Medicine E-Book” by Giovanni Maciocia
from Obstetrics and Gynecology in Chinese Medicine E-Book
by Giovanni Maciocia
Elsevier Health Sciences, 2011

Doses as low as 25 mg daily for achievement of numerically safe folliculogenesis may be necessary in some women using clomiphene either for ovulation induction or superovulation.

“Reproductive Endocrinology and Infertility: Integrating Modern Clinical and Laboratory Practice” by Douglas T. Carrell, C. Matthew Peterson
from Reproductive Endocrinology and Infertility: Integrating Modern Clinical and Laboratory Practice
by Douglas T. Carrell, C. Matthew Peterson
Springer New York, 2010

Clomid is given in 50 mg doses daily for five days and ovulation usually occurs 48 hours later and menses 14 days later.

“Family Medicine: Principles and Practice” by J. L. Buckingham, E. P. Donatelle, W. E. Jacott, M. G. Rosen, Robert B. Taylor
from Family Medicine: Principles and Practice
by J. L. Buckingham, E. P. Donatelle, et. al.
Springer New York, 2013

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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35 comments

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  • Does Metformin helps to get pregnant? I haven’t seen my period for 4 months now so my doctor prescribes Metformin 500mg she said is gonna help me get pregnant is that right or wrong?

  • Doctor Davis I have a question….. I have not seeing my period for a long period. What I mean is I can be a year or more and I don’t get a period…. I am married and I want to have a bby what is the first step I should do or what would u recommend… I been trying to get pregnant for 5 years

  • I been taking metformin for 6months now & still not ovulating. Any suggestions to help simulate ovulation & getting pregnant ����

  • Hi. I have PCOS and now ttc. My obgyne put me on clomid 50mg but didnt ovulate. I’ve been using 1200mg NAC with 50mg clomid that time but it didnt work. My obgyne upped my clomid dose to 100mg and 500mg/day metformin. My question is, is it okey to take metformin and nac together? Thanks in advance for answering.

  • thanks for information… i got misscarriage on septamber 2018 due to cervix incomtenc..its 16 weeks pregnancy but now i took 2 month latrozol 1st month i took 1 medicine for 5 days i got abdominal pain…and 2nd month i took 2 medicine morning evening for 5 days i got bloating,vomit sention,hair fall,abodminal cramps,abodminal hevyness its like hardly walk..this issue started on 18 days and kept 7 days toady is 28 days this symptomes went….is it side effect?

  • hello doctor, I was diagnosed with PCOS and my doctor gave me Provera and Glucophage it has been 2 days since I finished my 1st session of Provera know my question is when might my menstruation start?
    I am a little bit nervous because I did have spotting one day and after a few days later my pelvic area was cramping a lot and I bled lightly with urine once.

  • Is the laser/electric current new? My doctor has not discussed this option with me. Does the procedure have a name so I could ask about it? Thanks doc!!

  • Very informative video. Thanks for sharing. I have lean PCOS and my blood sugar is absolutely normal (that means no insulin resistance right) shud i be using Metformin? Please do reply

  • Sir mjy pcos hy Dr ny mjy letrozolr use krny k liye diya tha pregnancy ky liy but pregnancy ne hoi ab Dr ny dobra Di hy phli br me hi Jo follicle bna tha wo weak tha kiya me pregnancy ky liy use kr sakti hun.

  • Plz plzzzzzzzzzzz help me sir ye 5 days ka course tha to maine 4 days ta time pr khai dawai lakin 5 day mai maine bhul gai dawai leni to 6 days k morning mai 7.55am ko li to koi problem nhi hogi na plzzzzzz reply kro

  • Hi sir meri shadi ko 3 sal ho gye pcos ki wja sy conceive nhi ho saka then doctr ny mjy daine 35 ka course krwaya 4 month phr mjy (hmg150 ) 3 injection dye jis k bd mera tvs hua jis m mera follicle size left overy 19mm and right20 mm tha can i conceive with this overy size..

  • Thank you for explaining everything clearly and in a calm tone. I have PCOS myself, and I was lucky to have a doctor with great bedside manner and who explained everything clearly to me, like you do. Keep doing what you do. We need more doctors like you in the medical field. ��

  • I’m not insulin resistance my period was just irregular till now it’s every 40 days I don’t take any type of medication or anything I’m 136 pounds. How do i know if I ovulate or not and is a every 40 days cycle bad?

  • Sir I have as like same problem 27 yr age PCOS n follicular study reveals after clomiphen 50n letroz2. 5 mg dose is13*11 on day 11, day 15*10 hmg 75 inj given still growth on 18 day was 15*14 till last periods are regular, plz suggests me right track of Rx for me

  • Hi doctor, please I want to know if I can start Letrozole on the first day of my period instead of the usual 3rd day of period, I’ve heard of
    some women say they were prescribed Letrozole from the 1st day of their period. Thank you

  • Hello day to all the  mum in the world, Giving a big thank you to Dr for helping me with some herbal medicine for getting pregnant after 5 years trying to conceive and took in thank you once again for helping me you can inbox him on this number +2349038080393,I also give my friend  the number in UK and she inbox him on the number and he help her byy sending herbal medicine  to her through DHL courier company and she received the herbs through DHL and the Dr  told her how to use it, she is mother today by twins baby girls please contact Dr  on the number WhatsApp or call +2349038080393 helps in 

    Fibroid cur

    Ouvlation booster

    Unblock fallopian tube

  • Plz tell me what i do because my doctor advice that take 1 tablet in day but i take it 2 time and now my mensiz day is 6th and i have no bleeding however my mensiz days were 8 days and 6th day i have spot but now this tablet i have no spot or bleeding on 6th day

  • Dr can I use clomide, ovulation induction drugs although I’m not trying to conceive, I’m not married but have PCOS for 1yr my period is irrigular

  • Doctor,I had IUI once but I didn’t conceive.my doctor gave me letrozol.is there any risk if I take this medicine?or shall I buy ovulation kit and check at home?

  • Is it common for the ovarian cysts to only show up on one of the ovaries? I was diagnosed four years ago and my acne immediately went away and period became regular after implementing lifestyle changes but images of my right ovary shows that I still have the disease. I am 30 years old and not planning on getting pregnant, would you recommend birth control? Would I have issues with fertility if it is only affecting one of my ovaries? Thanks for your help.

  • I have pcod my doctor give me fertility treatment clomid for 2 days of period till 5 days with this I’m taking metformin, Ovalife and glit tablets. She give me injections for egg quality and last 10 days of periods doctor prescribed me dhupastan tablets and 1 injections for egg repture she did scan after 2 days she says ovulation is done do pregnancy test and come. but pregnancy did not happen when my period started. Why does this happen after ovulation? Please help me doctor. I’m struggling a lot for childrens

  • I was diagnosed with PCOS in November 2018. I was having a period but was not ovulating. I was prescribed metformin. After taking the medicine I had terrible side effects. I had constant diarrhea, frequent urination, black outs of fatigue after I ate. The diarrhea was so bad at times I had trouble holding my bowels, so embarrassing around my fiancee and family and co workers. I was so frustrated that i decided to stop taking it and after some research, I started to really watch my blood sugar, and keep carbs down daily, take a super greens/fruit blend and try to eat healthy fats, protein and if I ate carbs tried to eat high fiber one. I slowed up on diary, i think it caused my skin to break out. I always exercise and lift weights, but I started to do more cardio but not to intense cause i think heavy weight lifting causes a hormonal imbalance, at least with me. I noticed my mood swings got better. My conditioned flared up when I was working a toxic job and going to school full time, emotions of anger kept my adrenaline high. So I had to change my lifestyle (found a new job). Started to practice stress techniques to master my emotions (prayer).. after all of this I noticed I started to ovulate. So diet(low carb), moderate exercise, stress management can help…Hopefully this can keep me from taking metformin for right now.

  • Metformin really helped me lose weight and fall pregnant and stop early miscarriage and recommended by fertility dr. After my own GP for 2 years said I had a baby already I’m fine. Turns out I had insulin resistant pcos wouldn’t have second daughter without clomid and metformin. Third baby however was clomid and not metformin by a supplement called inofolic also recommended by fertility dr as I said to him I was feeling not benefit from the metformin anymore. Pregnant again completely naturally this time, all I was doing was low sugar diet, increased protein in diet but nothing specific, yoga every day and HIIT (high intensity interval training) every other day.

  • I met my Husband when i was 25, We both knew we wanted kids and we knew we needed to get started soon. So i decided to go for fertility test and get some basic testing done, when the result came out my report was totally discouraging, my doctor told me that probably my only chance to get pregnant was to use a donor egg. I was absolutely shocked, we hadn’t even started trying yet, and all of a sudden I was told that I had absolutely no chance of getting pregnant on my own, my head was full of terrifying thoughts like I wouldn’t ever be a mother etc. But luckily my beloved, i found dr ebhariagbe spell and herbs whose contact was shared on Fertility blog. He is in West Africa and the charges for the herbs was so sweet and more than acceptable for me, the herbs was sent to me in few days and i followed the simple steps and i was confirmed pregnant a month after using the medication. I want everyone desperately in need for a child to contact him on this info,WhatsApp contact number +2349064310416 or visit his Instagram page via @dr_ebhariagbe. I spent less money than planned, you gonna get the best from him. Thanks.

  • Hi thanks for information I want to get pregnant but I’m not sure what to do to lose some weight and get pregnant healthy and mutually I’m currently using only metformins as doctors recommend thanks

  • Hello sir, I have a doubt..
    Letrozole is producing hypoestrogenic state… Then it vl effect the proliferation of endometrium also… But this does not happen…
    Usually used from D3.. which is the exact time wn regeneration has to start in the effect estrogen of endometrium… N v r stopping this estrogen production…. Plz explain

  • Thanks Dr. Davis! I have been taking my Medformin but I have just started again! I’ve had 3 failed IUIs, with injections no pregnancy. Should we try continue to Medformin, and lose weight, and try another IUI or should we try IVF?

  • Hi Sir my andrologist suggested to use letrozole 2.5 daily for month.How this tab will use for men.U mentioned this is mostly for women?

  • I haven’t had my. Grill thing in 3 months. But I think am going though the change off life am 44, years old. Can I be pergent I have took. Home test but it come back not pergent. But I am also rh o neg blood tape

  • Hi sir well explain i am trying to concieve for two years daignosed with pcos on right ovary. I m having irregular periods each cylce with the gap of two months.used clomid 50 mg from day 2-5 for two cycles with second cycle
    started taking inofolic, now i want to try letrozole 2.5 mg
    Plz explain what is best for me and explain inofolic

  • @Infertility TV  Will castor oil packs aid closed fallopian tubes? From a pcos individual that does not ovulate? Will it still be possible to conceive? Thank you Doctor.

  • What is the cause of heavy menstrual cycles for the first 7-10 days, then spotting with a yellowish/rusty colored discharge the rest of the month? Is this PCOS? BTW, this is post miscarriage. It has happened for multiple months now. Sorry for TMI.

  • I dont understand how this video does not have more likes……more information and better explaination in a video than some doctors in person

  • I feel like my shaving has increased over the years. How can I raise this topic with my GYN and inquire about getting checked for tumors?

    I have PCOS. My birth control pills have helped but now it’s not really working the same for my skin and facial hair �� but it still bring my period. Also I’m not overweight & never have been.

  • Hi DiMattina I would like to express how wonderful your videos are I wish it was an option to come to your clinic but live in Europe. I’m 33 with two natural kids been trying for 1 year to get our last baby with no luck. I chart my cycles and seem to be getting some anovulatory cycles and have been told my AMH 0.7ng I am longing so badly for our last baby. My doctor has suggested clomid day 2-6 my only worry is I have breast cancer in my family my grandmother and her mother had it. Is there any link with taking fertility medication and increasing my chances of getting breast cancer I have two children already so don’t want to put my health risk. I might go to London and opt for a natural cycle IVF that way I avoid ovulation stimulating drugs