Newbie - clomid questions

mrsbullard21 · June 2013

Hi everyone!

My name is Melissa and my husband's name is Alex. We've been married for 4 years and haven't necessarily been "trying" to get pregnant, just not using any form of birth control, for 2 years.

Went to the doctor this afternoon and she told me that she was going to have me start on progesterone and clomid. She mentioned that there is a 7% chance of having twins while on clomid. In addition to this, my husband has a couple sets of twins in his family.

It's hard to imagine what 7% really means, so I was wondering how many folks here have used clomid and ended up with twins?
I've always wanted 2 kids so, even though the work load is twice as heavy with twins, we would be delighted to have a set.

Thanks!

mrsbullard21 · June 2013

I'm seeing an OB.

I have PCOS, my cycles are extremely sporadic (my last period was in March, and the one before that was in October), and I'm not ovulating.
She explained that the progesterone will kick start my periods, and then I'll begin taking clomid on the fifth day of the period.

We're starting with oral meds because they are simple and inexpensive, and also because my doctor believes that the PCOS is the only thing preventing conception. We haven't had any fertility tests, unless you would count a vaginal ultrasound which was done to check out how severe the PCOS is (not very).
My doctor did write an order for my husband to have his sperm count tested, which he'll be doing once we contact our insurance company to check out how much it will cost.

JoJo42 · June 2013

Your DH having twins doesn't really mean much for you, it would matter more if you had twins in your family (faternal, identical twins occur randomly). However, clomid changes this. It increases your risk of twins by causing your body to ovulate mre than one egg. Even scarier, you could ovulate many more eggs (eek! This is how Jon and Kate +8 happened!). This risk is minimized by having an ultrasound before ovulation, you should stop if there are more than 3-4 follicles. Clomid can also cause your uterine lining to thin so as to prevent implantation, also checked through midcycle monitoring/ultrasound. Clomid also has many terrible side effects, even the possibility of OHSS.

Besides, what if you hve blocked tubes, or your husband has poor sperm quality? Clomid will do nothing but harm you in thse instances, so you need an HSG and semen analysis to rule those out.

What I'm trying to say is, you need to see a fertility specialist, called a Reproductive Endocrinologst, if you want to continue with fertility treatment. Your OB has done their best until now, but now it's time to seek proper treatment.

also, it could just be that you are very unlucky and haven't hit your fertile window yet (ovulation doesn't alwas occure on day 14). You only have a 20%chance each month, provided that you have sex around ovulation. You can try using opks or basal body temping to track and confrm your ovulation for a couple months before seeking further treatment. Try reading, taking charge of your fertility, and exploring the tutorials on fertility friend.

PenelopePond · June 2013

Ignore me. Poster above me has a great answer.

mrsbullard21 · June 2013

My doctor went over all of the information on clomid with me and my husband. She mentioned the possibility of blocked tubes, and as I mentioned, gave us an order to have my husband's sperm count tested.

We currently do not have thousands of dollars to spend on fertility treatments and testing. Because we are young and in good health, my doctor feels that starting out with a simple and inexpensive fertility treatment - i.e., clomid and progesterone - is a good compromise for now. I am aware that clomid has risks and side effects. Birth control does, too.

Right now my husband and I feel like this is a good option for us. It would be different if we were going into this blindly or completely ignoring the risks that are associated with clomid, but that is not the case.

I do appreciate all of your concern...I was simply curious as to how many members of The Bump community have used and had success with clomid and how many have twins. That's all.

DebateThis · June 2013

mrsbullard21:
My doctor went over all of the information on clomid with me and my husband. She mentioned the possibility of blocked tubes, and as I mentioned, gave us an order to have my husband's sperm count tested.

We currently do not have thousands of dollars to spend on fertility treatments and testing. Because we are young and in good health, my doctor feels that starting out with a simple and inexpensive fertility treatment - i.e., clomid and progesterone - is a good compromise for now. I am aware that clomid has risks and side effects. Birth control does, too.
Right now my husband and I feel like this is a good option for us. It would be different if we were going into this blindly or completely ignoring the risks that are associated with clomid, but that is not the case.
I do appreciate all of your concern...I was simply curious as to how many members of The Bump community have used and had success with clomid and how many have twins. That's all.

Then don't seek fertility treatments until you can save or figure out another way to see an RE. It sucks, but that's what you need to do. Just because clomid is "simple and inexpensive" does not mean it's without risk and it absolutely should NOT be prescribed by an OB. They don't know what they're doing and can put your fertility in jeopardy or even cause a miscarriage due to lack of training.

https://community.thebump.com/cs/ks/forums/thread/64391126.aspx

This is long but you need to read it:

Your DH should first have an SA. In terms of invasive testing and side effects, the SA is the only one with no side effects (except an orgasm, lol) and no intrusion into your person. It's estimated that nearly 40% of infertility in couples is MFI (male factor infertility), so it's not like its a small sample of the population that has issues with their sperm. It's a huge deal and is super cheap to test compared to the rest of them so you might as well get it done.

Next, your OB should not be "hypothesizing" that you are not ovulating. There are very specific tests (with just a simple blood draw and transvaginal ultrasound on specific days of your cycle, as I mentioned before) that can determine this with near certainty. Second, if you are having periods somewhat regularly (under 60 days between Day 1 to Day 1 of your cycles) then you ARE ovulating. It might not be regular or strong enough or any host of other reasons, but you are ovulating. It is not impossible to figure out when you're ovulating, either - basal body temperature charting or OPKs can go a long way toward pinpointing ovulation.

The most common diagnosis for lack of ovulation/weak ovulation/ is PCOS. There are a number of criteria that need to be met in order to be diagnosed with that, but again - you need to have the tests run. If PCOS is what is causing your ovulation issues (if you have ovulation issues at all) taking clomid, especially unmonitored, can cause ovarian cysts to grow out of control and potentially even cause irreversible damage to your tubes. This could all be a moot point if you don't have PCOS, but you need to rule that out first.

Last, you need to rule out that you aren't having any structural issues with your ovaries, tubes, and uterus that could be impeding conception. This is done via HSG (hysterosalpingoram - an ultrasound with radioactive dye injected into your uterus). It checks for tubal blockages and uterine abnormalities. All the Clomid in the world won't get you knocked up if your tubes are blocked or if you have a uterus full of fibroids or polyps.

This is from INCIID (International Council on Infertility Information Dissemination), and the ASRM and SART recommendations are nearly identical:

If you are not seeing an RE and your OB/GYN does not have the facilities to conduct these routine tests, you should seriously consider switching to a doctor who does. Minimally, a doctor treating fertility patients should have the following:

Availability of staff and technicians seven days per week. If your doctor or clinic does not offer weekend and holiday hours, you are clearly not in the hands of someone whose priority is helping you get pregnant. Transvaginal ultrasound equipment. You should not undergo treatment with Clomid or injectable fertility medications unless this equipment is available for routine monitoring. Though many OBs prescribe Clomid without doing this monitoring, it is in your best interest to have periodic ultrasounds to ensure that the Clomid is indeed stimulating ovulation and that the follicles are releasing the eggs. Under no circumstances should a patient undergo treatment with injectable medications, such as Humegon, Repronex or Follistim, without ultrasound monitoring. If you are using intra-uterine insemination (IUIs), ultrasounds are required for accurately timing insemination with ovulation. An on-site, certified lab to do semen testing and prep for IUIs and post coital tests, as well as facilities to do E-2, blood HCG beta and progesterone tests.
See also: How to Chose a Clinic

https://www.inciid.org/printpage.php?cat=infertility101&id=262

And all this, of course, is AFTER OP/DH have been tested and under the care of an RE, not an OB.

JoJo42 · June 2013

At the very least, you need a baseline u/s the same day you start your clomid, to ensure there are no large cysts, because the clomid would cause them to grow with potentally disasterous consequences. Then, you need a midcycle u/s to determine the #follicles (1-3 is best), and the lining thickness. If the lining is too thin, a common side effect of clomid, then the it won't be able to implant. In that case, they can prescribe estrogen to help grow it before ovulation, or you can switch to letrozole the next cycle (similar drug, with fewer side effects). My RE also wanted to know before hand my stance on selective reduction, in case of high order multiples (which really is a risk). Before any cycles, you need a blood pregnancy test. All this monitoring is not very expensive in the scheme of things, but does much to ensure your health and safety. Also, if things don't happen in 3-4 cycles, it's time to move on to a new protocol.

rachelstauf · June 2013

I also have PCOS. Before my dr even thought about anything else she put me on Metformin. It's entire purpose for someone with PCOS is to regulate ovulation. It's got much fewer side effects and they are much less severe. It just helps regulate your hormones so you have regular periods, are ovulating, and can help with some of the weight and other aspects.
I have a good number of friends with PCOS and am on board specifically for people with PCOS who are trying to conceive. I have never heard of going straight to Clomid.
I would strongly recommend seeing a different dr just for a 2nd opinion or seeing an endocrinologist since PCOS is an endocrine disorder before you jump into Clomid. The answer might be cheaper and easier for your body!