General Clomid Issues - questions?

[whigfield]

Hey ladies. I'd really appreciate it if any of you could shed some light on any of this!

Little bit of background: TTC since 2010. I have PCOS and don't ovulate too much on my own. We have had 2 early losses (natural conception), 1 twin loss from most recent pregnancy in Nov 2012, and 1 loss in Dec 2012 (conceived via clomid) which was a direct result of a subchorionic hematoma. Since then, we've had absolutely nothing. Since that's now 3 miscarriages in a row, I was sent away for a ton of tests including all different kinds of clotting factors and possible hidden causes, and all came back clear.

So our last one was conceived on 50mg clomid, taken days 3-7, with ovulation on CD13, CD21 results of 50 for progesterone, everything was great. It was a picture perfect cycle and without the SCH, we expect we'd have our much longed for baby in our arms.

Fast forward a year on, with advice from my FS to lose weight (I since lost 20lbs - cycles haven't made much difference, though even at my lightest they were still irregular) and has me on 1000mg x Metformin a day. We went for another 50mg clomid cycle, taken days 2-6 (her advice), and apparently we failed to respond (despite a temp rise - though it wasn't very great and dipped a lot especially towards the end. The cycle was 23 days long...). My CD21 results came back at 7, which she says means no ovulation. However I have since been reading and apparently any level over 5 indicates ovulation..? I have no idea if that is true or not!

Since then, I've been upped to 100mg and currently "3dpo", but I don't really have any post-O symptoms and I'm really scared we've "failed to respond" again. (Current chart: https://www.fertilityfriend.com/home/31f19e). Does it look possibly like I've ovulated? (One other thing - I am dry as a BONE this cycle. I'm really worried about my lining being too thin, or just having no CM/totally hostile CM. Though, we used pre-seed religiously!)

(And as a note, my FS isn't monitoring me via ultrasound. :/ I'm in the UK so this is NHS treatment and I guess that doesn't get factored in. If this cycle fails, I will likely pay to be privately scanned with the next one. What days are you meant to be scanned when on clomid?)

My main thought is.. How can my body suddenly become so resistant to clomid, despite 20+lbs of weight loss, which is supposed to help with clomid? Is it possible metformin could be throwing an issue, or?

My FS also says that if I don't respond to these 2 doses (given 2 cycles worth of 100mg, 1 more to go if this one fails) that we will be "going for IVF". I was really shocked when she said this and questioned her on it, and she mentioned there might be a different drug we can try in between (guessing she means femara??) with IUI. Is it normal to just give up after 3-4 clomid cycles, particularly at quite small doses, and especially when we conceived on the first go (with extra weight carried)?

Thanks!

 

[messica]

Your doc sounds ignorant (and I'm saying that as nicely as I possibly can lol).

It always floors me when I hear of doctors putting women on fertility medications and then don't monitor them. How are they supposed to know if they're fixing to release 10 follies or none? If the Clomid completely saps the lining?

Follicle studies are typically done a couple of days before ovulation to see how many are maturing and at to what extent. That way they can tell you if the med worked and how well (meaning how many mature follies will release at ovulation).

If I were in your shoes I would:
-Opt for private care
-Choose someone more qualified to oversee my care
-Insist on monitoring while on fertility meds (bloods and follicle studies), that way you'll have a much clearer picture of what's going on.


Absolutely there are quite a few options between trying clomid unmonitored a couple of months and jumping straight to IVF. Where I live that wouldn't even be an option, especially given you've been able to get pregnant naturally on your own before. Ethically, an RE would be hard pressed to take someone's money to do that before exhausting the many other options.

 

[Loup89]

Sorry to hear about your losses.

I really have no idea if this is related or not but I became pregnant first round 50mg clomid but miscarried after which I was given metformin and again 50mg clomid but it didn't work for me the next 3 cycles, no ovulation. I then went to 100mg clomid and decided myself again doctors advice to stop metformin and ovulated the next 2 cycles.
Like I said no idea if it was because of the metformin or not but thought I'd share.

 

[whigfield]

Your doc sounds ignorant (and I'm saying that as nicely as I possibly can lol).

It always floors me when I hear of doctors putting women on fertility medications and then don't monitor them. How are they supposed to know if they're fixing to release 10 follies or none? If the Clomid completely saps the lining?

Follicle studies are typically done a couple of days before ovulation to see how many are maturing and at to what extent. That way they can tell you if the med worked and how well (meaning how many mature follies will release at ovulation).

If I were in your shoes I would:
-Opt for private care
-Choose someone more qualified to oversee my care
-Insist on monitoring while on fertility meds (bloods and follicle studies), that way you'll have a much clearer picture of what's going on.


Absolutely there are quite a few options between trying clomid unmonitored a couple of months and jumping straight to IVF. Where I live that wouldn't even be an option, especially given you've been able to get pregnant naturally on your own before. Ethically, an RE would be hard pressed to take someone's money to do that before exhausting the many other options.

Thank you. I have thought this for a while but it makes me feel better to hear someone else thinks the same thing. I'm going to see how this cycle goes, and definitely pay for a scan privately next cycle if this one fails.

Sorry to hear about your losses.

I really have no idea if this is related or not but I became pregnant first round 50mg clomid but miscarried after which I was given metformin and again 50mg clomid but it didn't work for me the next 3 cycles, no ovulation. I then went to 100mg clomid and decided myself again doctors advice to stop metformin and ovulated the next 2 cycles.
Like I said no idea if it was because of the metformin or not but thought I'd share.

That is so strange! The only thing I can think of that is different is that I have lost 20lbs, and I'm on metformin now.. My first round of clomid I wasn't on metformin and it was successful! I may think about coming off metformin in that case for the next cycle and see how it goes!