Next Steps?

laynesmomma · July 2012

Hi ladies - What did your dr recommend for the next steps after unsuccessfulw ith Clomid. We are going to start trying again in December, but I'm prepping now. I had 4 IUIs (3 with clomid) then got pregnant and miscarried on #5. thinking that I need to be more aggressive next go around and just wondering what that means...

2brides · July 2012

we added injectibles to the Clomid. We used Follistim (though I don't recall the amount.) Good luck!

ctbride08 · July 2012

we skipped injectibles and went right to IVF after clomid (if i remember correctly). But, we had been trying for a year at that point and were ready to ramp up our odds significantly.

laynesmomma · July 2012

How do people afford IVF? Not to get too personal, but I imagine most people are in the same boat as us. It seems so crazy expensive. Are there payment plans?

Kershnic · July 2012

It depends on a lot of things. How did you respond to clomid and at what dose? Has your timing been good on all of those cycles? Was your miscarriage an early chemical pregnancy or later? Has your bloodwork indicated any concern for diminished ovarian reserve? PCOS? Any indication of a short luteal phase or endo or blocked tubes or anything like that? Are you nearing or over 35? Confident that the sperm you're using is decent? Do you have insurance coverage for anything, and if so what/what's your financial ability to cover OOP costs? What's your tolerance for risk of multiples? Not that you need to answer any of these questions for me, but they're some of the things you should be thinking about.

Options include:

-higher dose of clomid

-femara (oral medication similar to clomid, but some women respond differently to it)

-metformin (if PCOS is a concern)

-progesterone supps during the 2ww

-further analysis of your sperm/changing donors

-cycle(s) that combine oral meds (clomid or femara) with injectibles

-injectible cycle(s)

-IVF

laynesmomma · July 2012

Thanks for all of those questions. This is what is so frustrating. There has been no indication of anything. I did just turn 35, but our timing was perfect at every attempt with IUI and my cycles were and continue to be regular. The time I did get pregnant was without Clomid - I was doing acupuncture at the time. It was an early miscarriage (around 6 weeks). We are using the same donor as my daughter who my partner had so really don't want to switch. Just really hoping to somehow increase my odds this next go around. Each try with Clomid, there was only one dominant follicle which makes me think maybe I wasn't responding so well. I remember with my wife, she tried 2 times with clomid and each time had 2 or 3 dominant follicles (all close in size). 50 mg. THANKS!

Kershnic · July 2012

Unfortunately as maddening and heartbreaking as this process is, each cycle only has about a 20% chance of working, so your track record so far is I'm sure frustrating but not worrisome. There's a reason straight couples have to try for 12 months before counting as infertile. But for us it's a little different because the process involved in trying is more stressful/expensive of course than heterosexual sex at home!! A good clomid response is 1-3 mature follicles, so 1 is good, but if I were you (frustrated/tired and 35) I think my next step would be to increase to 100mg of clomid. Obviously with discussion with your doctor! But keep in mind that some people are of the opinion that increasing # of follies may do far more for increasing multiples risk than it does for increasing chances of pregnancy.

Have you had your progesterone tested 7dpo? That can indicate the "strength" of your ovulation. One reason to increase clomid and/or move to injectibles (other than increasing # of follies) is to help with egg quality and "strength" of ovulation. If you don't have insurance coverage for injectibles though, be aware that they are quite expensive, whereas clomid is quite cheap.

2moms2twins · July 2012

laynesmomma:
How do people afford IVF? Not to get too personal, but I imagine most people are in the same boat as us. It seems so crazy expensive. Are there payment plans?

there are payment plans- its pretty crazy what out there. We just emptied our savings account to afford it. See if your clinic has any clinical trials for IVF you are interested or see if they can help facilitate you getting mes from a couple who did not use all their meds .. We are talking about baby # 3 but we will prolly have to take a loan out for it...

its tough

ball.and.chain · July 2012

I can't really give you advice about next steps as I am just starting my first Clomid cycle after 8 failed unmedicated IUIs. However, I wanted to to reiterate what Kershnic said -- that your track record is not really cause for concern at this point. Yes it's absolutely frustrating, but it doesn't indicate that anything is "wrong." Sometimes it just takes some time. It seems like a good sign to me that the cycle you got pregnant was with no meds, but I can see why you would want to get more aggressive going forward. I'm sure you and your RE will come up with a good plan, and hopefully it will be successful! Good luck!

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