new and sick of the same things

henderfitz2 · January 2015

Hello, everyone! Looking for advice about approaching my RE with thoughts on more aggressive treatment. I'm 25 with "lean" PCOS and my husband is 26 with a great SA and no fertility issues. At the beginning of TTC in 2013, I did 3 rounds of unmonitored clomid stairstepped from 50mg to 150mg and never ovulated. Finally got referred to an RE who did monitored femara with me at 5mg then 7.5mg but I still never grew any follicles. Fast forward to October 2014 where we decide ovarian drilling is the next best step as my testosterone was in the 90's and my ovaries were huge. Surgery was successful and RE found both tubes were clear and hysteroscopy was normal. My ovaries have since shrunk down some and I had AF completely on my own 3 weeks later. RE decided we can go for a clomid cycle and started me on 100mg cd 3-7 but on day 13 we again saw nothing but a bunch of tiny follicles. He prescribed another round at 150mg immediately and I go back in 2 days for a scan that will probably show no follicle growth yet again. So how can I say oral meds are not working and we need to move on? I'm not familiar with injectable cycles myself as I've only read other women's experiences. My RE never offered injectables as an option for me previously because I have so many immature follicles. My AMH went from 22 to 14 after surgery. I just feel continuing this route is wasting our time and money and I'd love to move on. Thanks for any suggestions.

BunnyBerry · January 2015

I'm so sorry for what you've had to go through. I think it makes sense that the RE is attempting a Clomid cycle after your surgery seemed to make such a big difference. Perhaps check on what your insurance covers in terms of injectable meds - your RE may be hoping to save you that cost, since it can be so high that IVF might be more cost-effective, especially with the chance of overstimming in PCOS. Definitely schedule a consult with him to make sure you are both on the same page, and bring all your questions. My gut says that if Clomid doesn't lead to a mature follie (or few), it might make sense to try one more cycle with Femara 7.5, stair-step if needed, and see how that goes.

If cost is not a big factor for you or if you have good coverage for injects, that might tip the scales more in favor of going to injects, even if there is a risk of cancelling. Definitely ask your RE what his plans are to help keep the stimulation under control but make sure you ovulate. It should involve a lot of monitoring!

The reduction in AMH sounds good for injects!

Then again, mine was 14 this month (a little lower than usual) and the RE upped my injects just a bit since I'd only gotten one egg before. And, suddenly there were 5 mature follies and IUI was cancelled.

So, just anecdotal evidence, but the RE felt that it was not worth trying injects and we should just go to IVF because of DH's MFI and because of my chance of over-stimming and throwing away the cycle - we're just doing it because insurance covers it anyway.

henderfitz2 · January 2015

Thanks! It has definitely been tough not responding to anything all this time. My insurance doesn't cover infertility of course but I've been able to get away with the scans being covered and getting some cost cut on Clomid and Femara. The trigger shot was full price (and still sitting in my fridge unused) so that doesn't bode well for other inject costs I suppose. I never thought it wouldn't be an option for me at all and definitely didn't think we'd be looking at IVF already. I would just love it if something, anything worked.

Remylove1011 · January 2015

Hi and welcome! I'm sorry that you find yourself here. I agree with PP's that it would be good to sit down with your RE to discuss injects/IUI versus IVF. I'm just starting my journey so I don't have a ton of advice, but wanted to say good luck and I hope you can come up with a plan.

SND1231 · January 2015

Welcome. I am sorry that you aren't feeling like you are getting anywhere. I would definitely try to sit down and talk to your RE about why he is using this treatment instead of something more aggressive. Good luck!

Hope1989 · January 2015

My RE was also keen to move straight to ivf after clomid but i wasn't ready for that quite yet. He ended up starting me on a tiny dose of 37.5iu on gonal f, on the low and slow stim protocol, ended up increasing to 50iu (still a very small dose) to get good response and i got 1 mature follicle. Next cycle just did 50iu, got 2 mature follicles and now in TWW.

So it is possible to use injects with pcos but others are right, it can be risky and difficult to find the right dose. If you get any more than 2 mature follicles at my clinic the cycle will be canceled so you need to be prepared for that too. I was lucky my RE was so conservative in the dose used, from what i have read even pcos sufferers have often been started on 75iu, which i likely would have overstimmed on.

henderfitz2 · January 2015

That's good to hear. I just got back from my cd 11 scan and I finally have some progress! I had some 14s, 15s, and one 17mm follicle. I am so glad to have growing follicles for once! Now the discussion is whether they all keep growing or will the 17mm take over and be dominant? Or will they stop here? I've never got this far so I'm both nervous and excited. I go back on cd 14 to see what we've got and we'll decide then if it's safe to trigger. I'm really hoping for good results!

Thanks for all your advice. I do think I'd try to do at least 1 or 2 low dose monitored inject cycles if I had to. Hopefully I'll keep responding to the oral meds and won't need to go there.

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