To Clomid or not to Clomid

RatParade

I had my first meeting with my RE yesterday and we have been diagnosed with severe MFI (low motility).  The doctor sees no reason to believe there is anything wrong on my side and my transvaginal ultrasound showed follicles forming as they should.  Because of the severe MFI he feels that our only chance is IVF with ICSI but he's open to us trying IUI first (because it's cheaper and less invasive and I'm 31 so there's no immediate rush) which is what we want to do.

However, he said he can put me on Clomid for the IUI "if I would like".  I don't know much of Clomid outside of these boards, but my understanding is it's a pretty serious drug and there's a limited amount you can take.  I believe he suggested I take it simply to increase my chance of ovulating healthy eggs. 

Any advice?  Does Clomid increase the chance of multiples?  My instinct is to try unmedicated IUI's first, but my head is still spinning and my Internet research is seriously bumming me out.

Also, while I'm here, anyone else have issues with severely low motility (his is 14% although his count is normal) and have their doctor recommend IUI?  The fact that mine wanted me to skip straight to IVF-ICSI makes me want to cry.

Sorry for all the questions when I'm not a regular poster, but I seriously value your input.

Aera11

I did quite a few rounds on clomid (I triggered the last two before my IUI).  *tw* the only two bfp's I got was from my clomid rounds and both ended in m/c.  
I didn't have any side effects or trouble with it but I know some people do.  I do fertility acupuncture now and she thinks all that clomid didn't help my egg quality situation so I guess if you ovulate on your own and the issue is DH, maybe skip the clomid?  Looking back I wish I would've stopped after my second loss and not done a few more rounds.  That's just my experience though.  It can increase the chance of multiples but it doesn't go up exponentially.

BornReady

Sorry you are in this situation. We were diagnosed with MFI (low motility) as well and no known problems on my end. After the first SA my RE said we could try clomid/IUI, but after the second showed the same results she said her recommendation was now IVF/ICSI. I wanted to do something to feel like I was doing something proactive so I chose the clomid/IUI route for our first cycle. We had 2 eggs, but BFN. I'm sure you'd read the stats, and they are not great for MFI couples using IUI. My doctor's actual percentage number made me cry in my car after leaving. I had no issues at all with the clomid in terms of side effects.

In the end we ended up doing just that one cycle and moving to IVF/ICSI with PGS testing. ----TW----- We were successful with our 1 PGS normal embryo and due soon. We do also have a history of spontaneous BFP before working with an RE that came after 14 months of active trying resulting in a live birth and another BFP after 6 months of trying that was a MC @ 9weeks.

With all that said our IVF/IUI was covered through our health insurance, so we didn't have to factor in the cost/benfit aspect, more just the time investment. Wishing you luck, and I'm sure you'll get lots of good feedback here.

Bababatty

@RatParade We're also dealing with low motility and we've done four medicated IUIs. My recommendation before doing anything else is to see a urologist. There are likely things they can do to improve motile count that are far cheaper than IVF, depending on what the issue is. We did three IUIs before seeing the urologist and it was a waste of time. My H's motility % was a bit higher than yours but his total motile count was about 2 million for each. Not good. He's now been on clomid himself for six months--a common treatment for low motility--and his total count and motile count have improved dramatically. At our IUI on Wednesday he had 9.9 million total motile sperm, which was fantastic. Obviously I can't tell you if it will result in a BFP, but we're in a much better place. I really recommend the urologist.

As for whether or not to do clomid for yourself, I have no known issues but my RE still had us do clomid (and subsequently letrozole for later cycles) for me in conjunction with the IUI. I honestly don't know the reasoning, but if you're nervous I'd recommend discussing it with your RE.

ETA That said, we're so committed to the IUIs because our insurance covers them but not IVF. Otherwise I'd probably have considered moving to IVF earlier. 

krenee124

We too have MFI. DH has 100% sperm head defects, low count, and low motility. We were told he should start Clomid and we could try IUI 2-3 months later. We did one round of IUI with me taking Femara & HCG trigger. BFN. 2nd time we went in for IUI, DH gave another Sample and SA came back no changes after him being on the Clomid. They cancelled our IUI and recc straight to IVF with ICSI. 

IVF with ICSI - I had 18 eggs retrieved, 9 fertilized & 6 were good. We had a BFN on first fresh cycle transfer. It's a long road. I don't think there is anything wrong with questioning the clomid use for you but it is supposed to help with follicle growth and numbers of follicles produced. I think it raises chances of multiples by a TINY bit! I would definitely set a number of IUI tries in your head before you get started. It's a giant mind game, but hopefully try #1 will work!! 

FYI - after DH being on Clomid for 6 months, sperm count and motility increase but morphology stayed the same! 

RatParade

@aera11 Thank you for sharing your experience – I’m very sorry for your losses.  That’s interesting that your acupuncturist didn’t think it really helped.  

 

@bornready The stats are horrible and very depressing, but I feel the same and want to be proactive and at least try the IUI.  I’m so happy the IVF/ICSI worked for you!  It puts a light at the end of this very dark, long tunnel for me J

 

@bababatty Thank you for the recommendation!  It seems obvious but I didn’t think of sending DH to a urologist and our RE didn’t recommend it unless we were interested in varicocele surgery.  The RE said if DH’s post wash count is less than 5m million (which it will likely be since after some optimistic math the most we can hope for is 3.5 million) then there’s really no point to the IUI, so anything we can do to get his motility up will be time well spent!

 

@krenee124I’m anticipating we will have the same results with the IUI and will need to move to IVF ICSI eventually (even though I’m mostly still in denial about it).  Thank you for the advice!  So when your DH’s count and motility increased after 6 months, did they recommend going back to IUI as an option?  I’m just so stuck on wanting the IUI to work.

funkykey

Oh @RatParade - Sorry for your DX! But good for you for gathering more info and moving forward.

We're about to do our 3rd round of clomid with IUI, and I've seen several women with MFI have success with it. I read somewhere that when a non-IF couple BDs, only about 100,000 sperm make it through the cervix, so the IUI can make a huge difference when dealing with some MFI.

That said, obviously, it depends on the extent of the MFI. If I were in your shoes, I'd definitely try to see a urologist, and just get some more info. 3.5 million is not so low that it's not worth looking in to.

We are undiagnosed, so were pretty terrified to try IUI + clomid when our RE suggested it. He told us that your odds of having twins are about 2x what they are for the general population - I think in general it's like a 5% chance, and with clomid it's a 10% chance, maybe?

I don't love clomid - last night I slept on top of the sheets because of the hot flashes - but I'm conscious that we're playing a numbers game. If I produce 2-3 eggs a cycle, instead of just one, I have better odds of getting KU-ed. This is my last run with clomid - after 4 cycles on it, if we have no success, we will move on to IVF. 

Good luck!

RatParade

@funkykey Thank you!  I would be ok with trying Clomid but my DH is pretty anti-drug and really doesn't want to increase our chances of twins (2x seems high!), so we will probably just try without, at least at first.  He's very optimistic that we'll be able to conceive either naturally or with the IUI (which is very comforting but not very realistic).  We haven't really even discussed IVF as an option and I'm anticipating he'll be resistant so this will be a long road and I'm really hoping the urologist will lift the fog on our situation a little.  Good luck on your next IUI!

krenee124

@RatParade they did not recommend us going back to IUI. With 100% of the sperm heads having a defect post wash, they will never be able to penetrate an egg. My husband sees the only male infertility doctor in Cincinnati and so far, there's nothing they can do to change the morphology. We are still trying & praying tho! 

funkykey

@RatParade - I can't remember exactly, but I think our RE said that using clomid with an IUI increased the chances of conception by maybe 6-8%. That might be different depending on the dx, though... I seize on to all these numbers, I think because we are unexplained - sometimes the stats feel like one of the few tangible things on this journey.

My DH is still terrified of twins, as much as he was when our RE first suggested IUI+ clomid - I am less so, but then between us, I'm the one who's more tired of TTC and the one who's more, um, grounded. After all, at this point, it's actually more likely we will never be able to conceive than it is that we'll conceive twins. At times, my DH has been very resistant to different treatments, but then a month without conception passes, and he's like: "Hm, maybe you're right, honey." Can't live with him, can't live without him.

I hope the urologist lifts the fog for you too, and that you can get in to see one soon!

J1006

We are also dealing with MFI. We have decided to go the donor route using IUI. I have no known issues however my doctor left it up to us if we wanted to try an unmedicated round first to see if it worked. Since we are paying OOP we decided to just start with a medicated cycle. She put me on Femara instead of clomid because she said her patients usually respond better to Femara and have less side effects. She did explain that we have a higher risk for multiples. We had to sign off on a form stating that we understood the risks of using this fertility medication. After 4 years of trying, we are perfectly fine with multiples. 

JESSABER0414

@RatParade My 2 cents...i do have ovulation issues so I needed both clomid and letrozole. I responded beautifully but 9 months of BFN because of sperm issues.  We did timed intercourse 6 of those months, which was the worst,  but I was a rookie and didn't want a ton of intervention.  Then we exhausted ourselves and the maximum months of each. The sperm never got better despite Robitussin, and COQ10, and we went to I VF with ICSI. (He had viscous samples) low motility, crooked heads... so,  now we have 11 frozen embryos. 
I wish we would have pursued a urologist but it wasn't pushed and he was offering to go !

RatParade

@krenee124 That makes sense not going back to IUI then.  My dr said now is the best time to have issues though because science has come so far - best of luck to you!

@funkykey Yes I think my DH might be the same - he's resistant until some time passes.  He's much more open to IUI now than he was when I first brought it up months ago.  I'm the same way though I guess, I was a pretty hard no on IVF until I had some time to process it and realized that it's likely our only chance.  It just takes time I guess.

@J1006 Thank you, I made a note to ask my dr about Clomid vs Femara if/when we get to that point.

@JESSABER0414 I was the same way - didn't want intervention.  But as our odds get slimmer I become much more open to it!  Hope the FETs work for you! 

[Deleted User]

Late to the party, but Heeeey! @RatParade  
So excited to hear that you're starting to formulate a plan!  I don't have any real known issues either, but due to our dx we would have to jump straight to ivf/icsi (barring some total freak miracle of microsurgery where we can cross over a vas that may or may not be there, which we won't count on...) so I never took Clomid. :/ We were referred straight to a urologist, and <i>he's</i> now on Clomid in preparation for what will hopefully be a successful retrieval (and exploration to assess the likelihood of the crossover situation).

Not such what can specifically be done about morph/motility, but I know they will give men Clomid to increase production, which should thereby increase the motile count by the same ratio anyway, right?  I kniw if we had ANY chance at iui, personally, we would be taking it bc it's SO much less invasive.  But that's not a possibility for us at all in our case.  I get how devastating that is to be told your only real shot is ivf/icsi. Do not pass "Go;" Do not collect $200.  It sucks. :/

@BornReady. Congratulations!!!!! :D Wow!!!

@krenee124 Congrats on your embryos!  Sorry the first transfer didn't stick... :/ (((hugs)))