Next Steps - What would you do?

dressagetiger · January 2014

I have been on clomid for 6 cycles, temping and opks have shown ovulation each cycle and cycles are lasting between 35 and 40 days, getting one day longer each cycle. My GYN has recommended IUI or offered to refer me to an RE. I do not understand, nor has anyone been able to explain to me, why IUI increases chance of pregnancy when SA is normal. At our initial consultation with an RE she recommended continuing on clomid with ultrasound monitoring at $1200/mon. or IVF, she is willing to do the Femera injection with clomid and ultrasound monitoring at $1800/mon. but does not recommend it because of increase chances of multiples. She said she would not recommend IUI because the research has not showen that increases chance of pregnancy. I have an appointment with a different RE on February 18th, I like the first one but this company (Shady Grove) was the one recommended by my GYN, I want to shop around before settling on an RE. At this point, all I can afford is to continue on clomid (which my RE says is fine) and hope for the best, however, with each BFN I'm growing more impatient, especially because I would like time to have more than one child. DH and I are both 27.

I've considered doing some type of fundraising to help with cost of treatment/adoption but after looking at the list of causes on giveitforward.com (cancer, transplant, memorial) I just felt greedy asking others to help us start a family. Also, I keep coming back to if we can't afford to conceive a child we probably shouldn't have one.

My questions to the group is what did you try before IVF? I didn't think we were anywhere near IVF yet so I was shocked when the RE brought it up. What are your thoughts/opinions on fundraising or should I just be patient and continue on the clomid? Personally, I would like to try monitoring and Femera before IVF but I keep coming back to money.

Also, I'm noticing that each month the week before my period I experience irritability, crying, depression. I'm thinking it's a side effect of clomid and I need to battle through.

JadziaDax · January 2014

After Clomid was not successful for me, and ended up thinning my lining, I moved onto Femara. When that didn't work, I moved onto injections (Follistim). You can see my history in my siggy. Right now, i'm in the middle of a hybrid cycle with both Femara and Follistim. Were you getting ultrasounds done when you were taking Clomid?

I also found a coupon online for Femara that i've posted on here a few times.

https://www.goodrx.com/femara

I used mine at CVS and they took my coupon the last 2 times I tried.

Addressing the fundraising question, you have to do what you feel comfortable doing. I would not feel comfortable fundraising for fertility treatments, but I would consider it for adoption. Good luck with your new RE!

dressagetiger · January 2014

I would feel more comfortable fundraising for adoption...

I'm thinking Femera isn't the right drug name, I think it's an FSH injection. The paperwork is in my car and it is very cold out

dressagetiger · January 2014

I was not getting ultrasounds on Clomid, both my RE and my GYN recommend I start but at 1200/month, it's not an option.

dressagetiger · January 2014

TTC - since Aug 2012, no u/s since starting clomid, had bloodwork and HSG, had day 28 bloodwork first round of clomid, no test since

RE recommending some additional bloodwork when cycle starts

dressagetiger · January 2014

I'm not opposed at all to twins, two for the price of one sounds great! My Dr is opposed. Wasn't monitored because I was trying to keep treatment affordable and my GYN was working with me on that. I knew from a young age I would have trouble TTC but always thought my problem was a common one and would be an easy pill fix. I have watched CM and knew clomid could thin my lining but I was on a low dose (50 mg and then 100 mg), I asked my doctor if anything could help that, she did not recommend anything.

ronniesgirl1981 · January 2014

We recently made the decision to move on to IVF. I'm also with SG. Here's my moving on to IVF story: https://forums.thebump.com/discussion/12235697/re-f-u-moving-on-to-ivf#latest Good luck withw whatever you choose!

chickysue · January 2014

dressagetiger said:

I'm not opposed at all to twins, two for the price of one sounds great! My Dr is opposed.

Unless there is a medical reason, which I don't think you know at this point, your Dr. should have no opinion. Is there a reason why the Dr. is opposed? (I'm just trying to see if there is medical info that could be important here).

DreadGamerWife · January 2014

@Rumbera28. Yes, you decide with the RE how many eggs get transferred. Some of it depends on what type of transfer 3 or 5 day. It seems that for a 3 day, the REs typically recommend transferring 2. If you are able to do a 5 day transfers, they typically recommend 1 transfer (if the quality is good and you are under the age of 38). We did a single 5 day transfer.

jszy10 · January 2014

Read this -- https://www.fertilitytoday.org/fertility_drugs.html

"In general, Clomid should only be used for a maximum of six cycles, and possibly their is no significant advantage of treating for more than 4 cycles. Numerous studies demonstrate that if pregnancy will occur on Clomid, seventy-five percent will occur within three to four cycles. There is no medical indication for taking Clomid for longer than 6 cycles. Clomid can have side effects and extended use is never recommended."

...and I agree with PP's, you really should be having regular ultrasounds -- to check lining and follie count. Who even knows how your body is responding, or what kind of negative impact it has had?

Clomid is known for creating 'hostile CM', which can create a poor environment in welcoming sperm. An IUI passes by that environment and puts it right where it belongs!

I'm not OOP, and I can't really speak for what I would do if I were...but monitoring is definitely an essential part of this process!

Lillovebug79 · January 2014

I did 5 cycles of clomid with no success and 3 were with IUI but our issues are different. I have now moved on to Follistim. PP are so right, clomid shouldn't be unmonitored. I would definitely follow the recommendations of an RE vs GYN. They know so much more about infertility. Have you looked into if the monitoring could be covered by insurance? All of my monitoring and testing is covered by my regular insurance and not my infertility benefit. If or when you do decide to do injectables, I would highly recommend doing IUI. It is an extra cost but the meds are so expensive that it is worth maximizing your chances. A trigger shot and well timed IUI does that. Good luck to you!

dressagetiger · January 2014

My insurance covered all diagnosis testing but will not cover txt, they will cover a pelvic u/s but only for medical necessity, which is now how the GYN bills it.

Thanks for the well wishes everyone.

shannonm97 · January 2014

Do you have insurance coverage? If so your doctor should be able to bill monitoring using a different gynecologial diagnosis code so it is covered. I don't have infertility coverage for treatment- only the underlying condition. I get blood work covered because of a hormonal imbalance and ultrasounds are covered beause of possible PCOS as they are the underlying conditions. Maybe they can get it covered that way. I pay OOP for all IUI, sperm washing for IUI, and meds.

I agree with PP that monitoring is too important to not be monitored. I made the rookie mistake and took Clomid unmonitored with my GYN. When I met with the RE for intial testing, he found a 55mm cyst that ended up having to be aspirated. Yikes!

Milagros315 · January 2014

dressagetiger said:

I'm not opposed at all to twins, two for the price of one sounds great! My Dr is opposed. Wasn't monitored because I was trying to keep treatment affordable and my GYN was working with me on that. I knew from a young age I would have trouble TTC but always thought my problem was a common one and would be an easy pill fix. I have watched CM and knew clomid could thin my lining but I was on a low dose (50 mg and then 100 mg), I asked my doctor if anything could help that, she did not recommend anything.

Twins are definitely not two for the price of one. Besides the fact that costs after birth are doubled with two children, there are many risks (to the mother and babies) associated with a multiples pregnancy. The mother and babies are at a higher risk for health problems during the pregnancy and the babies are at higher risk for health problems they would have to deal with for life. Your doctor likely advises against twins because that is the standard medical recommendation for a woman under 35 who is trying IVF for the first time. Transferring more than one embryo is the right option for some people and many people have healthy twins, but it's not something to take lightly.

As PPs said, the risk of multiples is lower for IVF than medicated IUI because the doctor has more control over the situation. For some unknown reason, the incidence of identical twins seems to be increased during IVF cycles but the chance of fraternal twins depends on the number or embryos transferred.

And I'm going to agree with everyone else - if you want to continue treatment, it would be best to go to an RE and follow all of the proper monitoring procedures even though they are very expensive. It's not worth risking your health and fertility to save a little bit of money. We are OOP as well, so we decided to skip IUI and move right to IVF. It's expensive, but the chances of success are much higher than IUI so we decided to save our money and put it toward IVF instead of 3-4 IUIs.

jaco0207 · January 2014

As others have said, I also think an ultrasound is a good idea, at least one so you have a baseline. One of the reasons my obgyn does it is to make sure that I don't have too many follies.

I am doing IUIs through my obgyn right now, but I did shop costs before deciding to do it. A typical cycle for me with clomid, day 10 u/s, and IUI is about $1000, and the clinic offers a 30% cash discount if you can pay the bill w/i two weeks of getting it. Don't be afraid to call the billing offices and ask about costs and their cash discount policy.

ky29 · January 2014

I find it odd that your doctor is opposed to multiples, yet, you're not monitored on clomid.

Anyway, I know it's expensive, and it's hard. But that's why it is expensive, it's very important. And it can end up being more costly if it's not done properly. Take your time, and save up money (easier said than done, I know).

Regarding IUI success rates. We are MFI, and DH has under10mil for post-wash numbers. But when the nurse was doing the IUI, she said that was awesome because during intercourse only a could hundred thousand make it up there. Getting through the cervix is the hardest part. But here I am, on #3, which will likely be our last before IVF.

Good luck to you!

rox825 · January 2014

dressagetiger said:

I have been on clomid for 6 cycles...

At this point, all I can afford is to continue on clomid (which my RE says is fine) and hope for the best...

I'm really surprised that your RE has said it's fine to continue on clomid after taking it for 6 months. Also, 100mg is *not* a small dose of clomid. I've been on 25mg for the past several cycles- that's a small dose. Just about everyone who takes clomid for consecutive cycles will have thinned lining- it happened to me after just 2 cycles on 50mg, which is how I ended up on 25mg. Like Naria said above, after 6 cycles on 50/100mg your lining is almost certainly too thin for you to become pregnant or sustain a pregnancy (AKA if your lining is too thin and you were to become pregnant your chance of miscarriage would be much higher). And even if you're checking CM, that alone doesn't tell you whether it's "good quality" because you can't tell pH, which is what kills the swimmers. IUI will bypass that and get the strongest ones much closer to where they need to be.

Anyway, all that to say, I think that you definitely need to find a new OBGYN and a new RE. A really good OBGYN won't prescribe clomid at all, and even an average OBGYN will only prescribe it for a few cycles before referring to a RE. And after 6 cycles on clomid, your RE should really be pushing more thorough testing and a new treatment protocol instead of saying that you can continue with monitored clomid and TI. Whether you opt to go for IUI or IVF the cost is going to be high, so I'd probably start saving now and make the decision in a few months based on your financial situation. IVF will give better success odds.

Sorry that you've been stuck spinning your wheels for so long without success, I hope that you can come up with a new *safe* plan that will work quickly for you.

CandaceC1020 · January 2014

I'm a Shady Grove girl - almost at the end of my testing process. I recommend meeting with the doctor at Shady Grove for the initial consultation.

Shady Grove works with insurance and they let you know what is covered and what will not be covered by your insurance up front. I was extremely worried about things not being covered, so the insurance information up front was a relief.

SG is like a well oiled machine .... They know what they're doing. They get you in, get you out.

I'm not sure what area you're in, but another place you might want to check into is Dominion Fertility. I hear commercials for them on a regular basis. I have a friend who used them for natural cycle IVF and had success (price is much cheaper than IVF with SG).

If you have any questions or need someone to talk to, feel free to PM me.

dressagetiger · February 2014

Thanks for everyone's advice and concern. If we had the money I would gladly spend it, it's not a matter of shifting funds from somewhere else, we simply don't have it. My husband is a farmer and we're just starting out so we rely largely on my income and have a huge mortgage since we bought land to get the farm going.

I did have a baseline ultrasound and blood work last Friday. My lining was 6 and I had 10 follicles on one side and 15 on the other. The nurse who did the ultrasound said this was good. Dr. called later in the day to say all blood work that came back looked good, other blood tests will take 2 weeks to come back. Now waiting to hear back from those blood tests and then we will go from there.

tippytoes06 · February 2014

There is so much wrong with this, I can't even comment without being a snarky bitch. So I'm just going to say good luck.

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