Conflicting Information about Clomid and Thoughts about RE's Plan

csy2947 · May 2014

Hey all,

I thought I'd post on this because of how different it was from what I'd been reading on the message boards and what not and get your thoughts. So I had a consult last week after my BFN on cycle 5 of clomid. I went in pretty distraught but got a very different consult than I was expecting. I was thinking he would move me to injectables/IUI but he said that the latest medical studies showed that if clomid is accomplishing its goal (regular ovulation in my case) then there's no real reason to switch to injectables. He said that you can use clomid without any fear of real danger for 12 cycles, not 6 (and that the increased cancer risk after 12 isn't even confirmed), and that he thinks that the pressure to stop at 6 and move to injectables becomes a self fulfilling prophecy. IE, everyone moves off at 6 cycles therefore there are no stories of it working later and therefore everyone thinks it doesn't work after 6 cycles. In his experience the pharmeceutical companies like to get people onto the injectables becuase they are (clearly) so much more profitable than clomid.

He scheduled us for an HSG/SA to check to make sure everything else was ok (HSG was totally normal, we should get the SA results today).

The current plan is for me to just continue on TI with clomid unless the SA shows something wrong on that front, and we'd move to IUI. This was actually a big relief to me because I'm very nervous about the financial and emotional aspect of IVF and don't think I'm ready to make that leap...but it also seems VERY opposite to the 'internet common knowledge' on clomid. Has anyone else gotten a similar treatment plan? He made an analogy like, the only difference between you and a 'normal' woman is that you have to come in and get poked and prodded all cycle, and if you had a 'normal' friend who had 5 cycles and had had a couple positives in that 5 months, you would tell her to keep trying.

Anyway, just wondering about other people's experiences with choosing to do more extended clomid treatments.

Thanks!

AnnaClaire256 · May 2014

This is almost word for word what our RE is telling us!

Since my husband's SA came back great and my tubes are clear, he sees no reason to move me off clomid. We've done well over 10 clomid cycles already but just recently found the right dosage that's gotten me ovulating like a champ. RE says now it's just a matter of timing. He said clomid is doing it's "job" and to try and look at it with fresh eyes. Even though I've had LOTS of previous cycles, I'm just now ovulating well and "in the game." He says to look at it as if we had just started trying.

We are currently on our second "successful" round of clomid...CD 21 bloodwork looked great. If I get a BFN this month, our plan is to start clomid again CD3.

adadeart · May 2014

Maybe I'm confused, but you're on cycle 5 of Clomid and you don't even have your SA results yet? If that's the case, find a new RE immediately. You may have been taking drugs when your issue is your husband.

Also, I don't know how long you can take Clomid (I've also heard 6 cycles max) but it can really reduce your lining (it did to me after just 2 cycles) so that an embryo couldn't implant. You should be having ultrasounds at day 3 minimum to check for cysts, and hopefully before ovulation to check to make sure you don't have too many follicles (i.e John and Kate Gosslin) and that your lining is adequate.

csy2947 · May 2014

adadeart said:

Maybe I'm confused, but you're on cycle 5 of Clomid and you don't even have your SA results yet? If that's the case, find a new RE immediately. You may have been taking drugs when your issue is your husband.

Also, I don't know how long you can take Clomid (I've also heard 6 cycles max) but it can really reduce your lining (it did to me after just 2 cycles) so that an embryo couldn't implant. You should be having ultrasounds at day 3 minimum to check for cysts, and hopefully before ovulation to check to make sure you don't have too many follicles (i.e John and Kate Gosslin) and that your lining is adequate.

We moved straight to clomid because I have been diagnosed with PCOS and have had VERY irregular periods my entire life, sometimes having to wait up to three months. We also had two chemical pregnancies so the RE said that meant my husband was likely fine, and that that was why they waited on the SA.

And I have heard about the reduced lining but I haven't had that happen at all yet, I have responded I think basically perfectly to it. And I am monitored very thoroughly. Sono at CD4ish, Sono at CD12/13ish, Prog blood test at 7DPO. The whole shebang. We did take one cycle off due to cysts.

@annaclare: That is so great to hear that there are other people out there getting similar advice Based on your sig it sounds like we're in very similar diagnostic boats

sundaybrunch · May 2014

I've definitely heard and read about the 6 cycle limit on Clomid. The biggest concern for me would be my lining (I haven't done too much research on the cancer link) but per your signature your lining has looked good each of your cycles so I don't know, maybe continuing on Clomid isn't a big deal?

I guess I have a couple of questions though. Have you asked your RE about switching to Femara? Because that's a typical next step after Clomid. Have you considered doing IUI even if the SA results are good? I guess if it were me after 5 cycles I would be really eager to try something different!

csy2947 · May 2014

princesskatie22 said:

I guess I have a couple of questions though. Have you asked your RE about switching to Femara? Because that's a typical next step after Clomid. Have you considered doing IUI even if the SA results are good? I guess if it were me after 5 cycles I would be really eager to try something different!

We talked about other drugs but his point was like, you need a medication that will help you ovulate regularly, and clomid is accomplishing that at a low dosage with minimal side effects. Why switch to something else and risk a different reaction when this is accomplishing its goal? I agree though that I am getting itchy to try something else, but everything else is so expensive! I have no IF insurance coverage, so anything beyond clomid will be OOP. He said if the SA is good (which actually, my husband just got the call and everything is normal there too!) then IUI will likely not help us along since that only helps the swimmers get to their destination, but that is happening.

adadeart · May 2014

@annaclaire256 Your bloodwork should not be done on CD 21 unless you are positive you ovulated on CD 14. Also, same advice, are you getting ultrasounds? After 10+ cycles of clomid, I hope they are also checking your lining. Letrozole is an alternative to Clomid that does not affect lining, and after 10 cycles I would want some alternatives. Good luck!

csy2947 · May 2014

NariaDreaming said:

We've had 2 chemical pregnancies, and my husband's SA results are now so abysmal that our only shot is IVF with ICSI.

Ah I'm sorry, that sucks. We actually just got my husband's results and his are normal but that is a bummer.

I feel like moving to IVF is exciting though! Much higher success rate Good luck!

sundaybrunch · May 2014

csy2947 said:

princesskatie22 said:

I guess I have a couple of questions though. Have you asked your RE about switching to Femara? Because that's a typical next step after Clomid. Have you considered doing IUI even if the SA results are good? I guess if it were me after 5 cycles I would be really eager to try something different!

We talked about other drugs but his point was like, you need a medication that will help you ovulate regularly, and clomid is accomplishing that at a low dosage with minimal side effects. Why switch to something else and risk a different reaction when this is accomplishing its goal? I agree though that I am getting itchy to try something else, but everything else is so expensive! I have no IF insurance coverage, so anything beyond clomid will be OOP. He said if the SA is good (which actually, my husband just got the call and everything is normal there too!) then IUI will likely not help us along since that only helps the swimmers get to their destination, but that is happening.

Sounds like a logical approach and one you feel comfortable with, which is super important. I'm also 100% OOP (even for Clomid) and totally understand how expensive IF is. I would still be tempted to add IUI to the protocol if I were you (it only costs $150 at our office) since Clomid can negatively affect CM and make it difficult for the sperm to even make it to the uterus. But to each his own! I swear I'm not an IUI pusher!!

FX for your next cycle!

jszy10 · May 2014

My RE is very happy with my response to Clomid and doesn't see a need to move to anything else. I have been told though that my AMH is so high that I am almost guaranteed to overstim and get canceled on injects. How many follies are you getting on Clomid? If you are getting multiple follies with Clomid then it might be the right choice to stick with it? I just read an article that was from a tv broadcast/report about the most recent research on clomid NOT being linked to an increase chance of cancer. Maybe try to look that up?

AnnaClaire256 · May 2014

@adadeart‌
Yep. Ovulated CD14, right on time. We do a CD3 u/s, if all clear (which it always has been) then we do clomid CD 3-7. We have u/s starting CD10. This month I wasn't quite ready so I came back CD12, triggered and ovulated CD14.

My lining was on the thin side CD10 (6.5mm) but grew right along with my follies. It measured 8mm on CD12 when I triggered.

ETA: We did try Femara but I just don't respond well to it.

csy2947 · May 2014

jszy10 said:

My RE is very happy with my response to Clomid and doesn't see a need to move to anything else. I have been told though that my AMH is so high that I am almost guaranteed to overstim and get canceled on injects. How many follies are you getting on Clomid? If you are getting multiple follies with Clomid then it might be the right choice to stick with it? I just read an article that was from a tv broadcast/report about the most recent research on clomid NOT being linked to an increase chance of cancer. Maybe try to look that up?

I'm getting multiple on clomid, one month I had 3, most of the time its 2...I am also very worried about overstimulation when moving to injects.

Yeah I feel like clomid might have a scarier rep then it deserves. I'm glad to hear other women here have heard similar advice...I felt like a lot of the posts had a lot of 'OMG why are you still on clomid?' and it made me worried.

csy2947 · May 2014

NariaDreaming said:

csy2947 said:

NariaDreaming said:

We've had 2 chemical pregnancies, and my husband's SA results are now so abysmal that our only shot is IVF with ICSI.

Ah I'm sorry, that sucks. We actually just got my husband's results and his are normal but that is a bummer.
I feel like moving to IVF is exciting though! Much higher success rate Good luck!

Yeah. So excited to pay somewhere in the range of $10k out of pocket for something thousands of girls will get unexpectedly at their after-prom parties this year.....

Ugh that is the worst. My 23 year old brother just accidentally knocked up his GF and I had a total meltdown about it. Its amazing how much of a roll of the dice it is. I will be thinking positive thoughts your way that you only have to go through one cycle!

BunnyBerry · May 2014

That is a very complicated question!

If I were you, I'd be wondering about a couple things. First, could the CPs be related to poor sperm quality (SA results coming soon sound great). Second, could the cervix or cervical mucous be tough for the sperm, or their motility low since 10% or something of infertile couple have both male and female factors? (IUI might make a difference). Third, could a problem with egg quality have contributed to CPs or interfering with conception? (in which case, injects may cause better egg development as compared Clomid).

Personally, after so many tries, I would no longer consider just the O'ing a success - although your lining still looks good (usually the biggest concern with continuing Clomid), I think there are just too many other possible or even unknown factors and I wouldn't want to put all my eggs in one basket, so to speak.

On the other hand, there is something to be said for trusting an RE, especially if he is trying to rectify some misconceptions possibly caused by the drug companies! Ick, hate them. So, whatever you choose, it will be a positive step toward having a baby, and I wish you the best of luck!

I also wanted to say, I understand how you feel about IVF...at this point, I am using the thought of a future IVF to avoid getting my hopes up about IUI. Even though we're pretty broke (I'm a teacher, he's a college student, and we just bought a house), we are willing/able to fund one 2-for-1 IVF deal at our RE's if needed. The trouble is, if/when we get to that point, there won't be a way to escape the pressure, inevitability, and awesome expense - what if it doesn't work? Oh my goodness, I can't even imagine that place!

So for now, I'm looking at IVF as that guilty pleasure that I would jump straight to if DH would just let us, but in reality I'm afraid it won't feel like a relief if I actually get to it. Anyways, I just hope that our REs keep getting smarter and smarter about IF and help us all get our take-home babies sooner rather than later in our expensive process!

lebradford · May 2014

csy2947 said:

NariaDreaming said:

We've had 2 chemical pregnancies, and my husband's SA results are now so abysmal that our only shot is IVF with ICSI.

Ah I'm sorry, that sucks. We actually just got my husband's results and his are normal but that is a bummer.

I feel like moving to IVF is exciting though! Much higher success rate Good luck!

_________
Seriously??

csy2947 · May 2014

lebradford said:

NariaDreaming said:

We've had 2 chemical pregnancies, and my husband's SA results are now so abysmal that our only shot is IVF with ICSI.

Ah I'm sorry, that sucks. We actually just got my husband's results and his are normal but that is a bummer.
I feel like moving to IVF is exciting though! Much higher success rate Good luck!
_________ Seriously??

I was just trying to see the positive. Which is an ongoing struggle in this process. I'm sorry if you felt I was being insensitive, hopefully very obvious that that wasn't my intent.

And @nariadreaming, I am VERY sorry if I made today any harder for you, it really wasn't my intent.

csy2947 · May 2014

Thanks @bunnyberry

Luckily looks like our SA was fine so that isn't the issue. I have wondered about egg quality but my RE didn't seem to think there was much scientific evidence pointing one way or the other. I am very fortunate to only be 29 so feel like we have a little bit of time to keep trying clomid. We'll definitely move on if it still hasn't worked after a year or so.

BunnyBerry · May 2014

Yay, congrats on your SA results!

And, thanks for sharing your RE's thoughts...it is a new perspective and I am glad to have heard it before we go in for our big planning consult Monday.

csy2947 · May 2014

BunnyBerry said:

Yay, congrats on your SA results!

And, thanks for sharing your RE's thoughts...it is a new perspective and I am glad to have heard it before we go in for our big planning consult Monday.

Good luck! I was a total wreck during mine but I suppose its always a little better to be informed? I can never decide lol

Sha259 · May 2014

MY RE was also very satisfied with my response to low dose Clomid. However, with my blocked left tube and DH's MFI, medicated IUI seemed like a waste of money after 3 failed cycles. Plus, we are lucky enough to have IF coverage, so with our diagnosis it made sense to move on to IVF.

In your case, I would say, as long as your RE is doing all of the important background work to increase your chances of success (and that includes thorough investigation of both you and your H's diagnosis) and he has answered all of the questions that you have regarding the medications that he is suggesting you use (backing his decisions with not just his opinion, but also with scientific data), you can make the decision as to whether or not you want to trust in him.

For us, my RE provided me with all of those things, clear diagnosis, answering ALL of our questions, not with just what we wanted to hear, but with the facts, explained every step of the way what we were doing and why we were doing it. For this reason, I trust him completely, and when he looked at me and said we should have our IVF discussion I was 100% on board.

Good luck!!

lupineaura · May 2014

(ticker warning and child mentioned)

Thank you all for sharing this info about Clomid- I had Clomid success in the past (how I conceived my daughter) and am about to start again (TFAS). I am with a different RE and feel like it's my first go-around! I'm glad to hear Clomid is less "scary" than it was in the past.

I have to say I am a little concerned/confused you and your husband were not sent for diagnostic testing prior to starting Clomid. Event though we had a previous successful pregnancy, I still had a saline sono and my husband had an SA prior to the Clomid perscription, in addition to repeat bloodwork.

Also, I noticed a couple other ladies here have Hashimotos....*waves.* I have that as well as a prolactinoma...my endocrine system is jacked.

csy2947 · May 2014

lupineaura said:

(ticker warning and child mentioned)

Thank you all for sharing this info about Clomid- I had Clomid success in the past (how I conceived my daughter) and am about to start again (TFAS). I am with a different RE and feel like it's my first go-around! I'm glad to hear Clomid is less "scary" than it was in the past.

I have to say I am a little concerned/confused you and your husband were not sent for diagnostic testing prior to starting Clomid. Event though we had a previous successful pregnancy, I still had a saline sono and my husband had an SA prior to the Clomid perscription, in addition to repeat bloodwork.

I had been EXTENSIVELY tested for PCOS prior to clomid. Done rounds on metformin and years of bloodwork to back it up and so the HSG was a follow up after the clomid had not worked to make sure there wasn't an additional anatomic component, which there wasn't. Husband was supposed to go in for the SA three cycles ago actually, but then we had a very strong chemical (if there can be such a thing) so they didn't follow up with him and I think he put it off cause he was nervous. Turned out to be moot!

Good luck to you on round 2 of all this And congratulations on your daughter!

csy2947 · May 2014

Sha259 said:

MY RE was also very satisfied with my response to low dose Clomid. However, with my blocked left tube and DH's MFI, medicated IUI seemed like a waste of money after 3 failed cycles. Plus, we are lucky enough to have IF coverage, so with our diagnosis it made sense to move on to IVF.

In your case, I would say, as long as your RE is doing all of the important background work to increase your chances of success (and that includes thorough investigation of both you and your H's diagnosis) and he has answered all of the questions that you have regarding the medications that he is suggesting you use (backing his decisions with not just his opinion, but also with scientific data), you can make the decision as to whether or not you want to trust in him.

For us, my RE provided me with all of those things, clear diagnosis, answering ALL of our questions, not with just what we wanted to hear, but with the facts, explained every step of the way what we were doing and why we were doing it. For this reason, I trust him completely, and when he looked at me and said we should have our IVF discussion I was 100% on board.

Good luck!!

Thanks! I do feel pretty confident in him actually and he has been very transparent with us. I think sometimes ALL the voices tend to make me a little mixed up but its good to hear I'm not the only person getting this advice

csy2947 · May 2014

@csy2947‌ Had your Dr talked to you about what your chances are with Clomid and TI only? Any good RE knows that Clomid and TI has a 3-5% success rate each cycle. On the other hand Clomid + IUI has around a 10-15% success rate (I am assuming you would be on the higher end since your only issue appears to be PCOS). Also, from what I understand Clomid will give you more follicles but they are of lesser quality whereas Femara will make healthier but fewer follicles. I know how much it sucks to have to pay OOP. We are 100% OOP as well. However, personally I would rather do three good IUI cycles with monitoring then 5 monitored TI cycles because overall you are spending more money for a lower chance of becoming pregnant. ETA: I forgot to add that my RE only does 3/4 cycles of Clomid and IUIs because any one persons statistical chances of getting pregnant after 3/4 IUIs w/Clomid are sooooo low. Not because of Clomid risk.

@catarinac Where did you hear that 3-5% success rate stat? I haven't heard that anywhere, from my RE or even my independant research. Perhaps that is in conjunction with a secondary IF issue? My tests indicate that my problem is ovulation based so clomid helps to put me on equal playing ground with a normal couple because my trouble comes from knowing when to do TI. Genuinely curious because I have never heard such a low estimate before...

The eqq quality issue is definitely the one I am most concerned about but my RE says that is mostly anecdotal, that there isn't really anything decisive that says that injects or femara give better quality. The other side effects of clomid I don't appear to be dealing with (CM self exams seem good, multiple chems make it seem like the sperm is getting there and my lining is always strong)

The OOP issue sucks, at my RE/insurance even one cycle of IUI would equal more than the last 6 cycles of clomid combined though so we feel like the risk/benefit ratio is in our favor for waiting a bit longer. I feel like we will probably skip IUI though if we move on and go straight to IVF.

Thanks for responding!

AnnaClaire256 · May 2014

@CaterinaC‌ With our diagnosis (which seems to be the same as yours @csy2947‌) RE says each viable egg has a 20% chance. Same, or maybe even a little better, than the average woman simply because I have the luxury of knowing exactly when I will ovulate. I've seen other women on here say the 3-5% chance statistic before but that's not at all our RE is telling us either. Maybe it's because our issues are so clear cut with PCOS and getting me to ovulate is 90% of our battle?

ankhwearer04 · May 2014

My RE said the same thing to me on Tuesday. She said 12 cycles where I ovulated. If you didn't ovulate, apparently it doesn't count toward that 12. I am starting cycle 4 today and she said I will be on this for awhile (depending on my SHG next week). We had also previously heard 6, but she said theres been no studies on women to prove it has any negative effects. Good luck!

Lillovebug79 · May 2014

I personally did over 6 cycles of clomid and on my 6th cycle, I asked my RE about switching to Femara. My RE said that there was no danger in doing more than 6 cycles of clomid and given the fact that I had responded well, she would rather stick with it. I did have 1 cycle with only 1 follicle but that was my 6th cycle and I think my body had just become used to it so the 7th cycle, we upped the dose. I was also doing IUI but my circumstances are different than yours, our issue is MFI and I always ovulate on my own anyway. My RE told me (and I've read in research) that clomid has the highest success for annovulatory women as does any kind of ovulation induction (as long as the result is ovulation). It has the lowest success rate with MFI and also with I explained infertility. It makes sense because it's correcting your issue. For those of us that ovulate on our own, all it does is produce more follicles (sometimes) which can help but isn't correcting the issue for our IF.

don't be discouraged, if the success rates for Clomid are low! it is taking into account everyone who uses it for every reason. As long as you are monitored (and it sounds like you are), more cycles should be fine. The cost of injects compared to their success rate just doesn't seem worth it. I tried a few cycles and in hindsight, I wish I had just saved that money! Good luck!

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