TTC after 35

XP: Curveball at today's regroup appt with RE (long winded - sorry!)

Confirmed this morning that my second Clomid+IUI cycle was a bust and I went in for a regroup appointment (which I so endearingly call WTF appointment.) As background I only produced one follie with each cycle of 50mg Clomid. I was fully prepared to ask for and be switched to injectibles for the next 2-3 cycles. My RE recommended that I try 1-2 cycles at 100mg Clomid and then if that doesn't work, move on to IVF.

He said he used to recommend injectables + IUI if Clomid didn't work within 3 cycles, but that was when IVF success rates were only around 35%. Now that IVF success rates are at 60% he moves on more quickly. Reason being that injectables are expensive and the success rates of injectables + IUI are only 20%.  (He quotes 10-15% success rates with Clomid + IUI). He cited a study called the Fastt Trial that found in 508 couples, patients got pregnant quicker and with less expense when bypassing injectables/IUI cycles. Here are a couple of links to the study that I found interesting. Have you guys heard of this study before?

Also, as previously mentioned from other Bumpies, some doctors don't correlate higher doses of Clomid with increase follies. The only way we could cycle in August would be to use Clomid since injectables require more monitoring and we'll be out of town for 10 days. He gave me the option to increase and I took it. I figure it couldn't hurt as I already know how I respond to 50 mg.

Of course at the end of the day he leaves the decision entirely to us. If we want to do another Clomid, and then three injectibles before IVF, we could choose to do that and he would support it.  In my mind right now, I think I'd do one cycle of 100mg Clomid and one cycle of injectables before IVF. But I'm nervous nelly about the IVF. Unfortunately we are 100% OOP for this but thankfully we both have good jobs and I'm way ahead of my number so far this year. Better go sell something! lol

Sorry that was so long and rambling. Lots to process right now! 

Re: XP: Curveball at today's regroup appt with RE (long winded - sorry!)

  • I'm sorry about the BFN.

    That is a lot to consider. Seems to make sense to give the increased Clomid a try. Beyond that is a tough decision-making process for you and your DH. Good luck.

    TTC #1 since June 2010
    Me: 36, DH: 42
    Dx: DOR and MFI

    DH: low count + very low motility; hormones all normal; Sperm DNA Frag. test = poor to fair; male karyotyping normal
    Me: FSH 13.4 + AMH 0.26 + hypothyroidism; Scratch the hypothyrodism (?); Blood clotting and immune panel all negative; endometrial biopsy normal

    IVF #1 (MDLF - Jul/Aug 2011): BFN (9R, 5M, 3F with ICSI, 3dt of 1 10-cell grade 2, no frosties)
    IVF #2 (EP-antagonist - Sep/Oct 2011): BFN (6R, 4M, 3F w/ ICSI, 3dt of 1 6-cell, 1 7-cell, grade 4s, no frosties)
    DE IVF #1 (shared cycle - June 2012): c/p (6R, 6F w/ICSI, 3dt 1 8-cell grade A- and 1 7-cell grade A-; no frosties)
    DE IVF #2 (shared cycle with new donor - Nov/Dec/ 2012): - BFP!!!!! 12/14/12. U/S on 12/27 shows twins!!!!!

  • ugh

    i like your plan of 100mg clomid this cycle (since you can't do injects or ivf why not do something), and then 1 round of injects before ivf.  maybe i'm crazy, but i feel like the way you respond to each protocol better informs the doc of what to do next.  like if you respond really well to 100mg of clomid, maybe it's worth doing that again.  or if not, then it that is definitely not the road to take.

    my insurance paid for all meds but not ivf, and oop ivf was not really an option for us, so i definitely wanted to explore all med options and permutations.  i did 5 clomid cycles (3 at 50mg, 2 at 100mg), and 2 follistim cycles.  if i hadn't gotten pg when i did, the next protocol i would have done is femara + follistim. 

    not easy  ...

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  • Wow!  That is a lot to process, but I think that I would do the same thing as you with increasing the Clomid this cycle.  I hope that it works & that August is your month!!!!
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  • Sorry about your BFN.

    And thanks for posting a link to the study! Interesting to know about.

     Good luck with the decision making.

    Me = 38, Husband = 31. TTC since 1/10. M/C at 8 wks 5/10. Started trying again 9/10. All tests normal: AMH/MIS, FSH, HSG, SA. Estradoil high. 6/20/11 - Clomid+Ovidrel+IUI#1=BFN. 7/17/11 - Clomid+IUI#2=BFN. 2 natural cycles = BFN. 10/6/11 - Clomid+Ovidrel+IUI#3=BFN. 10/31/11 - Clomid+Ovidrel+IUI#4 = BFN. 11/26/11 - Follistim+Ovidrel+IUI#5 = BFN. IVF#1 - Menopur+Follistim. 2 ET 5/11/12 = BFN.
  • My RE quoted that study as well. It's kind of mind blowing just how much things cost when you look at the breakdown. We did one cycle of injectables, because the meds are really cheap at our clinic, so the cost differential wasn't that big and neither I nor DH were ready for IVF then. At this point though, I'm so ready to try something with better than 50% odds! Good luck with this Clomid cycle, hopefully you won't have to worry about the next step!
    Image and video hosting by TinyPic
    TTC #1 since 2009 with unexplained infertility
    IUI#1-4 Jan.-Apr. 2011 = BFNs
    IVF#1 Aug. 2011 = c/p, FET #1 Nov. 2011 = c/p, FET #2 April 2012 = BFP!
    Beta #1 = 153, Beta #2 = 269, Beta #3 = 675
    1st U/S = TWINS!! EDD 12/29/12
    my blog: Journey to Somewhere
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  • clomid 50 mg always gave me only 1 follie and the clomid 100 mg gave me 2! Good luck. I think 2 more rounds of clomid would be good then IVF. btw I only got 1 follie with injectables too.
  • Wow - that study was really interesting. Thanks for posting! 

    I think you made the right decision for you.

    When I think about these things, the RE first asked me why I didn't want to move straight to IVF, and even my OB said that many women skip the IUI section of treatment. However, I am also 50% OOP for IUI treatment, and 100% OOP for IVF treatment. So I've decided to give the IUI's a go. Approximately $1000 per try is a lot more reasonable that $10-20,000 per try for IVF.

    Having said that, IUI with injectables is pretty also gave me just a bit of information as to how my body responded to Menopur. But I know that it is nowhere near as intense as the time and physical stamina one must endure for an IVF cycle. I think a number of docs consider this facet less since they really think of things scientifically.  

    ttc since 2/2010 ~
    me (36): Hypothyroid (on Levothroid), low vit. d, borderline/high fsh (day 3: between 7-10) (day 10: 13 during CCCT), AFC: 14
    dh (31): awesome (minus one sample with agglutination)
    Diagnosis:possible DOR and/or unexplained + elevated NK cells + MTHFR (C677T - one copy)

    MAY 2011 - FEB 2012 - 3 injectable IUI's with numerous cancellations due to high TSH levels
    MAY 2012 - onto IVF/ICSI (Antagonist Protocol) on BCP and Folgard (3 week delay - cyst - boooo) 5/21 start stims 5/30 ER 11R 8M 3F 6/2 3DT of 3 6/12 Beta #1 83 | 6/14 Beta #2 196 | 6/21 Beta #3 3818 | 6/28 Beta #4 22,213 | 7/2 1st U/S - 2 on board! 8/24 CVS reveals that we have a boy AND a girl on board!

    Healthy baby boy and girl born in February, 2013 at 38 weeks and 2 days!

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  • Thank you for sharing those studies. I have some reading to do.

    Since I produced 2 follicles on 50mg Clomid, my RE did not recommend going to 100 since the risk of a thinner uterine lining outweighed the possibility I might get a third follicle.

    We have been discussing injectibles. My RE said we could try a cycle if I want, but that given the expense and success rates, I might be a better candidate for IVF. And I think I agree.

    I have had 6 failed IUIs so I am going in this week or next week for my WTF appointment.

    Single Mother by Choice. Life didn't work out the way I planned so I did it on my own. IUI #s 1-3, unmedicated = BFN, IUI #s 4-6, 50mg Clomid, Ovidrel = BFN IVF #1: 23R, 20M, 17F. 5 day transfer 2 blasts. 2 Snowbabies BFP 6dp5dt, Beta #1 7dp5dt = 58, Beta #2 9dp5dt = 114, Beta #3 10dp5dt = 187 1st Ultrasound = 5/3, not much to see yet. 2nd Ultrasound = 5/17, TWINS!!! Hospital Bed Rest at 32 weeks due to pre-ecclampsia and severe edema. Audrey Grace, 5lbs9oz, & Lydia Louise, 6lbs, born via emergency c-section on 12/6/12 at 36w1d My IVF Journey
  • I tried three cycles of clomid with no success then my RE suggested that I move right to IVF because the success rates are so much better.   However,  my insurance wouldn't cover it.  I then did three unsuccessful IUI with injectable cycles.  I am now doing IVF.  Honestly, since you are OOP, I would just try the IVF.  I don't know how old you are, I guess if you are younger and have time maybe you could try the less aggressive.  However, you said you were OOP so it just seems like it would save money to go right to IVF.
  • BFN...sorry.

    We are also oop so all of these options are so difficult to make. I am kind of glad that we did the injectables ...the cost is more than Clomid but it can give the RE an idea of how you respond to some of the meds.

    TTC since 2009 very frustrated 42yr and DH 40

    5 cycles of Clomid with satisfactory response=BFN's
    Fibroid removal Nov2010
    IUI Clomid #1 Feb 2011...BFN..damn it!
    IUI Inject's #2 Apr 2011...CANCELLED...low estradiol
    IUI Inject's #3 June 2011...BFN
    IUI Inject's #4 Sept2011...BFFN
    Lap Dec 2011...severe endo..cyst removed..some remains...
    IVF#1 Apr 2012 ....cancelled due to over suppression
    IVF#2 July 2012....6 follies...only 1 retrieved....BFFN
    surgery suggested to move ovary to an better placement but....we moved two time zones away and are financially and emotionally empty

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