CD 21 Blood Draw

So today is CD 21.  I went to the doctor's office right after I dropped Aidan off at school.  I brought along the paper I glued all my OPKs to, just to get a second opinion from the nurses.  Unfortunately none of them know much about OPKs and suggested to me that I start charting my temp instead of using the OPKs.  I think that's what I'm going to start doing.  Those little strips with the two lines of varying shades have been driving me bonkers.  I think my main problem is I stare at them for much too long.  I told the nurses I was pretty sure I didn't ovulate...it's just my intuition.  They told me not to count myself out and to stay optimistic until they call me with the results (most likely Monday).  Easier said than done....

Anyway, I left there even more depressed than I have been in a while.  Generally I get bummed out being in that office anyway...it just reminds me of that day.  But I guess my hormones are in overdrive, because when they put me in the same room I was in when they told me the worst news of my life, I honestly thought I was going to cry.  Everything hit me all at once...the smell of the room, the big framed picture of an infant's clasped hands that read "We thank God for Dr. Mixson", the picture film that covers the fluorescent light, and the sight of the stool where my husband anxiously sat waiting for me to change into a gown.  It was like emotional overload for me.  I held it together, but I won't lie, I hated being in that room.

So, that's it.  All I have to do is try to forget everything until Monday.  Everything that could be done this month, has been done.  If this doesn't work though, I'm feeling like a I'm going to have to take a break from the Clomid and start on Metformin so that we can try a combination of both.  Here's why:

"It is important to remember that 70 -80% of patients who will respond to Clomid will ovulate on the 50 - 100 mg dosage and of those who get pregnant 80 - 90% will do so within 3 - 4 ovulatory cycles.

What to do about Clomiphene failures? When clomiphene fails, it is extremely important to distinguish between ovulation and conception failure

Clomid Ovulation Failure: This is arbitrary defined as failure to ovulate on doses of 150 mg / day for 5 days (even though 10 - 20% of patients can ovulate on higher dosages, it is important to re-evaluate the patient at this stage. Clomiphene is also approved by the FDA for a maximum dose of 750 mg / cycle.)

a)Clomid doses can be increased to a maximum of 250 mg / day for five days or consider increasing the duration (100 mg / day for 8 days).

b) Clomid does not work well in extremely obese patients (> 200 lbs or BMI > 30).These patients usually have insulin resistance and those patients should be highly encouraged to lose weight before induction of ovulation. Insulin sensitizing agents such as Metformin (Glucophage) should be the primary treatment. Metformin can be started at the dose of 500 mg / day for one week, increased to 500 mg p.o., b.i.d. for the next week, and maintained at 500 mg p.o. t.i.d. from the third week onwards.

Patients should be placed on a BBT chart while on Metformin therapy. Approximately, 35 % of patients will ovulate on Metformin and weight loss only within 2 to 3 months of therapy. For those patients who fail to ovulate on Metformin alone, Clomid can be added at a dosage of 50 mg / day for five days. 80-90% of those patients will ovulate on Metformin and clomiphene therapy."

That's as good an answer to all the questions I have as any. If the 100mg dose fails, I will obviously not fall into the 70-80% of women. I know it's not even certain if I have to worry about it yet, but I'm a worst case scenario type of person. No harm in planning ahead, right?