I need some advice please

eminbmore

First though, I want to apologize for not being here more and not being more vocal and supportive when I am here (because I'm always cheering you on from lurkdom!).  I'm in a pretty bad mental space right now, and I just don't feel like I have a lot to give   I hope that doesn't sound super selfish, because it's not meant to be - I'm just really down in the dumps and full of doom and gloom... which I don't need to spread to anyone.

Anyway, I do need some advice regarding meds and our plan and how to approach my nurse and RE about my feelings.

Quick background - we've been TTC #2 since last August, had losses in January and April, started seeing the RE in May.  I was diagnosed with PCOS, all other testing (including the RLP) came back clean - so we're one of those lucky 55% of couples with unexplained infertility.  We did discuss how my long cycles (my cycles range from 35-60 days) could possibly be creating poor egg quality and it's a slight possibility that's part of the issue, but my RE didn't seem too concerned about this.

Last cycle was our first medicated cycle, and we did 50 mg of Clomid.  The first round of Clomid did nothing, on my cd 11 and 13 u/s I had a bunch of small follicles and nothing really measurable.  I did another 5 day round of Clomid (that same cycle - cd 13-17), and then went back in and had two 17mm follicles on cd 18. I triggered that night, and it's estimated I ovulated on cd 20. 

I have to wonder though, if it was the Clomid that caused my follicles to grow like the did, or if it was just what my body was doing naturally? I mean, it ended up being a 38 day cycle, which is on the shorter side for me - but not unheard of.  So, I was already wondering if the Clomid was working or not.

So, this cycle we did 100 mg of Clomid, cd 3-7. I went in this morning for my cd 11 u/s and b/w and it's EXACTLY the same as last time.  A bunch of smaller follicles, one just barely measuring 10 mm (which was not what they were expecting at all - at my cd 3 u/s they told me to be prepared to do the IUI on cd 13 or so).  

The nurse I spoke to about my results and bw (not my normal nurse, because it's the weekend) said that "it's still early in the cycle" and that things could still be progressing as they should be - but honestly, I'm feeling VERY discouraged.  Based on this cycle and last cycle, I really don't feel like Clomid is working for me at all, and I now feel like we're wasting time on Clomid cycles (especially cycles with repeated rounds of Clomid) and it's really frustrating to me.  I feel like we've already put a lot of time into this process, and at this point I don't want to keep wasting time on things that aren't working - and IMO, Clomid isn't working for me. 

I told the nurse I wanted to move on to something else, to consider follitism or something - and she said I'll have to wait until Tuesday (when I have yet another u/s) when my RE will be back in the office and I can talk to him and my nurse about my med plan.

Ok... if you've gotten through of that... thanks   And this is what I need advice about: now what? Am I rushing to judgment here, or would you feel the same way?  How do I bring this up to my doctor/nurse and get them to understand that this plan is not working for me? I feel like each cycle is costing us so much time and money, I want to be sure we're doing what works and I want to be comfortable with what's happening and the amount of time it's happening in... and right now I'm not   Am I being too critical? Help me through this

CarrieLeigh84

Ok, I made it through all of that

I'm in a similar boat with the clomid, long cycles and PCOS. This is my third clomid cycle, and apparantly I ovulated on CD 22, what happens with that, we'll see.

I had a loss on my second cycle of clomid. I was bound and determined not to do it again, but here I am.

I understand about wasting the time and money, but is there a possibility of your Dr upping your clomid rx? It sounds like you'd respond better with a higher dosage. My advice to you is to try one more cycle at a higher dosage.

Have a talk with your Dr, and discuss what you would like. Maybe you can compromise and do one last clomid cycle and if thats a bust then have a plan in place to move to injections

eminbmore

LOL, thanks for putting up with my long windedness

I'm sure my RE will up my dosage next cycle, especially since it seems that neither 50 or 100 mg are doing what they're supposed to do.  I guess I'm just wondering though, if neither 50 or 100 do it, will 150 really make that much of a difference that it's worth "risking" a whole cycle on trying it? Do they ever do combinations of Clomid and something else?

bbhalphen

I have long cycles and PCOS too.  Here was my problem with the Clomid (I did 100mg both times)-- The first cycle I did it, we had one mature follie on CD14, so I triggered. I didn't get pg that month, and I got a cyst.  The second cycle I did it, I never had any real growth, so that cycle was cancelled.  We're banking on the "poor egg quality" thing with me O'ing so late, we're trying to get me to O earlier.

They switched me to Gonal-F and Ganirelix.  On CD13, I had two mature follies and one that *could* mature.  So it's working a lot better than the Clomid. 

I'm no dr., but I think that the injectables are the next step from Clomid.  So I'd try to get them to do that next if I were you.  Good luck!

eminbmore

BB - that's what I'm thinking, that injectibles are going to work better for me.  I just don't want to be *that* patient, who is pushy and impatient.  I don't think I'm impatient, I just don't want to waste time on cycles of clomid that don't work just because this is "protocol" or the standard way it's done, or whatever.  Sometimes I feel like I'm just an item on an assembly line, and they're only doing what they do for everyone else because that's "how it's done" you know?

lindsay.lou

eminbmore:

  I guess I'm just wondering though, if neither 50 or 100 do it, will 150 really make that much of a difference that it's worth "risking" a whole cycle on trying it? Do they ever do combinations of Clomid and something else?

I think, yes, it's worth it. I mean, Clomid is a very "low tech" drug. I think it's best to max out your low tech options before moving on. I can't be sure, but I'm sure it's possible that 150 mg of Clomid could work even if 100 mg didn't. 

(FWIW, I agree with you that I'd be skeptical about whether or not Clomid is working for you given your circumstances)

If I were you....I'd give 150 mg of Clomid at least one shot before moving on. 

I know Clomid can be combined with a trigger...but I don't think  a trigger would help you as you wouldn't want to trigger immature follies, kwim? 

GuppyAmy

I think I'm in a similar position as you- I had very long cycles and did clomid for 3 cycles just 50mg but I had only had one mature follie when I triggered and obviously it didn't work. So this cycle I did 100 iu of follistim and had TWO mature follies but I think next time they want to try an increased dose to see if we can get three to increase our chances.

That being said, I would say try at least 2 cycles of clomid before moving on. They say if you're successful on 3 cycles of clomid it's time to move on to a stronger drug. At least from what I've read. 

And I totally understand not wanting to spread your gloom and doom- I hope you are feeling more up beat soon- I felt like the clomid didn't help my mood. Which I don't have the "depression" as much with the injectables... good luck sweetie! 

eminbmore

GuppyAmy:

Which I don't have the "depression" as much with the injectables... good luck sweetie! 

That would be reason enough for me to switch! I spend entire days crying when I'm on Clomid (cd 4-8 are really rough! )

GuppyAmy

Actually, now that I think about it, I had to go on a "bump break" pretty much the entire time I was on clomid. I'm back now and feel fine here.

bbhalphen

eminbmore:

BB - that's what I'm thinking, that injectibles are going to work better for me.  I just don't want to be *that* patient, who is pushy and impatient.  I don't think I'm impatient, I just don't want to waste time on cycles of clomid that don't work just because this is "protocol" or the standard way it's done, or whatever.  Sometimes I feel like I'm just an item on an assembly line, and they're only doing what they do for everyone else because that's "how it's done" you know?

I'd just play it by ear and see how it goes Tuesday!  Maybe that's what they're thinking too.  I know exactly what you mean about the assembly line, I guess they probably try to go with what's tried and true, but it doesn't always work for everyone.  Hopefully you'll go in there and find that you're all on the same page already.

I agree with GuppyAmy--my mood swings weren't nearly as bad on the injectables as they were on the Clomid!

Sunflower730

I would as other people said, try the 150 ml of Clomid to see what it does. I was one of the rare few that clomid did jack crap for. But with follistim I produced eggs like they were on feeding miracle grow.

I hope you get some answers from your RE.

rjl07

My 1st RE did 3 cycles of Clomid and then 3 of injections, then the next step would have been IVF.  According to her, if a treatment was going to work it would work within 3 tries.  I think I agree with you that 150mg is unlikely to make a huge difference for you.  One of my friends had no response at all to Clomid, but was able to get pregnant twice on injectibles (the first time I think).  I didn't have side effects from Follistim either.  I hope you and your doctor can figure out a good plan.  GL!

KristysRedBarn

I would ask about switching to injectables, the worst they can say is no.  I have PCOS and long cycles and they wonder about egg quality for me too.  I tried one round of clomid and it did nothing (well except make me crazy).  The RE said we're not going to waste time with clomid and I will right to injectibles as soon as we get finished with testing.

surfergirlkona

I don't have any advice to offer as my RE would not give me clomid (age and response related - and he just doesn't like clomid) and put me straight on injectibles. Everyone had great input. As my RE said, it typically takes three cycles to succeed. Just voice your concerns with him and see what he thinks. Wishing you the best of luck

nemattox

I have no good advice, but I do think you should talk to your RE about your concerns, and maybe he will change his mind on his own?

eminbmore

This is all really helpful, thank you guys.  I feel like knowing that there are no "mental" side effects with the injections, combined with the fact that everything I've read says they'd be more effective in my situation - I think I'm going to push to move to that.  F you Clomid.

butterfly843

I would talk to your RE about all your concerns. Mine will only do 3 cycles of clomid and if that doesn't work they will move to injectibles. Sending hugs, I will keep you in my thoughts.