After Letrozole/Clomid?

LizzieJ13 · July 2016

After 5 rounds of Letrozole I will likely be starting Clomid in the fall. Is anyone familiar with anything that can be done after those two medications have been tried (other than IUI or IVF)? I hear "injectables" a lot, but I'm not sure what that protocol entails. I want to have at least some idea of what lies ahead in the event we have to move on from pills.

Thanks!!

AandDM2014 · July 2016

I'm pretty sure injectables means Gonal-f in a low dose, which is a med used for IVF. I don't know that TI is ever a thing with those, or if you have to do IUI. I think that generally if you're doing TI for as long as you have, it's time to try something else, like IUI.

LizzieJ13 · July 2016

For religious reasons we won't be trying IUI or IVF, so we want to maximize our chances with TI. I could have sworn I've seen a post (maybe not here) of injectables for PCOS... maybe in conjunction w/ IUI, maybe a lower dose?

Monica54321 · July 2016

I echo what @AandDM2014 said - I haven't heard of injectables being used to stimulate ovulation for TI before - only IUI or IVF. The big thing with moving on from oral medication to injectables is the cost increases drastically.

$10-$15 for 1 cycle of oral medication (for me)
$3,000 - $5,000 for 1 cycle of injectable medication (for me)

So obviously, if you're going to be investing thousands of dollars on medicine, you want to maximize your chances of getting pregnant.

LizzieJ13 · July 2016

Oh wow, thanks for that @Monica54321. I am very fortunate to live in a state where most treatments are covered so cost hasn't been an issue so far. I'm not sure we could afford that. Good luck to you.

AugustAng · July 2016

At my clinic we could have chosen to do injectables with TI. I did injectables with all of my IUI cycles. In my experience, I started the follicle stimulating injection (Gonal-F, Follistim, etc) on Day 3 of my cycle. I went back in on Day 7 of my cycle for a monitoring ultrasound and that day is when I typically started a 2nd injection that prevents you from ovulating prematurely (Ganirelix, Cetrotide, etc). I would do both of these injections for 3-4 more nights and then once they confirmed the follicle(s) were mature, I took the trigger shot (Ovidrel, not sure of the other name brands). Ovulation occurs approximately 36 hours after the trigger shot, so that is when you would do your IUI, TI. Hope that helps and best of luck to you!

srh18 · July 2016

I also had the option of using injectables with TI. My RE has always been adamant that in my situation iui does not increase my chances of becoming pregnant over ti (I do not ovulate naturally-thanks, PCOS-but had a lot of success with very low doses of clomid). She actually told us that we could just do TI over and over and would probably get pregnant eventually, I think her words were "you've just been randomly unlucky." Thankfully, I have a very engaged and supportive re who worked with us to move on after we got wore out from TI and Iui anyways.

Also, I believe I remember her saying that injectables raise your chances of success slightly with TI or iui but I can't be sure that I'm remembering correctly.

Whatever you choose, good luck!!!

LizzieJ13 · July 2016

@srh18 and @AugustAng, thank you. I guess my thought is if injectables are given for IUI why couldn't I substitute TI? (Assuming it's not cost-prohibitive.) Well, fingers crossed that I will see a difference on Clomid. Maybe 2 follicles instead of 1??

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