Next Steps after 4 Cycles....

icogburn

We are on our 4th cycle. 1st cycle ended with CP.  Outside of that, no other BFP. I have an appointment with my obgyn next week to discuss our other options or next steps.  A lot of women have asked me why I am not already on Clomid due to my age. I do not have an answer, I just didn't know I needed it. I do chart my CM and it is healthy every month. I also use CBFM and OPKS and receive a peak every month.  I am temping for the first time this month and will monitor that, too.  Any tips on what to expect or ask during my obgyn appt?  What are the normal steps of progression in treatment?  Any tips or experience you have is much appreciated.

ksgsmu

Mine started by doing a progesterone test at 7dpo and an HSG test ( make sure tubes are open and Uterus is normal).  After HSG we will meet back to discuss clomid etc... 

 

 I am 35, DH 37

10-4LilBuddy

The usual protocol is to get a referral or just go to a Reproductive Endocrinologist (RE) after 6 unsuccessful cycles - especially if you have regular cycles and no underlying medical conditions (ex. thyroid issues, diabetes, etc.).  I would count the CP as an unsuccessful one.  There will be bloodwork if you go to the RE and some people have their OB / GYN do it ahead of time to see if there is something that requires an RE referral ahead of time.

Clomid is not always appropriate.  I don't use it because my uterus lining is not very thick and Clomid has a tendency to thin your lining.  My RE also feels that the side effects are more pronounced.  I use Femara which doesn't have a lifetime maximum dosage like Clomid does.  You also need to be monitored on Clomid or Femara to prevent any complications.  You can develop cysts in your ovaries that the two drugs will feed.  A ruptured cyst can cause complications and even cause the need to remove an ovary.  Your doctor should do a monitoring appointment on cycle day 3 to make sure your ovaries are ready for stimulation and are cyst free.

My RE's progression is this - 1) Femara + Timed Intercourse (TI - using OPKs) for 3 - 6 cycles, 2) Femara + IUI for 3 - 6 cycles, 3) Femara + Ovidrel + IUI for 3 - 6 cycles, then 4) IVF.  You can be as aggressive as you would like.  Your doctor will tell you what is appropriate for you and your body.  The choice is up to you.

Good luck

icogburn

Thank you both! I appreciate the feedback. I had a large cyst removed at the age of 23. It required that 3/4 of my right ovary to be removed.  However, at the time the doctor said even 1/4 of an ovary would produce an egg.  I will make sure to bring this up to my OBGYN.  I am sure my insurance needs a referral, so I will get one then, too.  I also have lost 25 pounds since last November. I have about 20 more pounds to lose before I am consider a normal weight.  This could be part of the problem. But my blood pressure and cholesterol check out fine and I exercise regularly.  I am making my dr. check list now!

ksgsmu

icogburn:

Thank you both! I appreciate the feedback. I had a large cyst removed at the age of 23. It required that 3/4 of my right ovary to be removed.  However, at the time the doctor said even 1/4 of an ovary would produce an egg.  I will make sure to bring this up to my OBGYN.  I am sure my insurance needs a referral, so I will get one then, too.  I also have lost 25 pounds since last November. I have about 20 more pounds to lose before I am consider a normal weight.  This could be part of the problem. But my blood pressure and cholesterol check out fine and I exercise regularly.  I am making my dr. check list now!

If you have an issue with your ovary, then you probably want to get that referral to an RE instead of letting your OBGYN handle it.  It's ok do do basic testing with an OBGYN, but you really need an RE. Your weight might not even be a factor, but losing weight of course is awesome ( I am working on that right now!)  Also a basic thyroid test might be helpful.  Elevated thyroid levels can cause difficulty getting pregnant and holding on to a pregnancy. It's a simple blood test your doctor can do.

 

robbensm

For sure ask about the blood work ahead of time if you go the RE route.  My first RE visit I paid the $50 copay and half a day off work for a 10 minute appointment to get my orders for the blood work followed by having to schedule a second appointment, another $50 copay, and another half day off when the results came back so we could finally get down to business.  But then again my RE experience was not the best so I have since started over with a different doctor.

icogburn

Thanks to both! Ok, sounds like I will be making some calls to the OBGYN, RE and Insurance company tomorrow. I only have the morning off, so I want to make the most of it!