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Success after IF
DavezWife
member
Next step after clomid?
DavezWife
member
Even though I'm responding very well to clomid, and my lining is still doing fine (8 at it's worst).... I can't keep doing clomid/ovidrel/IUI cycles forever.
(ps - why not? I always read here "5 max" and such, why? )
Femera is the most logical next step, right?
In my mind, I don't need to think about injectibles yet, b/c I respond just fine to a mere 100mg clomid.
Right?
thanks.
(I'm just debating the move to the RE Dec or Jan)
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This discussion has been closed.
Re: Next step after clomid?
Even though I responded fine to Clomid, my RE moved me to follistim after it failed 3 times.
My (very conservative) RE would not use Femara because that is not its intended use. After Clomid (which made me crazy and gave me cysts), I moved onto injectibles.
Good luck with your decision. Thinking of you!
My friend moved from Clomid (responded well) after 2 cycles and 1 m/c.
She is currently very early in her second pregnancy with injectibles.
I think my RE's max on clomid was 10 cycles (over your lifetime, not necessarily in a row.) I think after that - there are some risks associated with clomid including thinning your lining for good. Here's something I just found on the Jones Institute site:
Clomid
Clomid ( clomiphene citrate ) was first synthesized in 1956 and introduced for clinical trials in 1960. Since then, Clomid has been widely used as a "first line" treatment to induce and regulate ovulation. Clomid is typically administered on either day's three to seven or day's five to nine of the menstrual cycle with "day one" defined as the first day of normal menstrual flow.
Clomid works at the hypothalamus, a small gland at the base of the brain. Clomid stimulates the production of gonadotropin releasing hormone ( GnRH ), which stimulates the pituitary gland to produce follicle stimulating hormone ( FSH ). FSH stimulates the development of the ovarian follicles which contain the eggs.
Clomid is taken orally and should be taken at the same time each day. The "fertile time," or the time of ovulation usually occurs five to eight days after the last Clomid tablet is taken. Sometimes Clomid is given to stimulate ovulation for intrauterine insemination, IUI, usually in combination with FSH.
The physician determines how Clomid cycles should be monitored. Early in treatment, patients usually take clomiphene for five days each month and return for a follow - up examination after three months of therapy if they do not become pregnant. Sometimes, the physician may wish to monitor the Clomid cycles more closely. A combination of ovulation predictor kits and / or ultrasounds may be used to determine the number of follicles present, their rate of growth, and to help pinpoint the time of ovulation.
Clomid has been used for many years and is considered a safe and effective medication. It does, however, have risks and occasionally there may be side - effects. Clomid side - effects can include abdominal discomfort often described as "fullness and / or soreness," hot flashes, moodiness, or visual disturbances. Acetaminophen ( Tylenol ) can help with these symptoms. In a few patients, Clomid can cause enlargement of an ovary; if this occurs, a patient is advised to seek an internal examination by her physician.
Clomid is associated with a 10% incidence of multiple births, but the vast majority of these multiple births are twins. There is no increased risk of birth defects. If Clomid has not produced a pregnancy within three to six months, alternate modes of treatment should be pursued. The literature strongly supports that using Clomid beyond six months is unlikely to result in pregnancy."When it comes to sleeping, whatever your baby does is normal. If one thing has damaged parents enjoyment of their babies, it's rigid expectations about how and when the baby should sleep." ~ James McKenna, Ph.D., Mother Baby Behavioral Sleep Center, University of Notre Dame
Sorry Hon but the next step after multiple failed Clomid cycles IS injectibles.
"Why when I'm responding just fine to Clomid?" you ask?
Because you may respond fine but it's not working.
(sorry... that came across harsh but you know me and I don't pull punches)
It's just like when women have trouble with the concept of taking Clomid when first seeing an RE. You often hear "but I'm ovulating fine"
And yet - it's not working. Clomid is the standard first line treatment regardless of ovarian function once testing has ruled out other factors.
Likewise injects are just the next step up the ladder.
I totally get you not wanting to go there.
No one does.
Ever.
Do a poll on here:
"What made you move to injects"
or
"If you responded fine to clomid but didn't conceive on it"
and get some IRL stories of how other women progressed thru their treatment options.
I'm not saying Clomid isn't gonna work for you - just telling you that a MD looking at repeat clomid cycles without conception will feel the need to progress to more aggressive treatment options.
((((HUGS))))
IF sux.
Total score: 6 pregnancies, 5 losses, 2 amazing blessings that I'm thankful for every single day.
Same for me. I remember my RE said there was no good reason to try other oral meds at that point since even though I responded OK to Clomid, it still wasn't working for us. He wanted to move to injectables and we were definitely ready (follistim in our case). Good luck with making a decision!
ok, rather than be a total posting whore.. can we turn this into a "Injectible 101" thread.... I'm SCARED TO DEATH of even the word follistim. It just seems to equal HOM or sitting out from over-stimming... I dunno, it just freaks me out. In my mind (and let's face it, it's a wacky world in there) it's just "too big" of a drug (injectibles in general) that I don't need....
argh.
Insight into injectibles, please and thank you.
hmm, I guess I come from a different point being MFI but aren't you a little mfi too? My doc said he wouldn't recommend inject. in our case since I was ovulating just fine (as you are on clomid). He said if IUI plus clomid didn't work he would move us to IVF. Injectables in someone who is o'ing on their own only increases the risk of HO multiples (of course the doc would be watching to prevent that) so IVF would be better. Are you sure the clomid isn't working? Are you sure it's an O issue and not a Davez issue?
I know you have an LP issue so that might negate everything I just said, but I though I would just throw it out there.
E
I only did 2 clomid cycles. Then I did Tamoxifen for one cycle. Followed by 4 injectible cycles.
If it were me I'd ask for something else. I wasn't super excited to do injectibles but it wasn't that bad. We thankfully had insurance coverage for them so it made the decision easier.
Foofoo, yes. MF. Supposidly 1% morph, but the most recent IUI wash came out middle of the room just fine with all numbers. (didn't do a SA, though). Fast lil buggers, too. lol.
good lord, never thought I'd even have to consider IVF.
I don't think I could mentally handle having something THAT EXPENSIVE not work. Chit, I lost my marbles over a cheap and easy clomid/IUI.
No way ;-(
It's all about the finesse. A good RE will know what he's doing with injects. He'll start you on a super low dose until he sees what happens.
Honestly - I think it's highly realistic that you'd end up with just as many targets from a well controlled injects cycle as you have from a clomid cycle. Ask your RE point blank what he thinks you'd see different in the way of quantity and quality with injects vs clomid. Let him explain it to you.
As for why "not" clomid - I'm a bit biased but here's my take.
It's not good stuff long term. It jacks with your ovaries - BAD.
I can't tell you how many women I met on the high FSH boards who took clomid, had their FSH go sky high, and saw it go back down once they'd take a few cycles off meds. There's something about how clomid works with the FSH hormone loop (don't remember the mechanics but as a nurse it might be interesting to you to research) that ends up maxing out your ovaries.
I don't think injects have the same MOA (mech of action) and there for they're easier on your ovaries. Could be 100% making this crap up. It's been a while since I researched it all.
At the very least I'd say that you should at least give your ovaries a cycle off of Clomid. Clomid has staying power and the ovaries usually hyper act on a break cycle post many clomid treatments. Up side? Good potential for conception without meds. Down side? Multiple follies growing closely in size will often not ovulate on time without a trigger. They tend to get "stuck" and overgrown before they pop.
Total score: 6 pregnancies, 5 losses, 2 amazing blessings that I'm thankful for every single day.
DD #1 {04-19-2004}
Secondary IF: Severe MFI (low testosterone, low count, low morph, & very low motility) & Annovulation
After 22 months IUI # 3 Clomid + Follistim = BFP
DD #2 {12-31-2009}
2 more years of failed IF treatments and a failed adoption TTC #3
TTC Journey Over~ Not By Choice
I did two cycles of Femara (first one with TI, and second cycle was supposed to be IUI, but I didn't respond so that cycle was cancelled, then 3 cycles of Clomid (I responded well to Clomid and it didn't jack up my lining, yet it didn't work for me), then I moved on to injectables. I did Tamoxifen, with Follistim, Ganirelix and trigger. I got my BFP.
Clomid speaks to the brain, and tells it to release the hormones necessary for ovulation to occur, whereas injectables are just follicle stimulating hormones so they speak directly to the ovaries.
With injectables, I had to have bloodwork done every other day, and my ob/gyn would call me and tell me if I should increase or decrease the dose of Follistim based on my levels. I also went for ultrasounds every other day. I started the Ganirelix injections when my follicles got to at least 13 mm, as this will allow the Follistim to continue to work to make them larger, but keep them from releasing prematurely. Then I would take the Ovidrel shot and go in for the IUI 36 hours later.
I had no side effects besides bloating with the Follistim, and had terrible side effects with the Clomid. I responded with better quality follicles with the injectables, and my first injectable cycle I got my BFP. We did have the talk with the risk of multiples. I triggered with 5 follicles (my E2 level was 892) and only got pregnant with a singleton. My ob/gyn will only do 3 injectable cycles, and then you have to move on to IVF.
Because we're fancy like that.
The next step would be Femara, if your Dr. will do it...some won't.
Other than that, the next step is injectables...
JC - no, not Corfman. I'm at a specialist OBGYN but heading back to RMIA soon if this doesn't work.
Thanks everyone for all you help - this is very information, helpful too in helping Mr. Davez understand all this, too. more welcome, just wanna say thanks.
I only did one cycle of Clomid before my RE moved me on to Gonal f. I had a much better response and no problems with my lining. I guess it depends on how aggressive you want to be.
Good luck!
Some more encouragement.
I was totally in your shoes, picture perfect response to clomid but it never worked. My first cycle of injectables (Repronex) resulted in a BFP. See siggie for the end result.
Good luck!
I did 2 IUIs on Clomid, and even though I responded fine (2-3 follicles each time), we still moved to injectables. That was my RE's protocol.
I think there is a sense that REs can control and understand your response better on FSH, because you're getting the daily E2 draws and more ultrasounds, and they can adjust your dose accordingly. With the pens you can adjust by as little as 12.5 units, I think. (I can't believe I can't remember.)
ETA: To answer your injectables 101 question: I was on a super-low dose of Follistim (50 to 75 units) and got 2-3 follicles each time. The only time I overstimulated was my first cycle on injectables when they put me on 125 units (the normal starting dose). We cancelled. I doubt they will make that mistake with you because of your history.... they can definitely keep the dose low to avoid lots of follicles if you have a history of being a good responder.
I am thankful every day for my miracle after infertility.
And thrilled to be pregnant again after FET!
I ovulated beautifully every month and had a lovely LP - DH had good sperm - and it still took follistim and IUI to get us knocked up. (Now, I did have some other stuff - mild endometriosis that may - or may not - have had any impact on my fertility - and 2 clotting disorders so treated those too.)
Clomid is not good for old ladies. Like me. And, well, you. It makes you run "hot" (hence the high FSH's that HS was talking about - and she's right about it messing with your body after a while.) Injectables actually have fewer side effects - yeah, you may get a few targets but you probably need a few - AMA my dear!! Not all of those eggs are good anymore. Your lining will be beautiful on follistim too. It's not scary! I loved follistim. It's good on salad too.
No matter what you decide - I hope your sticky BFP is right around the corner!
"When it comes to sleeping, whatever your baby does is normal. If one thing has damaged parents enjoyment of their babies, it's rigid expectations about how and when the baby should sleep." ~ James McKenna, Ph.D., Mother Baby Behavioral Sleep Center, University of Notre Dame
I did eight rounds of clomid (two with IUIs) and after that I moved on to IVF. The next logical step would have been doing a few IUIs with injectables but since I had coverage for IVF I wanted to do the thing that would give us the best chance at success before my insurance ran out.
I ovulate on my own and seemed to have two good eggs each cycle I was on clomid and yet nothing happened. My husband has 0% morph but I think you already are aware how controversial that diagnosis is. IVF worked for us as has just plain old sex so I'm probably not much help since there hasn't been an in between successful option for us.
Good luck with your decision.
Kelly, Mom to Christopher Shannon 9.27.06, Catherine Quinn 2.24.09, Trey Barton lost on 12.28.09, Therese Barton lost on 6.10.10, Joseph Sullivan 7.23.11, and our latest, Victoria Maren 11.15.12
Secondary infertility success with IVF, then two losses, one at 14 weeks and one at 10 weeks, then success with IUI and then just pure, crazy luck. Expecting our fifth in May as the result of a FET.
This Cluttered Life