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Clomid and follistem

post #1 of 16
Thread Starter 
Im on 100 clomid for 5 days and 150 of follistem injection for 3 days.

I'm 39 and have amh of .3

Is multiples increased more than usual?

My stomach feels so bloated. Even dh says it looks bigger. And the clomid is making me crazy hot.
post #2 of 16

It looks like your post might have been missed, so I'm bumping it up for attention. :bump: Anyone have experience to share?

post #3 of 16
Yes. You are certainly at a higher risk for multiples. But, honestly with your age and low AMH you've got a tough road to one baby, let alone 2.

For instance I'm 38 with an AMH of .26. With 12 days of maximum meds of 450 iu follistim and 150iu if Menopur I only had 3 embryos for embryo transfer (IVF). I don't think my experience is unusual.

Also, just my opinion, but I wouldn't spend many months trying clomid. It's not recommended for women over 35 because we tend to have a thinner endometrium anyways and clomid just makes it thinner. But, you, of course, might be the exception.

Also your doc and should be monitoring your progress to know how many follicles are growing and how thick your endometrium is.

Sorry your post was missed earlier. Your cycle's probably over by now. How'd it turn out?
post #4 of 16
Thread Starter 
Thank you for responding. Cycle produced a 20, 19, and 15 only on my left. Right did nothing. Bfn

Af started sun so today is day 3. He has me on clomid 100 for 5 days and 150 of bravelle on cd 5 cd 8 cd 9 cd10.

I am just coming off a pregnancy. My son was born at 38 weeks stillborn in July. So I don't know if that is why my numbers are low. This is my third period since he died. I turned 39 a month ago. Or maybe my numbers were always this bad and I never knew it?

So don't worry about multiples I guess? I guess I'm used to hearing about injectibles and multiples.
post #5 of 16
Ugh. I'm so sorry about your loss. There are no words.

I don't know the effect of a recent pregnancy on AMH levels, but my understanding is AMH levels are not variable. They do a steady decrease in age and where you are in your cycle has no impact, so I'd imagine a recent pregnancy would also have no impact.

So, this is your second cycle on Clomid? Ask your doc to check your lining when they check your follicles. I should be above a 10. If it's below a 10, your chance of pregnancy is severely diminished and, IMO, you should not be doing clomid.

Injectibles are strongly linked to multiples, but just not for women of our age. I've attached this study which I like. In the study, I think, women were stimulated much more heavily than you and they state that higher order multiples only increase with 6 or more follicles greater than 12 were seen. If you were worried about multiples, I wouldn't worry. If you want multiples, I'd ask the doc to be more aggressive with the injectibles.

http://www.advancedfertility.com/revmultiplescoh.htm

I pulled out these bullet points:

Effect of female age
The effects of female age on the rates of single and multiple pregnancy:

• The incidence of multiple implantations exceeded 20% before age 35 in HMG pregnancies and before age 39 in clomiphene + HMG pregnancies. No triplet or higher-order births occurred after age 34 in HMG and clomiphene + HMG patients.

•The implantation rates per follicle were identical for all three stimulation regimens and decreased sharply after age 39.


Follicle number
In HMG and clomiphene + HMG cycles for patients less than 35 years of age, the incidence of three or more implantations per cycle (but not of twin implantations) was tripled, while pregnancy rates were not significantly increased, when E2 was over 1000 pg/mL, when six or more follicles were > or = 12mm, and when four or more follicles were > or = 15mm.
post #6 of 16
Thread Starter 
Thank you. Yes 2nd round of clomid. I think he said my lining was 9 last time...can't remember.

So why does he have me on clomid then? We r paying out of pocket so maybe to save us money?

He said this cycle on cd 3 he saw 3 follicles on left and I think 3 on right. Does that sound like a low amh? All my other blood work is normal.
post #7 of 16
Yes. I would guess the doc is using the clomid to save you money since it's so much cheaper than anything else. It's certainly a good first line drug overall. Ask your doc and maybe (if needed next month) take a month off the clomid while you try on your own and then try another month of it. But, also ask about alternatives such as Letrozole/Femara. It's a more expensive med out of pocket, but some insurance carriers cover it since it's not technically a fertility drug.

Here's an informative article about AMH levels:

http://www.babymed.com/fertility-tests/antimullerian-hormone-amh
post #8 of 16
Thread Starter 

Thanks.  This month I am using Bravelle because it is cheaper so hopefully it is the same as Follistim $200 cheaper.

post #9 of 16
It's a little different, but it should work fine for later in your cycle like you're using it. If I'm not mistaken, Bravelle is half lh half fsh, whereas follistim is all fsh. Both are needed to mature the egg.

Good luck!!!! Let us know how this cycle goes!!!
post #10 of 16
Thread Starter 
Oh so if bravelle is both then maybe my eggs will respond better? My cm is nonexistent so I think clomid is affecting it.

If this doesn't work I feel like telling the dr to go more aggressive although I'm not even sure that would entail. At the begin I was worried about injectibles and also too many follicles. I don't care any more I just want a baby (or two)

How many tries will this take. My friend said a nurse once told her it normally doesn't happen on the first try.
post #11 of 16
Maybe. Some women respond better to one medicine and some to another. I think that's where the art in ART comes in. I would agree that clomid is probably having a negative effect on your cm. It's a very common and very detrimental side effect. That's why a lot of women end up with IUI's while on meds. Have you talked to your doc about an IUI? Have you looked into natural methods to improve your cm? I don't know much about that, but I have heard of Evening Primrose Oil and Guaifenesin and pre seed as being helpful. You might want to look into that.

The next more aggressive step would be an IUI where the doc places your husband's sperm inside your uterus at ovulation time. That gets past the hostile cervical mucous that Clomid causes and helps to get more sperm where they need to be.

Some women have success on their first try, but most do not. Personally, I wouldn't try too long before going to an IVF consult.
post #12 of 16
Thread Starter 
The dr said iui or timed. But last month my cm wasn't this dry.

I went to dr this am. Only one follicle size 20 on the left and one on the right of size 11. He had upped my shots this month and I actually had less. Last time I had 20, 19 and 15. And bfn. Now I only have 1 and poor cm. I am so bummed.

So tonight he said trigger and timed intercourse thur and fri.
post #13 of 16
The 20 is good. What did the doc say about the dry cm?
post #14 of 16
Thread Starter 
Said it was from clomid. If we did an iui it would bypass that. The dr didn't seem too happy with just one follicle. He made a comment about amh and working eith what we have but i dont remember exactly what. I am Not sure why this time only 1 matured.

The nurse said if this doesn't work he will get more aggressive and likely do just shots and tell us iui. My dh doesn't want to do an iui so dr was fine with timed intercourse for now.

Dh and I are really struggling with the whole iui. I am not good with exams and really struggle with the ebarrassment part. Dh doesn't want to have to give a sample bec of embarrassment.

What's crazy is before our stillbirth I had no clue we had issues. And now we find out about amh.
Edited by ilovemykiddos - 11/6/13 at 7:24pm
post #15 of 16
(((hugs))) The whole thing is hard and only you know what you want to do and what interventions are acceptable for you. There are no wrong answers.

AMH doesn't predict the quality of the eggs, just the quantity under aggressive stimulation. So, if you went for something like IVF you'd be unlikely to have a lot of follicles / eggs to work with. But, generally, if you just try naturally, you'll still be making one egg a month just like normal. So, it really only matters if you're trying to get a lot.

There are some supplements that have been shown to raise AMH. You'll have to google the research yourself because I don't have it right in front of me, but Vitamin D and DHEA are both very helpful.
post #16 of 16
Thread Starter 
Looks like it did not work. I got a bfn and am 12 dpo. Now I have to figure out if I should go back to re. I only had 1 follicle mature this time and I produce that ony own anyways. Ugh.
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