I'm TTC, was fairly recently dx as PCOS, and am currently taking Provera for my 2nd batch of CD3 b/w and to start on 50mg clomid this cycle.
I'm wondering if anyone (everyone?) :-) Could tell me what the process is for this TTC thing if things don't go "well"
Naturally, I'm hoping that I'll O this cycle, get my BFP and be done with it ;-) but.. since I'm reading that many thin cysters are clomid resistant and I'm not feeling too lucky.. I'd like to know what kind of timeline is usually involved in moving to more complicated therapy?
So I gather that first thing is to spend a few cycles increasing the dose of clomid.. and possibly adding other medications.. trigger shots... if you manage to O but don't get a BFP, How many cycles does it take for them to move forward to IUI ... and then after that how long does it take to get to IVF if IUI is a bust?
I guess I'm just trying to get a rough idea of what kind of timeframe I could be looking at if I dont get pregnant through anything short of IVF.. how many cycles do you keep trying clomid alone, clomid with other meds, IUI, etc?
Basically.. anything anyone has to say would be helpful :-)
Most docs will give Clomid about 6 cycles, and if you don't O they'll increase the dose each time. If you don't O on 150 mg, they'll usually have you move on (though some docs prescribe 200). Some docs will add a few days of injectables to a Clomid cycle. If that doesn't work, then most go to purely injectables for up to 6 cycles. If that doesn't work, then IVF is a next step if you so choose.
Usually one of the less invasive (non-IVF) things will work if your DH has normal or only slightly abnormal sperm. In my case my doc suggested IVF b/c I had an ectopic pregnancy on my injectable cycle. We could have tried it again but the risk was lower with IVF.
The thing you have to keep in mind is that EVERY doc is different. Some skip injectables entirely (they're difficult to manage in cysters). Some only do a few cycles of each. Some recommend IUI on any stimulated cycle, some don't. The best thing is to find a good doctor and trust them. It can be a short or long journey -- I hope yours is short!
__________________ Whitney, 33
After soy, Femara, Follistim, an ectopic pregnancy, and IVF, FINALLY BFP 8/08 -- twins -- but lost baby B at 7 weeks Preterm labor at 25 weeks... baby boy is here safely at 36w3d!
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I agree with Tummy, every doc is different, but so is every woman. My doc would prescribe me clomid but I got my BFP on my 4th cycle of Metformin (I didn't O very often before the metformin). I found out I was pregnant just before my 1st visit with the RE.
FYI, if you don't get pregnant after 4 cycles of clomid, your chances of getting pregnant on clomid alone don't improve. So there's no point in taking it alone for longer than 4 cycles...
Good Luck.
__________________ Me(27) DH(33)
TTC since May 07
m/c 29/06/2007
BFP 24/07/2008 - EDD April 1 '09
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Agree with mcoreen, except that sometimes you'll end up doing more cycles of clomid b/c for example you don't O on 50 mg or 100 mg, but you do O on 150, so you might do cycles of 50, 100, 150, 150, 150, 150, which ends up being 6 cycles, but the 1st 2 don't count as not getting pg b/c you didn't O. Make sense?
__________________ Whitney, 33
After soy, Femara, Follistim, an ectopic pregnancy, and IVF, FINALLY BFP 8/08 -- twins -- but lost baby B at 7 weeks Preterm labor at 25 weeks... baby boy is here safely at 36w3d!
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tummy and mcoreen gave great advice and every doctor is different, you really have to find one that is willing to be as slow or as aggressive as you want to be. i'm not sure how old you are but age also plays a big role in how long you try certain things. also if you have been TTC for years already you may not want to do 6 rounds of clomid. like mcoreen said after 4 rounds of clomid with no BFP probably means it won't work. some people also take it slow for monetary reasons. obviously clomid or femara with IUI is less expensive that injects.
my RE did one round of clomid at 100mg, i didn't O and he said let's move on to injects b/c i don't like using clomid in thin pcos patients. i reponded well to injects and even responded too well one time, but also was dealing with (male factor)MF issues. i only did 2 rounds of injects with IUI's, one round of injects with intercourse, but it was enough for me and DH to move on to IVF and my RE strongly recommended it. oh i also did one round of femara and had several natural O's with no BFP's so i knew there was something else going on.
the general rule is:
3-6 rounds of clomid/femara
3 rounds of injects with IUI
you should also have an HSG and semen analysis done early.
best of luck!
__________________ me 35; dh 37
pcos & MFI
TTC 2.5yrs: clomid, femara, 3IUI's and 3 fresh IVF's... finally a BFP!
BFP 1/09(triplets);
loss baby B @8wks(vanishing triplet);
loss baby Noel @16.5wks(pPROM) forever in my heart;
5 months of bed rest, cerclage and PRAYER delivered healthy baby at 38wks1day...humbled and forever grateful for my miracle baby Noah! Praise God!
Thank you SOO much for the responses :-) This is exactly the kind of stuff I wanted to hear about... I've been reading all of the forums, but people tend to only be talking about what they've been doing most recently and I've had trouble getting a sense of the different "timelines". I know that the timelines will differ depending on the issues.. male factor problems.. responses to treatment.. doctor's preferences.. but I figure that by hearing about a lot of different people's experiences it will better prepare me to evaluate what my doctor suggests. I'll be able to hear what his plan is.. and think "ok, that's similar to what other people are doing" or perhaps "wait.. other people had doctors that were moving much faster.. maybe I should get a 2nd opinion from another office.." I always feel a little intimidated in the doctor's office.. they always try to sound so sure of themselves and defensive about their plans being the "right" plan and I dont want to just take what they say at face value with nothing to compare it with!
We've had an S/A done already and all of the #s were good - except morphology. Which automatically makes me think that I might want to try IUI sooner rather than later .. because from what I've read, DH's S/A numbers mean that we'd have much better luck if we concentrate the sperm into a smaller volume to maximize the chances of the "normal" sperm getting to the right place! Because there are plenty of normal ones... but just very diluted amongst all of the abnormal ones!..
My OB-gyn recommended an HSG, but my RE didnt seem interested in doing one yet... I'm going to let him put me on a round of clomid before getting an HSG done, because I'm super eager to just see if I can ovulate on clomid... but in the meantime I'm going to be looking for a new RE because I'm somewhat disatisfied with the guy that I saw (I've only seen him once so far.)
As far as what we've been through so far.. we've been trying for about a year, but I was getting my period so infrequently during that year that it was clear that we were NOT going to get anywhere on our own! I'm 27 and DH is 29. I want to pursue this thing aggressively... so I'm definitely going to look for an RE that will not take too much of a leisurely "wait and see" approach. I've got a 1 year contract right now with my job - which provides great insurance that totally covers most fertility stuff... so I'd like to get as much done as possible while I'm under this coverage! - without of course rushing to any treatments that are too aggressive too soon..
I just took my last provera pill yesterday and am waiting for AF to show up... then I go for more CD3 b/w and a CD3 u/s ... then I'm supposed to meet with my RE again to discuss our "plan" for the future.. although I have to admit that I'm "two-timing" my RE and I went to my regular physician.. and my physician gave me a clomid prescription and said that I could just take 50mg from CD5 to CD9 and see what happens. He said that the monitoring is unecessary on such a low dose and that if I had any bad side effects I should just come in to see him or go to urgent care.... but that it was unlikely. (I had expressed to him how impatient I was feeling about just "wasting" all of this time not even trying to ovulate...)
So.. I might go ahead and take this dose of clomid before my current RE prescribes it for me... since I'll probably be switching to a different RE's office anyways (this one was extremely rude and the only reason that I'm going back to him at all is that I want to make sure that I get all of my test results - and get copies of all of my test results to bring to my new RE when I find one!
Yeah.. I'm new to this and still trying to find a doctor's office that I'm entirely comfortable with. I figure it wont be so bad if I go to a new RE and tell him that I've had a S/A done, CD3 b/w twice, a CD3 u/s, and I've been on one month of clomid.... and the new RE can probably pick things up from there and decide what he thinks that we should do next based on the stack of test results that I hand him, right? :-)
Others pretty well covered it, but one thing I want to mention is getting on Metformin. More and more I see people have mc's or not conceiving because their hormone levels aren't balanced, which is done by the Metformin.
For myself, I have so far only worked with an OBGYN. My plan the 1st time when I conceived my DD was Metformin for 3 months @ 2000mg, if No O add clomid for 3 rounds at increasing doses if needed. If no O after 3 rounds, go see an RE. Well I conceived 1st month on Metformin, my DD. Now we are ttc #2, and I have the same plan. I am O'ing but late. I will add clomid if I'm not pg in a few months. In your case, since you have male issues, seeing an RE is probably best. I personally wouldn't take clomid without Metformin, as PCOS miscarriage rate without metformin is near 50%. With Metformin it is the normal range about 12%.
As for timeframes, with ttc'ing you have to be ultra patient. It is hard, but it is always a waiting game. Wait to see if you O. wait to see if your pg, then start over again.
__________________
Ali (31) DH (33) married 4-04
7-05 bfp Met XR 2,000mg 1-09 bfp 2nd round clomid 50mg + Met XR 2000mg
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50%!!!! Not exactly. Actually, the miscarriage rate is difficult to calculate, because it is higher in people with insulin resistance and obesity, and higher in people with very high androgen levels, and all of us PCOSers are different and have different problems, so it's very difficult to generalize one flat m/c rate for PCOS. Metformin helps some people become more hormonally "normal," but not others. (didn't help me a bit). So yes, it is worth a try, but it isn't the magic cure for everyone, or even most PCOSers.
Oh, and also, the estimated m/c rate in "normal" women is 20-25%. Almost 1 in 4.
__________________ Whitney, 33
After soy, Femara, Follistim, an ectopic pregnancy, and IVF, FINALLY BFP 8/08 -- twins -- but lost baby B at 7 weeks Preterm labor at 25 weeks... baby boy is here safely at 36w3d!
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Whitney - I feel I must defend myself. I did read the rates I said in more than one place, so I do believe my rates to be correct. I also read them posted on here several times. So they are accurate. I definitely find the m/c rate at 25% very hard to believe, that would be 1 in 4 pregnancies!!
__________________
Ali (31) DH (33) married 4-04
7-05 bfp Met XR 2,000mg 1-09 bfp 2nd round clomid 50mg + Met XR 2000mg
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I've actually read statistics citing the miscarriage rate at between 20-35%... they say that most women underestimate the miscarriage rate because so many occur in the first trimester before women may even know that they're pregnant. And of course the rate is different depending on age and risk factors.. but I think that 25-31% is the closest estimated rate for the general population.
I'm not sure what to think about the metformin thing.. I thought that I would be put on it for sure - based on what I was reading about it - but my RE says that because I'm not overweight or insulin resistant and because my androgen levels are only moderately high, he doesn't think that metformin would help me. I'm starting clomid today. I've got an appointment scheduled with a different RE in mid-september.. I'm going to bring all of my test results and see if she has a different opinion on the metformin thing.. but until then I'm just going to try clomid and hope that my RE is right in thinking that it wouldnt do me much good!
__________________ Married March, 2006 To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
IVF #1 10-11/2008; Twin Girls! Born May, 2009!
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Natalie'smom -- not trying to spark a debate, but 1 in 4 is correct. Most are very early, and if it weren't for early pg tests, would be thought of as a late period.
Ladybug -- the most recent research says that Clomid is first line for infertility tx in PCOS (Kat has an article posted on here somewhere), so your doc is probably thinking along those lines (Metformin is no longer the automatic tx). I had my ob plus 2 different REs tell me the same thing your doc told you -- not overweight, no insulin resistance, not super high androgens -- so that Met most likely wouldn't help. I was persistant b/c I wanted to "try everything," and yet they were right -- Met didn't do a thing for me.
__________________ Whitney, 33
After soy, Femara, Follistim, an ectopic pregnancy, and IVF, FINALLY BFP 8/08 -- twins -- but lost baby B at 7 weeks Preterm labor at 25 weeks... baby boy is here safely at 36w3d!
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Thanks Tummy! (and congratulations on your BFP!) It's so great to hear about other peoples experiences... gives me a little faith in my RE's words. I tried to read everything that I could find about clomid/metformin/PCOS in lean women... and it just didnt seem to come to any firm conclusion... so I was hoping that I could trust my RE to at least have enough experience to have a good sense of what would/would not help me. So I didnt push for the metformin... although I will definitely be getting a second opinion about it!
From what I gather.. since PCOS is a "syndrome".. without a known cause... there's a good chance that a lot of us have similar symptoms but with different causes.. which would explain why we respond differently to different drugs and stuff... and it makes sense that you wouldnt be able to expect 2 groups of people who only share a few symptoms to necessarily have the same disorder with the same cause - that would respond to the same treatment in the same way.. *sighs* .. and I guess us "thin cysters" are just in the situation of being part of a smaller group that less is known about! That's the conclusion that I've come to from all of this. Additionally.. some of us might be "thin" because we work at it really hard.. while others might be "thin" because our PCOS is from a different root cause that doesn't really affect our weight or insulin resistance or anything.. So confusing!!!!
I hope that they get some more information about this whole thing!
__________________ Married March, 2006 To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
IVF #1 10-11/2008; Twin Girls! Born May, 2009!
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Ladybug -- oh that is all 100% true -- we are all such a puzzle. That's why you'll get so many different answers on here, and research is so up in the air. Best of luck to you with Clomid! (BTW come find the thin cysters TTC thread to get support from a great bunch of girls with similar problems)
After soy, Femara, Follistim, an ectopic pregnancy, and IVF, FINALLY BFP 8/08 -- twins -- but lost baby B at 7 weeks Preterm labor at 25 weeks... baby boy is here safely at 36w3d!
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1/07 off BC—no O
8/07 PCOS diagnosis, non-IR, thin cyster, 5'0, 130 lbs
9/07 Clomid, 50 mg—no O
10/07 Clomid, 100 mg—no O
11/07 Clomid, 100mg—no O
12/07 referred from OB to RE—more tests & labs—all in the normal ranges
4/08 Follistim, 75-150iu—overstim Canceled cycle
5/08 Follistim, 50-100iu, IUI, 2 follies, HCG trigger shot—BFN
6/08 Taking a break—totally burnt out! RE pushing IVF…not ready to go there yet.
7/08 Went Natural. Diet & Exercise, Metformin, 1500 mg & Supplements---Chromium, Calcium, B-complex, Vitamin D & Cinnamon
Started Adoption process
8/08 Totally surprised……. BFP! One month of metformin and vitamins!
TTC what's the "process"? 
