Thanks to all those who gave me advice back in May. Now I have started the infertility process again and have questions that I hope someone can help me think through. Background on my story: I’m 39, DH 48, 1 son 3yo. Infertility for 2 yrs and 1 m/c before son’s birth. Did infertility workup back in 2006 with HSG and Clomid challenge test (CCT), got pg with son 3 mth after w/u without doing infertility treatment (only did Clomid that one month for FSH levels day 3 and day 10 for CCT). In 2006 with CCT, FSH on Day 3 of cycle was 10.4 and FSH on Day 10 was 10.0 I’ve been getting my hypothyroidism under control with meds the past 6 months. I chart, eat healthy, use OPK, use TCOYF, etc.
Now experiencing infertility again (been TTC since Aug 2009) and had my first appt with OB/GYN office that does some infertility. They consult with an Infertility clinic in a big city over 1 hr away, and will send pts to this clinic for anything more than basic treatment. So I had initial consultation with a CNM at OB/GYN office. Had TSH and FSH done day 4 of cycle. TSH 0.01 (so thyroid med has been adjusted to lower dose) and FSH 17.2. Will have Progesterone drawn this week (7-10 days after ovulation). Plan for next cycle was to do ultrasound when OPK+ to confirm eggs ready to ovulate and then ultrasound 3-4 days after ovulation to confirm eggs are gone.
CNM called last week to confirm results and said she was going to discuss my case with infertility specialist in big city. On Friday she called me with what he recommended based on my history and FSH 17.2, and that I don’t want to do IVF. Infertility MD said that if I don’t do any treatment my chances of conceiving are 3-5% per month. He wants my TSH around 1.5 He recommended Clomid 50 mg for Day 3-7 to organize follicular phase: Clomid will help follicles develop better, that I might not need Progesterone support because Clomid will make better corpus luteum which will produce progesterone. He wants Progesterone supplement if 7-10, if above 10 no supplement needed. Also, said that risk of twins increases with Clomid, but since I’m 39 not a lot of eggs left so my chances not as much to have twins (normally has pts take Clomid Day 5-9 to decrease chances of twins, but day 3-7 for me to give earlier support to eggs). I questioned whether Clomid is good for me since I'm 39, as can thicken mucus and thin lining. CNM said that at 50mg, these side effects are minimized, that if go up to 100mg Clomid then estrogen is added to minimize those side effects. I asked about Femara. OB/GYN office doesn’t do it. Infertility clinic used it for a time than stopped due to side effects, CNM not sure if they are using it again. She left it up to me if I want to start Clomid with next cycle (I’m on cycle day 17 right now). Fertility MD says don’t do ultrasound to confirm ovulation, he only does ultrasound for injectables.
If I have more questions, I can call CNM and ask. She is very thorough, will call me back, and takes her time talking with me. I’m going to pick up a semen analysis kit for DH when I have progesterone drawn this week. 4 years ago DH results were excellent. My questions right now for CNM/InfertilityMD: Shouldn’t I wait until my TSH is back around 1.5 before doing Clomid, so my body is in a better place to get pregnant (takes 4-6 weeks to get effect of lower dose thyroid med)? If my chances for pregnancy are 3-5% without infertility treatment, what are my chances on Clomid? What are my chances of twins on Clomid day 3-7? What other questions should I ask? I would really like to have another baby, but feeling like perhaps my chances are gone. How much should I pursue infertility treatment with FSH 17? We have thought about foster/adopt for many years (DH was a foster child raised in a loving foster home). Is this the time for that? So many questions. Not sure if Clomid is the right answer. Looking for insight, what questions should I ask, etc. Thanks for reading and for any feedback you may provide!
Now experiencing infertility again (been TTC since Aug 2009) and had my first appt with OB/GYN office that does some infertility. They consult with an Infertility clinic in a big city over 1 hr away, and will send pts to this clinic for anything more than basic treatment. So I had initial consultation with a CNM at OB/GYN office. Had TSH and FSH done day 4 of cycle. TSH 0.01 (so thyroid med has been adjusted to lower dose) and FSH 17.2. Will have Progesterone drawn this week (7-10 days after ovulation). Plan for next cycle was to do ultrasound when OPK+ to confirm eggs ready to ovulate and then ultrasound 3-4 days after ovulation to confirm eggs are gone.
CNM called last week to confirm results and said she was going to discuss my case with infertility specialist in big city. On Friday she called me with what he recommended based on my history and FSH 17.2, and that I don’t want to do IVF. Infertility MD said that if I don’t do any treatment my chances of conceiving are 3-5% per month. He wants my TSH around 1.5 He recommended Clomid 50 mg for Day 3-7 to organize follicular phase: Clomid will help follicles develop better, that I might not need Progesterone support because Clomid will make better corpus luteum which will produce progesterone. He wants Progesterone supplement if 7-10, if above 10 no supplement needed. Also, said that risk of twins increases with Clomid, but since I’m 39 not a lot of eggs left so my chances not as much to have twins (normally has pts take Clomid Day 5-9 to decrease chances of twins, but day 3-7 for me to give earlier support to eggs). I questioned whether Clomid is good for me since I'm 39, as can thicken mucus and thin lining. CNM said that at 50mg, these side effects are minimized, that if go up to 100mg Clomid then estrogen is added to minimize those side effects. I asked about Femara. OB/GYN office doesn’t do it. Infertility clinic used it for a time than stopped due to side effects, CNM not sure if they are using it again. She left it up to me if I want to start Clomid with next cycle (I’m on cycle day 17 right now). Fertility MD says don’t do ultrasound to confirm ovulation, he only does ultrasound for injectables.
If I have more questions, I can call CNM and ask. She is very thorough, will call me back, and takes her time talking with me. I’m going to pick up a semen analysis kit for DH when I have progesterone drawn this week. 4 years ago DH results were excellent. My questions right now for CNM/InfertilityMD: Shouldn’t I wait until my TSH is back around 1.5 before doing Clomid, so my body is in a better place to get pregnant (takes 4-6 weeks to get effect of lower dose thyroid med)? If my chances for pregnancy are 3-5% without infertility treatment, what are my chances on Clomid? What are my chances of twins on Clomid day 3-7? What other questions should I ask? I would really like to have another baby, but feeling like perhaps my chances are gone. How much should I pursue infertility treatment with FSH 17? We have thought about foster/adopt for many years (DH was a foster child raised in a loving foster home). Is this the time for that? So many questions. Not sure if Clomid is the right answer. Looking for insight, what questions should I ask, etc. Thanks for reading and for any feedback you may provide!
