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Expert Q&A

	By Craig Sweet, M.D. Reproductive Endocrinologist

I am TTC and have been on Depo Provera for 2 years. I took my last injection on March 26. I have had past experience with Depo. The first time I got pregnant within 3 months. The second time around it took 6 months. I am suppose to return to my doctor in August, and at that time I will be put on Clomid. I would like to know if there is any chance of me conceiving without the Clomid?

Although not knowing all the details, it may make more sense to be patient and try with your partner for up to 12 months. It is quite normal to take a bit longer to conceive as we get older.

Giving Clomid to an already ovulating women may not do that much good, although this is commonly done. The problem is that Clomid acts as an anti-estrogen at the cervix and the inner endometrial lining of the uterus. Sometimes Clomid thickens the mucus so that it is more difficult for sperm to head on up to the egg. If Clomid affects the lining, it may thin it and make it slightly more difficult for the embryo to implant and grow. Clomid is an option for women who don't ovulate but it has limited use when used alone for women who do ovulate. Interestingly, performing an intra-uterine insemination (IUI) with the Clomid often works for women who do or who do not ovulate. Apparently the insemination process bypasses the cervical mucus making pregnancy more likely.

It should always be recalled that Clomid can result in a multiple pregnancy. While many couples would welcome this "problem," a multiple pregnancy is a high risk pregnancy with prematurity being a common problem. If possible, one at a time is a far better idea than a "two-for-one" sale.

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