Sun. night introduction + Urgent ? (loss mentioned really briefly) — The Bump
Trouble TTC

Sun. night introduction + Urgent ? (loss mentioned really briefly)

optimism3optimism3 member
edited May 2019 in Trouble TTC
Hi Everyone! 

Hope everyone had a good weekend (as good as can be in our circumstances). I’m a 36 yo who went from being on the pill for 16 years in sweet ignorance to finding out I have endo, possibly adenomyosis, and Hashi’s (just got my TSH back down!) once I went off the pill and started trying. 

Its been a rollercoaster few years of HSGs, surgery, meds and IUIs. Sure you can all relate. 

I apologize that in my first post I have a somewhat urgent question. I’m headed in for my baseline tomorrow morning for my 5th IUI and need to decide between Chlomid and Follistim.

We’re waiting for insurance to cover IVF and trying IUI again in the meantime, so we have (sadly) somewhat low expectations. Follistim is $800 oop, so wondering if I should just do a Chlomid cycle. I already did 3 Chlomid IUI cycles.  1st resulted in a chem, the other 2 were BFNs. Last cycle tried Follistim and another BFN. There was no real difference in follicle size or number on Chlomid v. Follistim - only difference was my lining was about 13 on injects and 9 on Chlomid. 

Would really appreciate any input. Don’t want to regret not going for injects, but also don’t want to throw good money after bad. Is the fact my lining was better enough of a reason to do injects? 

Thanks so much for reading this and for any input. Regardless of if you answer I hope you have an OK week. This all is extremely trying in just about every way as you all know and I’m sending good energy to each of you, and wishes for moments of peace and joy this week, along with some things that bring your comfort (even momentarily). 


Re: Sun. night introduction + Urgent ? (loss mentioned really briefly)

  • Hi @optimism3! Welcome!

    Ultimately the decision will be up to you and your doctor. I know with Clomid they really only allow using it for so many cycles (I think 6 is the max), but you did at least get a BFP from it even though it ended in a CP. If 13 is a more preferred lining compared to 9, then that's something to consider.

    If you think you will have the best chance moving on the IVF then you may want to save your money for that and stick with Clomid for the IUI.
    *TW* History:
    Me: 33 DH: 35 | Together since 2007 | Married July 2016

    TTC #1 since 7.2017
    Dx: low morph (1%), ANA positive, low decidualization score, high TSH and testosterone, histone antibodies

    IUI #1-3 all BFN
    IVF #1 | 6.11.19 | 24R, 17M, 15F, 6B, PGT-A tested - 5 normal, 3 girls & 2 boys
    FET #1 | 9.10.19 | BFN "I know you, but we've never met. I'm with you, but I don't know your name"
    RPL, Receptiva, & ERA testing | all normal/negative, recommended going on gluten and dairy free diet for next FET
    FET #2 | 3.31.20 | Opted to cancelled due to pandemic, continued diet and tried naturally over the summer
    2nd Opinion with another RE | 8.20.20 | Not immune to measles (received 1 dose); SA results similar to 2 years ago; decided to move forward with FET #2 redo at start of next cycle
    Surprise natural BFP! | 9.22.20 | MC 10.23.20 at 8 weeks
    TTCAL naturally | starting 11.22.20

    Initial consultation with Reproductive Immunologist | 9.14.21
    Decidualization score biopsy | 10.1.21 | abnormal - low score of 1; endometrial scratch recommended and progesterone supplementation
    Saline sono | 10.15.21 | normal
    Bloodwork | 10.21.21 high TSH, high testosterone, positive for anti-nuclear antibodies and histone antibodies
    BFP! | 11.3.21 | EDD 7.14.22 B) | biopsy provided same effect as endometrial scratch; added supplemental progesterone and estrogen, prednisone, levothyroxine, and MTX to maintain pregnancy
    DS born 7.19.22 after induction
  • Thanks inthewoods. Appreciate it. 

    I think the issue is we all just make the best decisions we can at the time, but you always wish there were some “definitely right” answer and this is not that type of thing as far as I can tell. 

    Have a good week. 
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  • Hello and welcome to the group!

    I’m sorry to hear that you’ve had such a tough time with various different diagnoses. I’m the same age as you, so I can definitely relate to the feeling of time moving on.

    It sounds like a really tough question and I think you’re best off discussing the pros and cons with your doctor, as @inthewoods23 suggests. Are they good at explaining all the ins and outs of the different options? I know that some can give the impression they don’t have time to do go into details and it can all be a bit like a conveyor belt system. But they should have had lots of experience of seeing how people react in the two different scenarios.

    I’ve looked into the research and the bottom line is, there isn’t really significant evidence providing an advantage for Clomid + FSH injections versus Clomid alone. The Cochrane multi-system review in 2017 (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008528.pub3/full) didn’t find any, and neither did this study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970796/ in the unexplained fertility group. 

    Having said that, the second study hypothesises that the FSH may contribute to higher oestrogen levels and a better environment for implantation, so I suppose that’s why some centres prefer to do both (mine didn’t offer a choice but I am in France where there isn’t a cost issue for the patient as it’s covered by the state).

    So I suppose it comes down to you individually and whether your doctor thinks it’s worth the added cost. Interestingly the second study did a single FSH injection which should in theory be cheaper, I wonder whether your centre would consider that as an option.

    Good luck with your decision and let us know how you get on!
  • Thanks so much @cigaline and thanks for those studies. I do envy countries like yours which cover these costs. 

    Great news this AM - the nurse gave me donated meds and is also pushing with my insurance, so I ended up doing the injectables. It was beyond nice to have someone jump in and solve the problem after so much time in the phone with the insurance, pharmacy, and doctor this weekend.

    In case anyone ever has this question, this nurse said that follistim creates better quality follicles in addition to the benefits for the lining. She highly recommended injectables over Chlomid. That being said, other nurses have told me there’s no impact on follicle quality 🤷🏼‍♀️ As with all of this I’m sure there’s never a best answer necessarily. 

    Thanks again
    hithertorueinthewoods23projectalice
  • @optimism3 that's great that some got donated to you!
    *TW* History:
    Me: 33 DH: 35 | Together since 2007 | Married July 2016

    TTC #1 since 7.2017
    Dx: low morph (1%), ANA positive, low decidualization score, high TSH and testosterone, histone antibodies

    IUI #1-3 all BFN
    IVF #1 | 6.11.19 | 24R, 17M, 15F, 6B, PGT-A tested - 5 normal, 3 girls & 2 boys
    FET #1 | 9.10.19 | BFN "I know you, but we've never met. I'm with you, but I don't know your name"
    RPL, Receptiva, & ERA testing | all normal/negative, recommended going on gluten and dairy free diet for next FET
    FET #2 | 3.31.20 | Opted to cancelled due to pandemic, continued diet and tried naturally over the summer
    2nd Opinion with another RE | 8.20.20 | Not immune to measles (received 1 dose); SA results similar to 2 years ago; decided to move forward with FET #2 redo at start of next cycle
    Surprise natural BFP! | 9.22.20 | MC 10.23.20 at 8 weeks
    TTCAL naturally | starting 11.22.20

    Initial consultation with Reproductive Immunologist | 9.14.21
    Decidualization score biopsy | 10.1.21 | abnormal - low score of 1; endometrial scratch recommended and progesterone supplementation
    Saline sono | 10.15.21 | normal
    Bloodwork | 10.21.21 high TSH, high testosterone, positive for anti-nuclear antibodies and histone antibodies
    BFP! | 11.3.21 | EDD 7.14.22 B) | biopsy provided same effect as endometrial scratch; added supplemental progesterone and estrogen, prednisone, levothyroxine, and MTX to maintain pregnancy
    DS born 7.19.22 after induction
  • Ah, glad that worked out!! I mentioned you in my post on the weekly update. Great ti hear someone was able to step in and step up for you! I just went through my first round of stimulation with injectables (Puregon was the one I was using). Hope that it goes well for you! Keep us posted!
    Me: 36 DH: 37 // Married: 2015 // TTC#1 Since: 2017 // PAWrents to 2 dogs: 6 yo female shepherd-malamute & 1 yo male weim/heeler mix // Dx: Unexplained endometriosis & adenomyosis 12/2020 // Rx: 2019: IUIx6 & IVF Retrieval Result: Abnormal/High Mosaic Laparoscopy/Excision - Surgery Sep 2021, Round #2 IVF Retrieval with new clinic - 2022
    projectalice
  • That's fantastic! If you ever have to use clomid and are worried about lining I found that taking pomegranate juice, raspberry leaf tea and Brazil nuts helped with my lining. :) CoQ10 helped with egg quality. 
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