The One With Our Confusing New Superpower
Hey! Welcome back to our little story. We were overwhelmed by the amount of support we've gotten over the last week -- thank you very much! If this is your first time here and you're (understandably) wondering what Project Waterbear is, check this out. Then come back here. Enjoy!
Clomid: the gateway drug of Western medicine fertility treatments. If you’ve been trying to conceive or around someone who’s trying to conceive or watched anything featuring characters who are trying to conceive, you might have heard of it. If you go to a doctor and start timidly asking about your fertility, no matter your symptoms and story, there’s a good chance you’re walking out of that office with a prescription for clomiphene citrate clutched in your hand.
[If you’re really lucky, you’ll take the scrip over to your pharmacy, find that they’re only doing drive-through pickups because Covid, and spend twenty minutes standing in a queue of cars in the rain, while very much not being in a car yourself.]
Ted and I were a bit giddy with relief when I first started taking it simply because it felt like we were finally getting help; that we were no longer struggling alone. It would’ve been hard not to get excited. Everyone we’d talked to acted like it was a done deal that I’d get pregnant instantly with Clomid. (My doctor even said that I should only take it “if I wanted to get pregnant right away.”)
Anyway.
CLOMID 101
Clomid is a common, cheap, and comprehensive fertility drug. It helps you ovulate, if that’s a problem you’re having. If it isn’t, Clomid helps improve your ovulation in various ways. It can be taken via injection or pill; we opted for pills. When you’re on it, you take it for five days in the beginning of your cycle - days 3-7, if you’re going for ‘ovulation improvement’, and days 5-9, if you’re trying to trigger ovulation outright. If everything goes successfully, it puts your body in a state of superovulation, or more than one egg per cycle.
We latched onto that word - SUPEROVULATION! - and made a lot of jokes about eggs shooting out of ovaries, lots of finger guns and pew-pew-pew sound effects, lots of jokes about lame superpowers, etc.
And then you’re told to have sex, like, a lot. A lot, a lot. Which is all yay, fun, but also...whoa.
Which reminds me, it’s time to discuss:
SIDE EFFECTS
As far as side effects go, Clomid’s not supposed to be that bad: hot flashes, bloating, headaches. All national and manufacturer guidelines somewhat ominously insist that you can’t take it for more than 3-6 months, but nbd. (Long term side effects include reduced fertility, which, WHAT, and possible increased risk for cancer, which, also, what.)
Let's zoom in to the experience of taking it on a day-to-day basis. My doctor did mention that I might be a little moody on Clomid, but I glibly disregarded this. Ted laughed when I told him. “When are you not moody,” he said, grinning. (One of my more lovable quirks is a propensity for intensity….which is also my alt rock band name and, as it happens, my wrestling ID.)
In retrospect, this was like when the dentist says that there might be a little bit of pressure before they use ice water and electricity to murder your gums.
OUR EXPERIENCE THUS FAR
No drama here, but I turned into a different person on Clomid.
Several horrendous examples come to mind, but one stands out: One day, I went on an early morning run because I was feeling horrid and I wanted to turn things around. It was beautiful and sunny and I hated everything. I stopped on our front stoop once I got home and literally said aloud, “I’m being moody. I’m feeling weird. I’m not going to take this out on Ted.” And then I walked inside and flew apart. You know that scene in one of the Fantastic Beasts movies where Credence destroys a building with his Obscurus? That's exactly what happened. Those were fun times.
ALL OF THIS led to a p big difference in expectations/reality for Clomid cycles. Et voila:
EXPECTATIONS
REALITY
Spoilers: Clomid hasn’t worked for us. Yet, anyway. We haven’t used up our six non-consecutive pre-cancerous cycles, and are currently weighing the risks-v-rewards of wading back in to the fray.
I do want to note that while our Clomid experience has essentially been an emotional firestorm, I did notice a few positives. While on it, I ovulated a couple of days earlier, my luteal phase was a couple of days longer, and my luteal phase temp was a little bit higher. None of those were stats were previously particularly abnormal for me, but Clomid may have helped them inch close-ish to textbook (aka the name for my upcoming line of knockoff, hilariously incorrect higher-ed study guides).
Flash forward to now. We’ve once again gone from being excited (pew! pew! pew!) to being jaded and bitter about our prospects re: Clomid...and we had some questions after initial usage.
OUR QUESTIONS
- Clomid causes a super-ovulatory state--meaning, more than one egg is going to be in the mix that month. (Hence the slight risk for multiples.) Do each of the Chosen Eggs ovulate at the same time? Or is there a staggered release situation afoot?
- Clomid boasts a per-cycle success rate of between 6-20%, depending on where you look. Natural conception, if you’ve gotten everything lined up perfectly, has a success rate of 20-35%. Why is Clomid’s success rate less than ‘normal’? I think we can answer this one. Is there an engineer in the house?
Engineer here! A lot of factors, including but not limited to ovulation, need to go right to achieve pregnancy. Clomid is very good at fixing 1-2 specific problems (via egg shotgun or machine gun), but what if those specific issues are not your particular infertility root cause(s)? If your only tool is a hammer, you can do some things, but you won't be able to fix your plumbing much.
Selection bias could also play a role. The general population of women trying to conceive includes those with low, typical, and high fertility, and the reported average success rate covers all of them. The population subset of women taking Clomid to address infertility would have more people who have a lower chance of conception from a variety of root causes.
Over and out.
This has been a TedTalk.
- Um, why cancer? You’re only supposed to take Clomid for six cycles, after which the risks outweigh the benefits. Those risks do not make me excited about taking Clomid for any cycles. What's my actual risk?
- One of the side effects of Clomid is a reduction in cervical fluid. Clomid is anti-estrogenic, and, as they all say, mo’ estrogen, mo’ fluid (aka the name of my startup marketing water bottles exclusively to women. It's hydration: for her). We’ll talk more about everyone’s favorite vaginal goop later on, but for now, know that cervical fluid is important for conception in, like, a million ways. So this seems problematic.
It'd be impossible to answer all of these questions without going way above the recommended readability word-count limits for this post, but that's where our heads are currently at. Anyway, these questions prompted us to start researching, again.
RESEARCHING, AGAIN:
It's time for some biochemistry, y'all.
When the drug hits your bloodstream, the party starts pretty quickly. Clomid works in the hypothalamus, which is basically your brain's hormonal control center. Its main function is to decrease the efficacy of estrogen by hogging estrogen’s parking spots on the pituitary. Estrogen gets mad about this, and so do you, ultimately. After a bit of this parking spot bait-and-switch (aka a fun game for kids ages 9-99), your brain thinks that you have less estrogen than you actually do. This makes your body start to churn out elevated levels of three hormones: FSH, LH, and GnRH.
I believe a few introductions are in order. [UNFURLS SCROLL]
- FSH: Follicle Stimulating Hormone. Stimulates the follicles, or the lil pods where eggs mature prior to ovulation, to get those bad boys all suited up and ready to go.
- LH: Luteinizing Hormone. Triggers ovulation. You get a big LH spike the day before ovulation happens. Normally, anyway.
- GnRH: Gonadotropin Releasing Hormone. GnRH just helps your body make more FSH and LH...so, focus mainly on FSH/LH; GnRH is mainly a backseat wingman in this scenario.
Together, these three guys work together to make sure ovulation happens effectively and on time. High levels of estrogen suppress production of these hormones. With Clomid, your body thinks you have low estrogen, so it overcompensates with production of these other hormones.
But wait! Plot hole ahoy! (aka the name of my forthcoming novel about poorly maintained roads, but, like, on implausible boats or something)
Isn’t estrogen super important? If we’re blocking its action to increase FSH/LH, we're blocking estrogen's activity for other things, right? Was there anything else it was supposed to turn on that we’re missing?
Yep.
ESTROGEN 101
Estrogen has two very very very important jobs prior to ovulation: it helps increase cervical fluid, and it helps thicken the endometrial layer. In other words: Estrogen provides both the slip’n’slide necessary for sperm to get to the egg in the first place, and it rolls out the critical red carpet to welcome a fertilized egg into your otherwise extremely uncomfortable uterus.
(I’m not mad about the fact that both ‘slip’n’slide’ and ‘red carpet’ work too well to be just metaphors.)
I’m not qualified to make generalized statements about other people’s health, so here’s an observation I’m going to make for my purposes only (quick! pretend you're not reading this!): It seems like Clomid may enable ovulation, but make fertilization and implantation much more difficult.
While I've got my tinfoil hat on: Clomid helps you if you’re not getting pregnant because of egg reasons. According to the Mayo Clinic, ovulation situations account for subfertility in 1 of 4 cases. Clomid has been determined to be not-so-helpful for ovulatory women with unexplained infertility. Ergo, some 75% of the time, Clomid won’t help. This likely helps explain its relatively low success rate: misapplication, essentially (aka name of my future consulting biz where I coach people who just can't land a job, or who can't figure out the right way to put on lotion, I haven't decided which).
BUT Clomid’s cheap, it works or doesn’t work almost immediately, and it’s an easy first thing to try. (Not to go on this rant right now, but I feel like this strongly mirrors how young women are put on the pill because of ~any period problem~ to suppress symptoms, but I digress.)
OUR PLANS
So here’s the thing. My hypothesis for why I haven’t been able to get+stay pregnant, if it’s my problem, is that I have some kind of hormonal imbalance. That would explain the maybe-PCOS non-diagnosis I’ve had my entire adult life, along with a bushel of not-specifically-fertility-related other problems I’ve had (insomnia, etc). To that end, I’ve somewhat successfully cultivated a bunch of healthy habits over the past several months to get my hormones in order (no dairy! no alcohol! no gluten! easy, low-stress movement!) … which I’m sure I’ll brag about further in an upcoming installment.
Based on a lot of the research we're seeing, and based on our assumption that I'm an ovulatory female (rationale: I'm boringly regular, and my BBT charts seem to indicate that I'm ovulating), it seems like Clomid may not be the best choice to help me. But! I did see some good chart optimization stuff while on it, so, mixed feelings = us. (aka the title of my upcoming relationship guide, 'How to End Relationships Via Text, In Middle School, Probably'.)
Ultimately, Clomid’s been around for a while (since the 60's), is relatively safe as long as it's used appropriately/not for long (citation: I used to work for Big Pharma, and I've seen ~much worse~), and even though it’s got pitfalls that I don’t love (lower cervical fluid, lower endo lining, risk for cancer), it’s hard for us to get over the mental idea of superovulation. Also: we haven’t gotten Ted tested yet (whole other thing, more later), so if he does have a lower count or whatever, giving his boys a few extra targets seems like it couldn’t hurt. 🤷♀️ We'll angst about whether to continue it or not and likely have a post-Clomid update after we've finished the course of treatment. (Sorry to leave this on a cliffhanger, but research shows that's the best way to hook your audience. LOL I'm a writer.)
Hey look! A diversion! Entrez Ted with another Talk:
Rebecca kept saying things like, "Time for Clomid!" and my first reaction was frequently concern about why it's our time for Covid.
Over and out.
This has been a TedTalk.
Okay. Two requests this week:
- If you know about this stuff, please let me know if/when/where I messed up. I’ll update this post and re-broadcast, if so - I don’t want to lead anyone else down a rabbit hole :)
- If you have a Clomid SUCCESS story, comment literally anywhere or send one of us a DM, if you feel comfortable doing so.
ANYWAY WOW.
For a welcome change to literally any other topic, join us on July 12 as we discuss our intro to TCM, or Traditional Chinese Medicine.
After that, we’ll have the first installment in our new series about BBT CYCLE OPTIMIZATION. (Did you know this was a thing? I didn't.) If you're a fan of de-identified charts, biohacking and ridiculous data tweaking, tune in on July 19.
References (that weren’t linked in-text):
http://www.thepreggerskitchen.com/blog-1/2017/10/8/what-is-clomid-and-how-does-it-work (a delicious UK infertility blog, with lovely phrases like ‘picking out the porkers’)
https://www.glowm.com/section_view/heading/induction-of-ovulation-with-clomiphene-citrate/item/336 (a good article at the crux of readable and impressively science-y)