Clomid (or maybe any stimming) "What-ifs"

lebradford

Hi ladies. I hope you don't mind me asking a question so soon after joining. I've been thinking (and googling) a lot about this, and I really think asking you guys is my best bet for mental clarity.

I'm about to start my first medicated cycle (Clomid, 50mg, details in siggy). I know there a lot of possible issues that can arise, and I'm feeling the need to be as mentally prepared as possible.

1. My main question is, how many mature follicles is *too many*? (I know I might get none, or one, but I'm curious.) My husband and I would be excited to get pregnant with a singleton or twins, but triplets would make me pretty worried for their health. However, it seems like people are often excited for and trigger with multiple mature follicles. Where do you personally draw the line? I know it might depend on other circumstances. If so, what are those circumstances and how do they impact how many follicles you're comfortable with?

2. My other question, is what you do if you don't respond well, other than waiting for the next cycle (and I know that happens). I've heard of stairstepping, but I don't really know how it works. Also, do you ever add a different drug mid-cycle?

Ahhh! Sorry so long! Can you tell I've been thinking a lot about this?

lebradford

I was also originally thinking 1-2 follicles would be great, and 3 would be questionable. However, I see a lot of people say they triggered with 4 or 5, so I'm trying to understand why that might be. Is that something people would only be more comfortable with as time went on and they weren't having success with 1-3 follicles? 

Then I was reading an article, "Relationship of follicle numbers and estradiol levels to multiple Implantation in 3,608 intrauterine insemination cycles," by Dickey, et. al. and the summary was basically that over *six* follicles was where the risk of HOM went up. But then, he was measuring follicles as mature if they were over 12mm, and I'd imagine 6 12mm-follicles would correlate with fewer, say, 18+mm follicles. Thoughts? I'm probably way overthinking this....

ETA- Missed "1-2" follicles in 1st sentence. :-p

cls78

I was on 50mg if clomid for all 3 of my iui cycles. (i ovulate on my own) The most I got was 3 and that was on the first cycle. The other cycles I only got 1 and 2. (all BFN) The chances for triplets is really small, but there is always a chance. If you get one good follie then that is considered a good response and they should keep you at that dose.

Sha259

Great responses all around. Long story short, there will be no way to tell how you respond until you take your dosage.

I have been on Clomid 50mg (one of the smallest doses, I believe there may be a 25mg dose as well) for the past 2 cycles. I typically have no issues ovulating on my own, and only have tubal factor issues (left tube is blocked). Cycle one I had 2 viable follies at trigger. But only one on each side, so effectively one good follie on my right side. This cycle I have only 1 follie, but it is on my right side again, leaving me with again 1 viable follie this cycle.

Others may respond to the same 50mg dose differently, some may not respond at all, it really depends on how your body handles the meds. In regards to stair stepping my Clomid, my RE never did that. You only take it for 5 days, and at my RE practice, they do not start U/S to check follicle growth until you finish the Clomid. Also, there is the possibility of trying to boost lagging follicles with FSH which I did last cycle and will do again this cycle.

Starting at 50mg is a good choice to see how your body will respond. It may be that if you do not respond this cycle, they will increase your dose for the next. Good Luck, and I hope you do respond to 50 mg!!

Lillovebug79

I was on 50mg of Clomid for several cycles (and this current cycle as well). I get 2-3 mature follicles on Clomid and I am okay with that. My RE was okay with more mature follicles on Follistim because we had been unsuccessful with 2-3 and our issue is MFI. And after 7 IUIs we have been unsuccessful at getting pregnant. Now that my DH has been on meds for over 3 months, I'm back to oral meds because I don't see the point in needing more than 2-3 follicles. If it doesn't work with that, it isn't going to for us and we will move on to Femara next cycle then IVF.
I think most REs look at the individual situation causing IF. If the issue is being annovulatory, I would think that 1-2 follicles would be great. I would just discuss this with your RE.
I have no experience with stair stepping but I know many on here have done it.

lebradford

Thank you so much to everyone for your thoughtful responses! 

jconno said:

Personally, I would never be comfortable triggering with 4-5 mature follicles and I'm pretty positive that my RE wouldn't suggest it. I've never heard of a 12mm follicle being considered mature. It's usually between 18 and 24mm. I understand your reasoning, though. I think it would be hard for a bunch of 12mm follicles to catch up in time to produce HOM. For the people who are triggering with 4-5, is that just the total follice count or were they all 18mm+?

I don't think they were necessarily saying that a 12mm follicle was mature. However, the study found that the number of follicles that you had at the 12mm stage was more highly correlated with the risk of HOM than the number of follicles that were larger later on. I know, it sounds pretty crazy. It's a really interesting article, if you (or anyone else) are interested in reading it, PM me with your email address. (It is hard to find the full-text online for free.)

Rachaeleigh

I have nothing to add but have enjoyed reading this thread. I've wondered lots of similar things lately as my first medicated cycle approaches. Thanks ladies!

Mommalawyer

My RE said he'd iui with 5. No more than 5 though.... I'll let you know, if, when I get to do my first iui. We are looking grim due to male sperm antibodies.

Mommalawyer

Stairstepping? Can someone elaborate?

lebradford

Mommalawyer said:

Stairstepping? Can someone elaborate?

Basically, it is increasing the Clomid dose within the same cycle that the lower dose wasn't effective enough. Like, if 50mg wasn't working, you could try 100mg without waiting for a new cycle. I just wasn't sure how the timing worked, but here's what Naria said above:

"We stair-stepped with Clomid on our first cycle. They started me at 100mg x5 days. At the end of 5 days I had no response, so they bumped my dose up to 150mg, and I started the new dose that night for 5 additional days."

I'm not sure, but I'm assuming your lining has to be good, and there might be other factors involved that determine when you can stairstep (if needed) instead of having to cancel your cycle and wait for a new one. Maybe someone else can elaborate on that?