Luteal Phase Dysfunction - a good overview

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Clomid after recurrent pregnancy loss?

We've decided to keep trying to have a baby - or at least give it one more go. That's what feels right, mostly. There is certainly a part of me that says we should just call it a day, given that I have already given birth to four healthy children. But considering how much older H (17), J (13) and E (10) are, and the fact that they spend half their time with their father, giving up would mean that 16 month old C would mostly grow up in an only-child-like household. And while I have no issue with other parents who decide a singleton kid is the right choice for their own family, I don't want that for her. She already misses her big brothers and her sister when they are away every other week, and I know that will only become more pronounced as they get older.

Even before this last pregnancy ended in miscarriage, I'd been carefully charting my fertility for the past several years, using the great info in this book, and I've also been doing a lot of research into the causes of recurrent pregnancy loss. Many healthy women experience one or two miscarriages in their lives, and the reasons are random and generally unknown. But when someone miscarries over and over and over, as I have in recent years, there is generally a specific cause - or several specific causes - behind the problem.

After the first several losses, I had some genetic testing done, and it was discovered that I have a fairly common genetic thrombophilia condition that CAN be the cause of recurrent losses. Because of this condition, I am taking what my perinatologist believes are the appropriate preventive medications, but I want to have some discussion with him when we next see him in about 10 days about stepping up the medication protocol to the next level, something he told me I did NOT need to do in this past pregnancy.

But one other issue I've discovered in charting my fertility is that I likely have what is known as a luteal phase defect. This means that I ovulate less than 10 days before my next period starts, while an optimal cycle (for fertility purposes anyway) has ovulation occurring 14 days or more before the next cycle begins. During a cycle where that ovulation becomes a pregnancy, the short "luteal phase" makes for a less favorable hormonal environment for the pregnancy to progress. My doctor has been treating this by giving me progesterone supplements after pregnancy is confirmed, but some doctors feel like a better way to treat the issue is to use Clomid to stimulate ovulation earlier in the cycle in order to force a longer luteal phase.

So I am going to point this luteal phase issue out to my doctor, and I am going to ask him to prescribe Clomid. I am more than a little nervous about the higher risk of multiples with the use of Clomid, but I think it's a risk I'm willing to take at this point. I also know that for me, Clomid is as far as I am willing to go in the way of fertility treatments. If it works, great. If not, I'll be really disappointed, but I am at peace with the fact that you really don't always get everything you want in life just because you want it. I want to remain very conscious that I don't let this baby quest get in the way of enjoying what I am lucky enough to already have: children, husband, work, family, health... It has to remain secondary.

So we'll give this pregnancy thing at least one more try. Maybe two - max. And that's a scary thought. I know that if we manage to get knocked up again, this time I really won't tell anyone at all until I am at least five months pregnant (of course, by that time, it would be completely obvious to anyone with eyeballs). And I will have to assume a mindset that expects the pregnancy to end badly. That's the only way to handle it, I think, and it will be somewhat mentally torturous. But my heart tells me there is one more baby coming to our family.

I hope I am not just delusional ;-)