Questioning Clomid Advice


I am 34 and have been trying to conceive (for the first time) for about 1 1/2 years. We’ve begun seeing a fertility specialist and our tests (the general initial tests for fertility) were all normal except my doctor said she saw only 3-4 follicles on each ovary. Is that reason for concern?
My doctor has suggested beginning Clomid and FSH injections. She seems to believe that the problem is during the first half of my cycle, but except for the follicle count, cannot give me a good reason. However, my intuition tells me that the problem is occuring during the luteal phase. About eight days after I ovulate, I bleed (brownish)for 1-2 days–my bbt also drops at that point. Then I actually get my period five days later and it last 2-4 days.

I have brought this to the doctor’s attention, but she glosses over it. I am apprehensive to begin Clomid until I fully understand why I am bleeding mid-cycle. My understanding is that Clomid injections will help me ovulate more than one egg, but is it possible that conception is occurring and the trouble is in the implantation??

Also, are there any pregancy symptoms that occur after ovulation and prior to actually missing your period?

Any help would be greatly appreciated.



Dear Maria,

Infertility can be very frustrating because it is a symptom of underlying disorders. Sometimes it is just one or the other spouse but often times both spouses can have disorders which contribute. So I am going to assume that your husband has been given a good bill of health.

I am not sure what your physician means by seeing only 3-4 follicles. I would wonder at what time of the cycle the ultrasound or laparoscopy was performed to make this assessment. Also,I would wonder what the sizes of the follicles were. Each month generally one follicle will develop and enlarge to the appropriate size and then rupture signaling ovulation. Ovulation is triggered by lutenizing hormome from the brain. The remaining follicle then starts to produce progesterone which makes the endometrium (lining of the uterus) nutrient rich with small blood vessels for the child to implant. If the follicle is of a small size or poor function, the amount of progesterone will be too low to stabilize the lining of the uterus. Women may get “ovulation bleeding”. The estrogen level has been sufficient in the first half of the cycle to build up the lining but the progesterone does not pick up quickly enough or at sufficient levels to sustain the endometrium. The amount and the timing of the progesterone is vital to sustain a pregnancy. Fatigue and breast tenderness occur earliest in pregnancy, with fatigue at 10-12 days post-conception and breast tenderness 3-5 days after conception.

Perhaps your progesterone is not rising quickly enough then you experience the brownish bleeding although I would expect more bright red bleeding. Based on what you say, your post ovulation phase is 13 days which is average although your BBT is dropping almost immediately. Your actual menses is a little on the short side and would wonder how much flow and what the pattern of the flow is. It would also be important to know about how much peak type (estrogen type) mucus you are producing. This also can give insight to how the follicle is functioning.

Clomid does stimulate ovulation and can be used well providing all other parameters are in place. You are right to be concerned about why you are having the mid-cycle bleeding because you would want to know that enough progesterone would be in place for a pregnancy. Generally, I would advise lower doses of Clomid than what is commonly used by most physicians as higher doses usually are associated with more ovulation.

So yes it is possible to be conceiving but no implantation.

It is possible with the help of CANFP to locate a certified NFP teacher who may be able to help you fine tune your charting. Then this teacher can help you locate a physician for a second opinion especially someone who is trained to interpret charts.

I hope that this is helpful!

Dr. Gretchen Marsh

Answered By:

Gretchen Marsh, D.O.
Dr. Marsh graduated from Western University of Health Sciences in 1987 in Pomona, CA and is board certified in Family Medicine by the American Osteopathic Board of Family Physicians. She has been certified as a NaProTechnology® Medical Consultant (NaPro) and Creighton model Fertility Care System (CrMS) teacher since 2001. She and her husband, Jon, have 5 sons and live in the Reno region, where she sees patients in person, in addition to her telehealth services offered via

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