When is it time to move onto different treatment?


#1

Hello all… we had a consult with my RE during my baseline ultrasound and I asked her why this wasn’t working since I have been responding so well with Clomid. Her response was I have about an 8% chance each month to be pregnant. She went through the other courses of treatment being Injectables and IVF and their success rates. I know i read online drs usually don’t keep you on more than 6 months of Clomid treatment; if it doesn’t work, they usually change treatment.

The impression I got from my RE is if we are okay with the 8% statistic, and I’m still responding to the meds I can continue with treatment. She said she was on and off Clomid for a year before she got pregnant herself. So, my question is, when should we move forward with a different course of treatment?

Our insurance doesn’t pay for anything, so the next course of treatment is way more than what we are paying now. My DH and I discussed doing this month and maybe one more month before moving onto Injectables…

This month I had 2 mature follies with a possible third one that may release. So, I am responding very well with the meds… and obviously my DH isn’t the problem. It’s just so financially scary to move onto a different course of treatment… but of course they have a higher success rate. Oy vey!

Any input if you were in my shoes???


#2

Well I am kind of in the same boat. But this clomid cycle (#5) I had some pretty severe side effects on day 4 of pills. So I think we will switch to femara next cycle. I’m excited because I was on 4 other rounds of clomid previously a few years back so I am kind of over it since it has not worked! Just ready for a change. We are completely out of pocket too so I get the financial strain.


#3

Given my personal experience I always recommend that women move on after 6 cycles as the studies show that if one is producing mature follicles and ovulating and yet has not gotten pregnant within that time frame the liklihood that they will is incredibly low. However, I also understand the whole insurance thing and cost as I too was in the same boat and is also why we took so long to move on.

Typically the reason clomid doesn’t work after 6 cycles is because there are other factors that haven’t been fully explored or treated. Also, it can backfire after so many cycle by causing hormones, cervical mucus, and the body in general to stop responding or to respond negatively in a manner that is counterproductive to TTC. Sometimes this can be remedied though simply by taking a 3 month break and then coming back to it.

I guess the things I would question is…
1.) Are you ovulating on the clomid every cycle?
2.) could there be something else wrong that is causing the failure/BFN’s such as male factor or blocked tubes that needs to be looked into? (looks like you had an HSG and a Saline sono so that is good. What about your thyroid and hormones though? May want to redo those as they can reveal things after months they didn’t reveal previous and just to be on the safe side. Has DH had an SA done?).
3.) if you are ovulating on the clomid and have checked for other factors and have come up empty then maybe just adding something to boost the cycle a bit will help such as doing a combo cycle with clomid and follistim. This way you are still keeping the cycle cost effective while just giving you an added edge of the FSH since the clomid works indirectly on the ovaries whereas the injectables work directly on them. Sometimes you just need the direct influence, but if you cannot afford to do only injectables then it can be effective to try just a couple injections added to the 5 days of clomid so because you are only using a couple injections for the entire cycle as opposed to several a day for say 10 days during the cycle the cost is greatly reduced and often doable for those looking for a more affordable option.

I notice you have pcos and clomid isn’t very favorable for those with pcos. Are you taking metformin? Is your luteal phase progesterone low and if so are you taking a supplement after ovulation? What is your BMI? Sometimes Metformin can help to protect the ovaries from the negative hormones so that could be a beneficial addition as well. Also, if you need to lose some weight sometimes just losing 10lbs can make a huge difference. As far as the progesterone, it is common for those with pcos to have low progesterone and this too can cause problems as it can cause AF to show too early in the cycle (luteal phase defect) and can cause miscarriage should one actually manage to get pregnant or chemical pregnancies.

Ovarian drilling via laproscopy may be an option your insurance would pay for also so may want to look into that as a possibility. Sometimes, if done right, it can help reduce hormones (like testosterone) that fill the cysts and act against the estrogen, LH, FSH, and progesterone of the ovaries causing negative results (such as low quality eggs and/or fewer eggs). Just some things to consider.

Hope this helps! :flower:


#4

i feel the same way as ahhny does. the issue just whether or not you guys are ready to deal with the extra costs that other meds may require. i know that can be difficult.


#5

[QUOTE=ahhny]Given my personal experience I always recommend that women move on after 6 cycles as the studies show that if one is producing mature follicles and ovulating and yet has not gotten pregnant within that time frame the liklihood that they will is incredibly low. However, I also understand the whole insurance thing and cost as I too was in the same boat and is also why we took so long to move on.

Typically the reason clomid doesn’t work after 6 cycles is because there are other factors that haven’t been fully explored or treated. Also, it can backfire after so many cycle by causing hormones, cervical mucus, and the body in general to stop responding or to respond negatively in a manner that is counterproductive to TTC. Sometimes this can be remedied though simply by taking a 3 month break and then coming back to it.

I guess the things I would question is…
1.) Are you ovulating on the clomid every cycle?
2.) could there be something else wrong that is causing the failure/BFN’s such as male factor or blocked tubes that needs to be looked into? (looks like you had an HSG and a Saline sono so that is good. What about your thyroid and hormones though? May want to redo those as they can reveal things after months they didn’t reveal previous and just to be on the safe side. Has DH had an SA done?).
3.) if you are ovulating on the clomid and have checked for other factors and have come up empty then maybe just adding something to boost the cycle a bit will help such as doing a combo cycle with clomid and follistim. This way you are still keeping the cycle cost effective while just giving you an added edge of the FSH since the clomid works indirectly on the ovaries whereas the injectables work directly on them. Sometimes you just need the direct influence, but if you cannot afford to do only injectables then it can be effective to try just a couple injections added to the 5 days of clomid so because you are only using a couple injections for the entire cycle as opposed to several a day for say 10 days during the cycle the cost is greatly reduced and often doable for those looking for a more affordable option.

I notice you have pcos and clomid isn’t very favorable for those with pcos. Are you taking metformin? Is your luteal phase progesterone low and if so are you taking a supplement after ovulation? What is your BMI? Sometimes Metformin can help to protect the ovaries from the negative hormones so that could be a beneficial addition as well. Also, if you need to lose some weight sometimes just losing 10lbs can make a huge difference. As far as the progesterone, it is common for those with pcos to have low progesterone and this too can cause problems as it can cause AF to show too early in the cycle (luteal phase defect) and can cause miscarriage should one actually manage to get pregnant or chemical pregnancies.

Ovarian drilling via laproscopy may be an option your insurance would pay for also so may want to look into that as a possibility. Sometimes, if done right, it can help reduce hormones (like testosterone) that fill the cysts and act against the estrogen, LH, FSH, and progesterone of the ovaries causing negative results (such as low quality eggs and/or fewer eggs). Just some things to consider.

Hope this helps! :flower:[/QUOTE]

Thank you so much for your detailed response! My thyroid and other levels in my bloodwork were good… I did have the sugar test and I passed that; so I do not need Metformin at this time. When I had my laproscopy to check for endo the re-checked my tubes and everything was good there. I also started losing weight before I had my first visit with the RE. I noticed when taking my bbt losing the weight had me ovulating on my own… so that does make a huge difference. I’ve lost 20 lbs and I am positive that is the reason why I have been responding so well with Clomid. Weightloss def does help ovulation; I can attest to that!

This month was the first month my lining was a little thin so they have put me on Progesterone suppositories and also baby aspirin. I am curious is the progesterone will help my cause a bit. My DH did have a SA and his numbers were excellent; the only issue he may have is the morphology was on the borderline of “compromised”.

Every month I produce 1-2 follies; usually 2 each month my DH’s numbers have been excellent with IUI… so I guess technically Clomid has been a success; now it’s just getting that end result.

I am okay with moving forward to Injectables; I just don’t want to try it more than 2-3 times because of the cost. I told my DH if it didn’t work by the third month I would rather just move forward to IVF. I just hate to spend all this money where we could have paid for IVF already.

It’s just frustrating because we do have such a good prognosis but something just isn’t meshing. Because I started progesterone this month I almost want to give Clomid one more month to see if the Progesterone was the extra boost I needed all along

Decisions, decisions… !! Thanks for all of your responses and support!!