Clomid question (six tries, you’re out) — The Bump
Infertility

Clomid question (six tries, you’re out)

Question for those of you who have exhausted Clomid options. I hear you can only do six rounds of Clomid due to safety risks. I ended up having my second of six IUI cycles cancelled this month because I overstimulated and released over a dozen follicles. Question is, does this mean that I really have only four IUI cycles left? I tried emailing my doctor after my last appointment, but only the nurse wrote back and said that yes, I used up one of my cycles. Has this happened to anyone before? Were you able to get in one more cycle by switching to another med? I will ask my doctor at the next appointment, but that won’t be for a couple of weeks. Thanks!

Re: Clomid question (six tries, you’re out)

  • I have no idea. Can you have intercourse so the clomid cycle isn’t a total waste?  Wondering if they could prescribe you one of the other fertility drugs
  • RE: the above comment from PP, I would not have intercourse if you have over a dozen follicles. You don't want to end up pregnant with high order multiples. 

    I'd call and ask to talk to your doctor over the phone, and see what he/she recommends for the next steps. My RE told me 80-85% of women that get pregnant with IUI do so within 3 cycles. He said he'll do 4, but your odds at that point of IUI working are so low they recommend moving on to IVF. Good luck!
    *TW*
    Me:32 DH:32
    Dx: PCOS - on metformin
    DS born 11/2014
    TTC #2
    5 failed IUIs
    1 IUI ending in mc & d&c at 9.5w - girl with trisomy 16
    Pursuing IVF with CCRM - ODWU done - IVF set for May-June
    Surprise BFP 3/5 - Rainbow baby due 11/9/18 - Team Green


    adirattinjp78
  • dmo1371 said:
    RE: the above comment from PP, I would not have intercourse if you have over a dozen follicles. You don't want to end up pregnant with high order multiples. 

    I'd call and ask to talk to your doctor over the phone, and see what he/she recommends for the next steps. My RE told me 80-85% of women that get pregnant with IUI do so within 3 cycles. He said he'll do 4, but your odds at that point of IUI working are so low they recommend moving on to IVF. Good luck!
    My bad. I’m new to the game.
  • Every clinic is different in terms of how many Clomid cycles so only your doctor can tell you the rules your clinic follows. But yes, there are other meds to keep doing IUI without Clomid. In your case the doctor may even decide to use other medications sooner rather than waiting given how you responded to Clomid.

    Can you reach out to your doctor's office again to make a plan?
    ***Siggy Warning Child and Loss***

    Officially diagnosed with unexplained infertility after 4 years of TTC
    IUI#2 gave us DS#1 who became an angel a few minutes after birth from Noonan syndrome
    IUI#4 gave us DS#2 - going strong as a toddler!

    TTC again... Found a clinical trial for unexplained infertility and finished 16 weeks of "lifestyle intervention"
    Cycle #1 - cancelled for ovarian cyst x3...
  • Thanks, all. No worries, I totally know not to BD or anything this month to avoid becoming the next Jon and Kate plus 8 (as cute as their kids are). I can certainly reach out again to my doctor when I next go in, but was just curious in the meantime. 
  • It all depends on your clinic really. I took a combination of Femara and Clomid over a year period so longer than 6 times. They also did monitor for cysts because they can be common in prolonged fertility drug usage. 
    TTC 4 years. 7 failed IUI's with either Clomid, Femara and/or Trigger Shots. Started IVF journey in February 2017. Polyps removed in May. 1st IVF Transfer September 26th. BFP. Expected due date 6/14/18. Baby boy born 5/25/18 at 6 lb 9 oz. My bundle of joy. 
  • Yes, there's definitely other options. I had no response to Clomid so my RE put me on Letrozole and then Puregon injections. These were all with TI rather than IUIs though. However, as others have said, if you have repeated failed IUIs, most docs will suggest considering IVF - but that's way down the line and I hope you don't come to that. Best of luck with your treatment :)
    **History in Spoiler**
    Me 39, DH 40
    Married Oct 2010, TTC ~7yrs
    Seeing RE since Spring 2013
    Clomid - no response
    Letrozole (6 months) 2015 
    Laperoscopy/Hysteroscopy in 2015
    Puregon injectibles + trigger x5 in 2016 - all BFN
    Started IVF March 2017 - 25 follies, 9 eggs, 3 fertilised, 1 survived-> frozen due to hyper stimulation of ovaries
    FET May 16th 2017, BFP May 27th 2017, m/c @ 9wks
    IVF #2 February 2018 - 16 eggs, 8 fertilised, 3 frozen embabies
    Awaiting FET April 2018 - cancelled (cyst)
    FET May 2018, BFP June 2nd 2018, m/c @ 8wks
    FET October 2018 - BFN
    Final FET - late November 2018


  • Thanks for the responses! Yeah, we are limited to just IUI (IVF isn’t an option for us) so even if first three fail we still want to max out (otherwise, our only other option will be adoption or a miracle). Glad to hear there are other options! I will discuss with my doctor. 
  • @scully127 - my RE recommended 4 rounds of clomid, because he said statistically they don't see much difference in results after the 4th round. Like, if clomid + IUI will work for you, it's likely to work in the first few rounds. But, of course for us, we moved on to IVF, so for you it might be different (I know you've said IVF isn't an option for you). 

    They also want to limit your exposure to clomid because it can be hard on your body. If memory serves, it can even increase your risk of ovarian cancer, taking it too much.

    I'm curious though if clomid is actually the right option for you. It seems like you're over-responding to the clomid, so I'd talk you your doctor about your dosage, and also I'd ask about PCOS. Do you have a diagnosis about your IF? Have you had other testing done? There are other drugs than clomid - some women have taken Letrozole, I think.

    Also, because you have a history of cysts with these clomid cycles, did they test your E2 levels? Your E2 levels will give some indication of whether or not you have any mature eggs in those follicles. Keep in mind too, if your follicles are too big, there's a possibility that your eggs will be "overmature" and won't fertilize either.

    During my clomid + IUI cycles, I usually had about 4 follicles with (we estimate) 3 mature eggs. I didn't get pregnant any of the times. I have unexplained infertility.

    Truthfully, if I had many follies (even a dozen), but a n E2 level indicating about 3-4 mature eggs, I'd proceed with the IUI or at least TI. (That is, if I were comfortable enough to have TI. Having that many follicles is really uncomfortable!)

    Good luck!

    Me: 34 DH: 35
    TTC #1 since Nov 2015.
    dx: unexplained
    Dec 2016 - Apr 2017 - IUI + clomid x 4 - all BFN
    July 2017 - IVF#1 - 4 frozen embryos, medical freeze
    Oct 2017 - D&C
    Nov 2017 - Apr 2018 - 3x FET - all BFN
    Sep 2018 - IVF#2 w PGS - 3 frozen normal embryos
    Nov 2018 - FET #4 - BFP

    AlohaKumu
  • There's definitely more options, but for sure should be discussed by your RE since they'll have the most accurate information and knows your history and medical records!!!! I hope everything works out love!
  • I did 6 rounds of clomid with TI and my IUI with puregon, so yes there are other medications you can use for iui.
    But as PPs have stated if iui hasn't worked after 4 or 5 cycles you may be better off moving on to ivf (if that's a possibility for you). Continuing to try iui after repeated failures would most likely be a waste of both time and money. 
    I'm 34, SO 39
    TTC since July 2015
    Unexplained infertility - delayed/weak ovulation but don't know why
    BFP Feb 2016 MC at 6.5 weeks
    Started Clomid November 2016
    BFP March 2017 (third cycle on Clomid) HCG failed to rise, MC at 6 weeks.
    IUI July 2017 BFP which turned out to be CP
    IVF scheduled for Feb 2018

  • I am sorry you are having to go through this. I know a failed cycle sucks no matter why the cycle didn't work out. I hope they find some other med for you to try. 

    You said ivf isn't an option. May I ask why? I'm nervous they may tell us ivf is our only option because I'm not sure if we will be able to afford it. 

    I have done 6 rounds of Clomid with an ob. I am moving to an RE on the 21st and I have no idea what meds they will try but I don't feel comfortable using Clomid any more than 6 times so I am glad there are other options! 
  • Thanks for the feedback and thoughts, everyone! I don’t want to sound judgmental when I talk about IVF since I don’t judge others, but in my faith tradition (Orthodox Christinity) IUI is allowed but not IVF (there isn’t an absolute prohibition per se, if you can find a way to avoid freezing or destroying embryos but that just seems too difficult for me to navigate or control). So I am okay trying IUI for the max number of tries (especially since it is fully covered by my health insurance... thanks, Massachusetts!). If IUI doesn’t work, then I am going to proceed to adoption. But I really want to give IUI all my best. Glad to hear there are other options besides Clomid. 

    So far I seem to have unexplained infertility (33 years old, with the only thing being kind of off a borderline AMH of 1.39 as of a year ago). I only had blood tests way back in May, and my clinic doesn’t test them monthly just with Clomid. So don’t know much about E2. 
  • I don't know what the max number of IUI is but I really hope you find what works for you. 
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