RE says this is my last cycle...

[Shabbers]

So. First off, I have Kaiser HMO as my insurance. I've been seeing the RE there, and while they do IUI, they don't do IVF.

We tried-by-not-preventing for a year and a half, then went to the RE to find out what's going on. Male factor is fine, all my hormone levels are normal and I O regularly even withoud drugs. The RE put me on Clomid 100 mg, and I've been on it for 3 cycles so far. I respond really well, my ovary (only got the one) makes nice big pretty follicles, and I haven't had any cysts or side effects at all.

The idea had been to do IUI, but no luck - the first month, August, DH and I were travelling when I O'd (plus we got in a huge fight, so no BD then either) - in September, we timed BD but on the day we were supposed to come in for the IUI there was a huge comedy of errors and we wound up not getting there until too late, after the wigglers had wiggled their last. October, we again timed BD but the morning that we were supposed to go in for IUI my DH just couldn't "produce".

So here we are in November. I started AF on Hallowe'en, so I called them on Monday and went in today. I figured it'll be the usual - get ultrasound, be sure there's no cysts, give me the Rx for Clomid, and get on with my life. But no. The doctor didn't want to give me the Clomid - he says that he only gives it for 3 months, then you have to do Clomid + injections, which he will do for 3 months, then that's it.

I explain to him that we don't want to do the injections - the chance of multiples is too great. (DH is *really* uncomfortable with the thought of twins +, and even just the Clomid made him nervous. Because of this, we have agreed not to go that route.) He hems and haws and talks about how he can't just keep giving me Clomid forever, you know.

He finally agreed to the prescription, but flat out told me that if we don't conceive this cycle, he doesn't want to give me any more Clomid.

I personally don't see why not. From what I hear, up to 6 cycles on Clomid is fairly standard, then your body needs a break from it for a month or two, then you can take it some more. Especially since one of the cycles that we had was a nonstarter (no BD nor IUI), and we haven't made it in for the IUI, the fact that there's been no luck yet does not mean that the Clomid isn't working. It just means that we've not been lucky.

I left the office pretty

Any ideas? Or reasons I might be wrong? I of course want to succeed this cycle, but I know it might not happen, and I want to keep trying dammit!

Thanks,

Shabbers


(eta: xposted in TTC)

[kristenok18]

First of all, . It can be hard to take when you go in to an appt so hopeful and leave feeling confused/hurt/upset. We had something similar happen yesterday, and I'm still not sure how I feel about our options.

Did your dr explain his reasons? I would expect him to back up his reasons if he is going to be that adamant. Has he brought up other drugs besides just injectables? Femara is a drug that I've used, and have known others IRL and online who've had good success with it when they haven't responded to clomid. It sounds as if your dr really isn't all that comfortable treating IF, and seems uninterested in anything other than a formulaic approach. I could be way off, though.

Hope you are able to get some answers.

[goldfinches]

I have a friend who is new to the infertility game who was put on clomid. She also was only allowed to be on it for 3 months before adding injectables. Maybe it's a new thing they're starting after some new studies have come out?
Do you know how much greater the chance of multiples is with injectables vs. only clomid? As long as you're monitored, I can't see it as being that much greater? I only have my friend's expeerience to go from, since I was never lucky enough to try IUI's. She regularly made 2-4 follicles.

[newmommy7-08]

I do clomid w. an ovidrel trigger shot, every month when i go in for the u/s they tell me how many folicles are mature, usually just 1, but last month 2. It's up to me then if i want to DTD and take the risk of twins.

[SleeplessMommy]

Did the RE office do blood tests a day or two before planned IUI to make sure you are really releasing the eggs? (really really important!) Did they do the HSG to make sure your tubes are open?

I am wondering which injectables they are talking about? Ovidrel is an injection, but just a "trigger" shot to release the egg(s) - no increased chance of multiples.

Is your husband donating at the RE office or at home? If you can afford it, it would make LOTS of sense to freeze a semen sample as backup for this month. Alternately, you could beg your primary care provider for some samples of Viagra, to have on hand for the donation. You really don't want him to have performance anxiety on this cycle.

If you are sure Clomid is working (eggs being released, tubes open) you might be able to get an RX from a regular OB/GYN. Some docs have a *lifetime* limit of 12 cycles of Clomid, however.

If twins are totally out of the question, it is pretty challenging to pursue infertility treatment - not that it is easy otherwise. If you are less than 30, you could do IVF with a single egg returned, and have the rest frozen. This is a pretty expensive thing to do, though, and there could be many rounds as you wait for exactly one to take. Twins could happen to anyone, though, even without meds. Your husband has to understand this.

[AmyKT]

Grrr. I'm just so frustrated for you that you never really got to have a real go at this. Clomid was detrimental to my uterine lining, so at a certain point I had to switch to Femara. Maybe ask about that. It doesn't sound like you've been given a fair shake.

[Shabbers]

Originally Posted by SleeplessMommy

Did the RE office do blood tests a day or two before planned IUI to make sure you are really releasing the eggs? (really really important!) Did they do the HSG to make sure your tubes are open?

I am wondering which injectables they are talking about? Ovidrel is an injection, but just a "trigger" shot to release the egg(s) - no increased chance of multiples.

Is your husband donating at the RE office or at home? If you can afford it, it would make LOTS of sense to freeze a semen sample as backup for this month. Alternately, you could beg your primary care provider for some samples of Viagra, to have on hand for the donation. You really don't want him to have performance anxiety on this cycle.

No, he didn't do blood tests - but I've been temping, and my temperatures have been very consistent with regular O around day 15 - the only cycle that I haven't gotten that was my very first cycle temping, and that I chalk up to learning experience.

I did get a HSG, and my tube is definitely wide open.

He donates at home - we live only about 20 mins from the office, and they don't have a special room for that there, you have to just go into the bathroom. He is very much a creature of mood, and no way could he 'produce' in that environment! And no, we can't afford to freeze samples.

I'll ask him about asking his doctor about Viagra...it could be useful.

:frustrated

[nyteacher]

I am doing injectables. My RE monitors me every 2 days on the injections. When you are so closely monitered the chances of multiples is less. I only have a 20% chance of twins and 1% of any more than that. With the monitoring they will see how many follicles you have, if you don't want to risk twins then you can choose not to do an IUI or BD when you have more than that. Many people have singletons even with 2 or 3 follicles. Just something to think about, multiples aren't as common as you think.

[FtMPapa]

I sort've skimmed everyone else's comments - you're getting a mix of good and bad advice up top.

Are you getting ultrasound monitoring? How many follicles are you recruiting on Clomid? How big are they getting?

I recently learned the ideal time to trigger is 25-30 mm, but in the past, I triggered at 18/20 mm which is widely considered too small.

Are you getting Ovidrel or another HCG trigger? When you're doing IUI, it greatly boosts your chances of getting the timing right. It's an injection, but it will not increase your chance of multiples any more than the Clomid is already.

Do you fully understand the risk of twins on Clomid or injectables? What about higher order multiples? (In which case, you'd be offered selective reduction...which is a terrible decision to have to make. I get that. I am hoping to avoid making that choice myself.)

Obviously, this is only anecdotal, but I've recruited up to four follicles on Clomid in the past. And not gotten pregnant, let alone had twins.

If I remember right, the risk of twins on injectables is 20% and with ultrasound monitoring, you can decide to either cancel the cycle (i.e. don't inseminate, abstain from sex), or convert to an IVF cycle (which at many clinics will be half the cost of a regular IVF) if there are too many follicles.

Here's the thing: the research shows that Clomid is unlikely to work if it doesn't work within the first three cycles of use. Basically, if you're not pregnant after three cycles, your chances of conceiving on Clomid are pretty slim. (I say this, hoping to be pregnant on my third Clomid 100 mg + IUI cycle... I'm 5 DPIUI, so we'll see.)

Secondly, Clomid is unlikely to help if you already ovulate on your own. (I do, which is part of why I think Clomid doesn't work for me...or hasn't so far.)

I know many, many singletons born following injectables cycles. I am going to move to Gonal-F next cycle, if this one doesn't work.

As for hubby and the performance anxiety - that has to be very difficult for both of you. You could try freezing his semen, if you think that would be possible, but in my lay person opinion, I would only do that for IVF. Previously frozen semen is going to drop your chances of success with IUI, don't believe any doctor who tells you differently. Sadly, I don't think Viagra will help. It's not the getting hard, it's the ejaculating that you need. You may wish to talk to your urologist or RE about using a collection condom (special condom that won't kill sperm the way the latex/lube in regular condoms does). That way, you could have sex, retrieve the ejaculate, and then have the insemination done.

Good luck, both in conceiving and making this decision.

[Sasha299]

I agree with the pp. There is no way I would take clomid - knowing what I do now without constant monitoring. On my FIRST cycle of clomid my lining thinned out so that it was unlikely that I would get pg and if on the off chance I did I would surely have a mc. Do you know that you are likely to have multiples with unmonitored clomid cycles? If you want to reduce to risk of having multiples then you have only 2 choices - 1)trigger with no clomid or stims 2)femara with trigger. Femara, unlike clomid, usually causes no more than 1 lead follice. Remember the McCully septuplets were the result of clomid cycles.

[Shabbers]

The Clomid cycles are being monitored, trust me.

Though the doc hasn't mentioned thinning uterine lining as a side effect - I'll talk with him about it when I go in next (follie check on 11/11.)

[allisonrose]

There are so many tough choices that get made along the road in IF.

My personal experience: I ovulated fine on my own, seemingly. No explanation for our IF. We did three cycles of Clomid + IUI with no success. Our RE was fine with us continuing on Clomid if we wanted but we elected to move up to Gonal F since our insurance would only help with two more cycles (they covered 50%). Our son -a singleton- was conceived on our first injectable cycle.

Hope you get your BFP very soon!