Dr. doesn't prescribe Femera... WWYD? — The Bump
Secondary IF

Dr. doesn't prescribe Femera... WWYD?

I'm hoping that given some background on my situation you ladies might have an opinion (that's more educated than that of my DH, whose opinion is just whatever I think is best).

I have charts documenting 1.5 yrs of long/irregular cycles. My OBGYN was convinced this is what's causing our problems, and was going to prescribe Clomid but not monitor me. I decided on my own to go to RE instead.

I was expecting RE to prescribe an ovulation-inducing drug, but just monitor me. However, since I also was diagnosed with incompetent cervix during my last pregnancy, she is hesitant to give me any drugs that might increase risk of multiples. It appears after initial testing that I probably have PCOS, but I am ovulating on my own, so she's recommending unmedicated IUI. We don't have insurance, and I'm hesitant to spend money on IUIs when all signs point to PCOS as my issue (not MF).

I've read a lot of good things about Femera, including that it carries a lower risk of multiples than Clomid b/c it generally produces only one follicle. However, my particular RE won't prescribe it b/c it's not FDA approved for IF.

I'm about to start my period, and I need to make a decision here soon. Do I push current RE to give me Clomid, and just see how many follies I produce before having TI? Do I give unmedicated IUI a chance? Or do I go to a different RE to see if they would prescribe Femera given my unique situation?

Re: Dr. doesn't prescribe Femera... WWYD?

  • You "probably" have PCOS? Why the probably? Did they not do an internal ultrasound? That sounds odd to me.

    I would never jump into iui/ivf before knowing everything...

    So with the choices you have stated I would say give the clomid a try. But I personally wouldnt do anything until you know how severe your pcos is and if it needs to be medicated or not. I have PCOS, but not bad enough to be medicated, although I dont ovulate on my own, and clomid worked for me at 100mg.

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    Brynlee Reece is 4!

    TTC #2: 7 IUIs, 2 Miscarriages
    Lennon Grey is due 12/20/12
  • image June24Bride:

    You "probably" have PCOS? Why the probably? Did they not do an internal ultrasound? That sounds odd to me.

    Yes, she did do an internal U/S and she said that I have multiple follicles on my ovaries, but she said that some women with "perfect" cycles have them too. She said that I don't "look like" someone with PCOS, but based on my cycles I could have a mild form of it.

    Anyway, this was before I had my surge day BW or CD3 BW, so maybe she'll have a more definitive diagnosis the next time we talk. Hoping!

    (ETA: and her plan was, if we did do Clomid, she'd start me at 25 mg, which seems like a very low-risk dose but what do I know)

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  • Mine doesn't prescribe Femara either.  He doesn't like to stray from what a drug was manufactured to do. 

    One of the reasons, I like my RE is he is very thorough.  He will not go into treatments until he has determined the root of the problem.  Personally, I wouldn't agree to any treatment until all testing has been completed and exhausted first. 

    Most (all?) fertility treatments carry some risk of multiples.  

  • If DH has no sperm issues and you don't have any CM issues, IUI isn't going to do much more than timed intercourse, honestly. 

    Are you OOP or will insurance cover treatments?

  • image MrsT1209:

    If DH has no sperm issues and you don't have any CM issues, IUI isn't going to do much more than timed intercourse, honestly. 

    Are you OOP or will insurance cover treatments?

    I haven't noticed a problem with CM personally, it seems to follow the normal pattern, but they haven't tested it.

    We are OOP. $800 for an unmedicated IUI cycle.

  • I personally wouldn't go into an unmedicated IUI out of pocket with no sperm issues or CM issues. 

    I think that you should give Clomid a try if that is what the RE is recommending.

  • image MrsT1209:

    I personally wouldn't go into an unmedicated IUI out of pocket with no sperm issues or CM issues. 

    I think that you should give Clomid a try if that is what the RE is recommending.

    In our consultation, RE definitely recommended IUI. But, then when I met with my case manager right afterwards she also gave me the option of the 25 mg of Clomid and provided literature on both. I left with the impression that the RE's recommendation was IUI, but she'd prescribe the Clomid if that's what I wanted.

  • image MandyMilller:
    image MrsT1209:

    I personally wouldn't go into an unmedicated IUI out of pocket with no sperm issues or CM issues. 

    I think that you should give Clomid a try if that is what the RE is recommending.

    In our consultation, RE definitely recommended IUI. But, then when I met with my case manager right afterwards she also gave me the option of the 25 mg of Clomid and provided literature on both. I left with the impression that the RE's recommendation was IUI, but she'd prescribe the Clomid if that's what I wanted.

    I'd ask to bump up your clomid, 25mg is nothin.

    I mean, ultimately it's up to you...but i wouldnt be spending 800 bucks if I knew that Clomid and timed sex would do it.

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    I'm a doula! Ask me about it

    Brynlee Reece is 4!

    TTC #2: 7 IUIs, 2 Miscarriages
    Lennon Grey is due 12/20/12
  • Thank you guys for your input!

    Do you want to know the most frustrating part about this?? I switched OBs once I gave birth b/c my old one is no longer practicing. My new OB, the high-risk specialist I consulted AND even the RE all agree that there's no real evidence I even had incompetent cervix in my last pregnancy.

    My old OB recommended an elective, preventative cerclage (where they stitch your cervix closed) at 14wks soley based on the fact that I had one LEEP procedure to remove precancerous cells when I was in college. I had no prior pregnancies, so no history of m/c or preterm labor. Not knowing better at the time, I agreed to the cerclage. All of the issues I had afterwards can be linked to the stitch itself and the extended bedrest that was prescribed. My cervix was never shown to be short or dilated on an U/S. And the RE commented that it didn't look short or excessively scarred when she gave me my exam. I delivered a full term baby -- with an induction!

    Yet, because I have this history, I'm being deprived of what I understand to be the standard of care for a person with PCOS and TTTC.

  • Ah that's such a hard decision. I personally wouldn't want to do an unmedicated IUI. I guess maybe I would try clomid to see how I respond, many people only get one follie from clomid so may that would be your case as well?

    My dr also doesn't prescribe femara. I originally asked to try that before clomid because I read clomid can make endo worse, but he doesn't like it.

  • FWIW, while TTC #1 I left my 1st RE in large part b/c he wouldn't prescribe Femara, and I got pg my first cycle on Femara...my first cycle with my new RE.  For *myself*, I felt strongly about not taking clomid.  If you feel strongly about your meds/treatment, you need to advocate for yourself.  My current RE continues to listen to me an infinite amount more than my first RE did.  Good luck!
    Pregnant with #1 with PCOS and LPD, success with mostly naturopathic treatments
    Our Thanksgiving Day baby 11/22/07

    imageimage image

    Pregnant with #2 with LPD, uterine polyp/hysteroscopy, DOR (AMH = 0.17), 2 c/ps
    Our early Christmas present 12/9/10
  • Honestly, I just wouldn't feel comfortable with your new RE.  I might try to find another one.  I don't think any of your options sound like good options, imho.  I would not be comfortable with Clomid, for all the reasons you've already gone into.  Don't get desperate and do something you don't feel is right.  (easier said than done I know) 
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  • i am confused.  you say you ovulate on your own but have long/irregular cycles.  has your RE tested your progesterone at 7dpo?  are you determining the ovulation from charting?  how long are your cyles?  i probably would not do an unmedicated IUI, and if you were medicated and monitored, couldn't your RE just skip the IUI if you had multiple follies?

    and someone said the other day that when you have multiple mature follicles in a medicated cycle and you DON'T trigger, you will only ovulate the leading follicle.  so could you do a 50mg clomid cycle, medicated and monitored, not trigger and still do the IUI?

    if you are OOP, i would pull out all stops for whatever both you and your RE are comfortable with, not "just" timed IUI.  if you are PCOS-like, i'd push for some sort of ovulation inducing drug.  and i wouldn't waste my time on 25mg clomid.  i believe that 100mg is the standard dose, but most RE's will start with 50 in hopes it does the trick.  so 25mg is essentially halfing the half dose.

    and how was your DH's SA?  i think IUI helps more for MF than anything.  but, i've been told 90% of sperm die before reaching the uterus.  so IUI helps with that.  my RE told me it ups your chances by approx. 10%.

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  • image krys2729:

    i am confused.  you say you ovulate on your own but have long/irregular cycles.  has your RE tested your progesterone at 7dpo?  are you determining the ovulation from charting?  how long are your cyles?  i probably would not do an unmedicated IUI, and if you were medicated and monitored, couldn't your RE just skip the IUI if you had multiple follies?

    and someone said the other day that when you have multiple mature follicles in a medicated cycle and you DON'T trigger, you will only ovulate the leading follicle.  so could you do a 50mg clomid cycle, medicated and monitored, not trigger and still do the IUI?

    if you are OOP, i would pull out all stops for whatever both you and your RE are comfortable with, not "just" timed IUI.  if you are PCOS-like, i'd push for some sort of ovulation inducing drug.  and i wouldn't waste my time on 25mg clomid.  i believe that 100mg is the standard dose, but most RE's will start with 50 in hopes it does the trick.  so 25mg is essentially halfing the half dose.

    and how was your DH's SA?  i think IUI helps more for MF than anything.  but, i've been told 90% of sperm die before reaching the uterus.  so IUI helps with that.  my RE told me it ups your chances by approx. 10%.

    I'm just assuming that I O on my own based on +OPKs combined with a thermal shift on my charts. The only BW I had was the day of my last +OPK. I asked about 7DPO testing, and was told it wasn't prescribed for me b/c my progesterone was so high they were confident it wasn't necessary to confirm O. My cycles are from 29 to 55 days.

    My DH's SA needs to be repeated. It was ordered by my OB before I went to see the RE. He said the results were good, but then RE said everything was good except the volume was boarderline and there was some coagulation.

    I was basically hoping RE would follow what my OB was recommending -- starting out w/ 50 mg of Clomid -- and just monitor the follicles. Like you said, we can skip TI if I have too many (or IUI, but I'd rather try a few cycles with Clomid and TI first). That's an interesting point about the trigger too -- I didn't know that.

    I guess if I start 25 and it doesn't work, I haven't lost anything, but it just feels like RE isn't really interested in helping. And, like I said, I don't get why she won't consider Femera if she's truly that worried about multiples with me. She also never ordered an HSG, which seems to be standard. It's acutally a pretty reputable clinic in my area, and I know several people who have had successes with them, but I have to say I'm not impressed yet.

     

  • image MandyMilller:
    image krys2729:

    i am confused.  you say you ovulate on your own but have long/irregular cycles.  has your RE tested your progesterone at 7dpo?  are you determining the ovulation from charting?  how long are your cyles?  i probably would not do an unmedicated IUI, and if you were medicated and monitored, couldn't your RE just skip the IUI if you had multiple follies?

    and someone said the other day that when you have multiple mature follicles in a medicated cycle and you DON'T trigger, you will only ovulate the leading follicle.  so could you do a 50mg clomid cycle, medicated and monitored, not trigger and still do the IUI?

    if you are OOP, i would pull out all stops for whatever both you and your RE are comfortable with, not "just" timed IUI.  if you are PCOS-like, i'd push for some sort of ovulation inducing drug.  and i wouldn't waste my time on 25mg clomid.  i believe that 100mg is the standard dose, but most RE's will start with 50 in hopes it does the trick.  so 25mg is essentially halfing the half dose.

    and how was your DH's SA?  i think IUI helps more for MF than anything.  but, i've been told 90% of sperm die before reaching the uterus.  so IUI helps with that.  my RE told me it ups your chances by approx. 10%.

    I'm just assuming that I O on my own based on +OPKs combined with a thermal shift on my charts. The only BW I had was the day of my last +OPK. I asked about 7DPO testing, and was told it wasn't prescribed for me b/c my progesterone was so high they were confident it wasn't necessary to confirm O. My cycles are from 29 to 55 days.

    My DH's SA needs to be repeated. It was ordered by my OB before I went to see the RE. He said the results were good, but then RE said everything was good except the volume was boarderline and there was some coagulation.

    I was basically hoping RE would follow what my OB was recommending -- starting out w/ 50 mg of Clomid -- and just monitor the follicles. Like you said, we can skip TI if I have too many (or IUI, but I'd rather try a few cycles with Clomid and TI first). That's an interesting point about the trigger too -- I didn't know that.

    I guess if I start 25 and it doesn't work, I haven't lost anything, but it just feels like RE isn't really interested in helping. And, like I said, I don't get why she won't consider Femera if she's truly that worried about multiples with me. She also never ordered an HSG, which seems to be standard. It's acutally a pretty reputable clinic in my area, and I know several people who have had successes with them, but I have to say I'm not impressed yet.

     

    yeah, i would definitely push to try a monitored clomid cycle, especially considering your possible "inaccurate" incompetent cervix diagnosis.  and also demand an HSG.  there is no reason to do anything at all if you have a blockage in your tubes.  i find it incredibly odd that they have not done or suggested one.  you are right, it is very standard.  unless they are just going on the fact that you have already gotten pregnant once. 

    anyway, the femara thing is b/c the drug was actually originally manufactured to treat breast cancer in post menopausal women, but for whatever reason, is actually a great ovarian stimulant in non-post menopausal women.  but there is liability involved b/c it is not FDA approved as a fertility med - yet.

    stand your ground.  you are paying OOP and it is your body.  explain to your RE that your opinion matters just like a paying customer in a restaurant.  good luck!

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