Infertility

It has been determined that your ovaries are not producing an egg each month. Because you are not ovulating, it has been recommended that you consider a trial of Clomiphene treatment.

Clomiphene comes in a variety of brands as well as in generic form. Two common brand names are Clomid and Serophene. Clomiphene is generally a very safe drug; however, there are some risks to taking this drug that you should know about. There is about a five percent risk of a twin pregnancy in patients who are taking clomiphene. There is also a one percent risk of triplets. Thus, 94 percent of patients who conceive on clomiphene carry just one fetus.

Clomiphene is successful in producing ovulation in 80 percent of patients who are not ovulating. Pregnancy is achieved in 40 percent of patients who are being treated with clomiphene.

Clomiphene may also cause a condition called ovarian hyperstimulation syndrome which is where large ovarian cysts develop. The symptoms of hyperstimulation syndrome include severe abdominal pain, bloating, ovarian enlargement, and poor urine output. This complication is very rare. Some research has suggested that there may be a potential increased risk of ovarian cancer if the medication is used for extended periods of time.

Common side effects include: hot flashes, visual symptoms (spots in front of the eyes), nausea, and breast tenderness. Clomiphene is not associated with an increase in birth defects.

The schedule for taking clomiphene is as follows:

• Day 1 — This is the first day of your menstrual period, or this is the first day you have bleeding after a period is brought on by medication such as Provera.
• Day 5 — This is the first day that you take clomiphene. The medicine is usually taken daily for five days at a time.
• Days 8 through 16 — This is the most likely time that you will ovulate. It is recommended to time intercourse daily around this time of your cycle. If you are using an ovulation kit, such as Ovu-Quick, you should time intercourse around the time of the color change with the kit. You should use the ovulation kit in the afternoon rather than in the morning. Avoid drinking a lot of fluids during the time that you are checking for ovulation, as this may dilute the urine and affect the ovulation kit results. You should restrict fluids somewhat. Plan to time intercourse on the day after the color change occurs.
• Day 9— This is the last day you will take clomiphene.
• Day 21 — A progesterone test is usually taken at this time. This blood test can be drawn at any outpatient lab. Check your insurance to find a participating lab, Quest or Lab Corp. You do not need an appointment to have this blood test. When you go to the laboratory, please tell the laboratory personnel that your doctor has asked that you obtain a serum progesterone level because of your diagnosis of anovulation. After we receive the results of your progesterone level, we will notify you. If the progesterone level is elevated, it suggests that you have ovulated. If you have not ovulated, there may be a need to increase your dosage of clomiphene in the next cycle.
• Day 28 — If you have conceived, you should do a home pregnancy test when you are seven days late for your period. If your period starts on day 28 or shortly thereafter, you should contact us in order to obtain the proper dosage of clomiphene for the next cycle. You should not take another course of clomiphene until you have had a period.

• Combination of the above
• Extreme semen viscosity
• Mucous of poor quantity and/or quality
• Poor sperm quantity (low counts)
• Poor sperm quality
• Retrograde ejaculation (failure of emission)

1. Hours of sexual abstinence.
2. Exposure of sperm to the seminal plasma (should not exceed 30 minutes.)
3. Presence of white blood cells and/or dead cells
4. Capacitation time
5. Ideally there should be no sexual activity for 48 hours but not more than 5 days prior to semen collection.
6. Ideally collection should be done at the lab in order to process the specimen within 30 minutes. If it is necessary to collect the specimen elsewhere, the patient should produce a "split ejaculate" using a set of containers taped together. Special wash media, provided by the Andrology Lab, should be used for insemination.
7. Ideally through special separation processes, white blood cells and dead cells are removed from the specimen used for insemination.

* The wash media supplemented with non-human protein is made in the lab and closely resembles that used in IVF procedures. Each batch is portioned into individual tubes of 7 and 15 ml., therefore media used to prepare sperm is never exposed to room temperature until it is used. Each batch must support sperm survival for at least 24 hours.

* Only approved plastic ware, materials and reagents which come in contact with the specimen are used.

The physicians at The OB-GYN Center offer intrauterine insemination with or without clomiphene therapy. This procedure is performed by taking a sample of semen and placing a tiny plastic catheter through the cervical opening into the uterine cavity. The semen specimen is then injected into the uterine cavity.

Intrauterine insemination may be recommended in situations where the wife's cervical mucous is of poor quantity and/or quality, and the husband has a low sperm count or has lots of abnormally shaped sperm.

Semen analysis is a first line infertility test. It is a panel of preliminary measurements and evaluations done on a semen sample. Because sperm counts and quality can vary, often two or three analyses may be requested by your physician.

This test is done at the Swedish Medical Center Andrology Lab, located at 601 East Hampden Avenue, next to Swedish Medical Center. Our phone number is (303) 788-7672. This test can be done by appointment between 6:30am and 4:30pm, Monday through Friday, as well as 6:30am until 11:00am on Saturdays and Sundays.

Semen should be collected after two days but not more than five days of sexual abstinence. The semen analysis should be collected at the laboratory. It is preferred that the semen analysis be collected at the laboratory. If this is not possible, it should be collected in a container which is provided by the andrology Lab. It then must be delivered within one hour of collection.

The semen analysis is obtained by masturbation with ejaculation directly into the container. It is important that all of the ejaculated semen goes into the container. If some of the specimen is lost, it is important to let the lab know. Studies have shown that men produce 80 percent of the sperm in the first two drops of semen.

The semen specimen should not be collected in condoms, because they often have spermicide on them. There are special condoms available from the andrology lab which can be used to collect the specimen if necessary.

Coitus interruptus (withdrawal) is not an acceptable method of collecting the semen specimen because of the loss of the first portion of the semen specimen.