Clomid and metformin

[shreyasi]

Hi, I have been trying to conceive for a year now. I had a suspected miscarriage a year and a half ago afetr which i was on pill for 2 months.When we first went to the doctor after trying on our own for 4 months, she started me on 50 mg clomid from day 2 of my periods. Simultaneously she tested me for LH, FSH and prolactin. She said my prolactin was too high. So she gave me a prolactin inhibitor afte which in the next cycle she said it was normal. She also said my progesterone levels were not ok, so she started me on Duphaston from day 16 to day 21 for every cycle.

I had HSG done on me and my tubes were found to be patent. I have been on clomid for total 4 cycles now. Second and third cycles was on 100 mg when she gave me ovitrelle to induce ovulation. nothing happened.in 4th cycle she said she saw 8 follicles (4 on each ovary) i dont know why but she told me its is PCOS. she started me on glucophage (2 times a day) for the next 2 cycles i was just asked to take duphaston on day 16 -25.

Now i am on my 5 th month of clomid. this time i am going for ultrasound and she says if the response is good, she will try 2 more cycles after which she said would like to do a laproscopy. i really do not know what to do.

She has never mentioned IUI so far. Also i dont know if i have PCOS or not, but glucophage has helped me shed excess flabs on my tummy and body. I usually have a 30 day period and it has been regular all my life varying may be a 2-3 days. I used to havea very heavy bleeding on day 2 and 3 which has surprisingly reduced now since i started glucophage. however other than that no complains (even the cramps have reduced).

i have been reading a lot on internet and it seems laproscopy is not that necessary with the advent of better IUI and IVF techniques so i want to avoid it at all costs.

can anyone tell me if it would be wise to go for a laproscopy? Also should i tell my gynae to do an IUI on me this cycle?(expenditure is not a concern for us right now)

also if i have a 30 day cycle what are the days am i expected to ovulate? is it ok to take Duphaston from day 16 and is it ok to do an ultrasound on 11 th day. My gynae prefers to do an ultrasound uptill maximum 13th day and no more. Is that right??

i am asking this because i read soemwhere that with clomid ovulation is delayed and can happen even after 16 th day.

[BunnyLullabye]

Sorry no one has responded to you til now, and I may not be all that much help myself. I'm not a doctor or medical professional, I've just been through a lot myself and learned a lot of what's recommended and how to advocate for myself. 

Is it possible for you to see another doctor? Of course I don't have the full story, but a few things are sounding odd to me. Has she drawn a full hormone panel, including estrogen, progesterone and testosterone?  What criteria did she use to diagnose you with insulin resistance? It seems pretty obvious you'd have multiple follicles when on clomid. 

Do you know why she wants to do a laproscopy? She may want to check for endometriosis if you have painful cycles, pain with sex or unexplained infertility. I've had one, and it wasn't *that* bad. But it certainly isn't the first thing I'd check for!

It's possible for ovulation to be altered with clomid, either earlier or later. 

I would suggest you take your basal body temperature every day (first thing in the morning before you get out of bed) and use software like fertilityfriend.com to chart your cycle. You can also purchase ovulation predictor kits (usually cheapest on ebay) which will help detect your LH surge. That should give you a lot better idea when you may ovulate, especially for a few cycles.

As far as I know the recommendation is that clomid not be used for more than 6 cycles in a row. While it can increase egg quality and quantity and help with ovulation, it also thins the endometrial lining, and decreases fertile cervical mucus, so the disadvantages compound with every cycle, and your body will need to rest. 

So overall I'd suggest you see another doctor if possible. Ideally if it were me I'd think you should get your thyroid tested including Free T3, Free T4, and antibodies, not just TSH. A full hormone panal, usually done on cycle day 7. The necessary tests for insulin resistance (not positive what those are, but you can look them up), and a saliva adrenal test.

Then take clomid or try femara or injectibles, with an ultrasound or two to check follicle stimulation, a trigger shot when the follicles look mature, and an IUI or two the day before and/or day of ovulation. The ultrasound should check the number and size of follicles you have. They need to reach a certain size to be mature (I think about 22mm if I remember right), and that can happen any time in your cycle. I'd probably check first at day 13, and then get an idea how long til checking again from the size that time.

If you have PCOS a website that may help you is www.soulcysters.com