Thursday, September 12, 2013

Well That Escalated Quickly

My thoughts and emotions are still trying to sort out exactly what happened at today's appointment, so I apologize if this post isn't the most coherent.

So, to get down to the jist of things, I have a plan, which is really what I wanted to get out of this appointment.

1. Dr. B agreed to do a few cycles of Clomid after double triple checking with me that I understood that my risks of multiples increased from about 1% to 8%. I asked him how many cycles he would be willing to do (knowing that most doctors cut women off at 6 cycles,) and he agreed that after 6 cycles, you are considered a "Clomid failure." However, since we are only using Clomid to boost what my body is already doing, instead of using it to get my body to ovulate, he said that he wouldn't feel comfortable going more than 3 or 4 cycles.

2. If Clomid doesn't work, he suggests doing a laparoscopy to check for Endometriosis just so that we can say we've checked on everything. He asked if I wanted to do that laparoscopy before the Clomid, but I declined since I don't have any of the symptoms of endo (painful periods, pain during sex, etc.) and I don't want to have unnecessary, expensive surgery.

3. I asked what our next move would be if the Clomid doesn't work, assuming he would say IUI, but Dr. B said that an IUI would really only be beneficial if our problems were on Keegan's end, but from his past SA, we know they're not. Dr. B suggested that if Clomid doesn't work for us, he would give us a referral to an reproductive endocrinologist and suggest IVF.

I about fell out of my seat.

I wasn't expecting IVF to come into question until we had exhausted ovulation drugs, IUIs, and injectables.

However, after having some time to digest all of the information, getting a referral to an RE is probably the best step for us. I trust Dr. B, and he has helped us immensely with these beginning steps, but if we're talking about IVF, or honestly, even IUI, I'd rather talk to a professional that is versed in these procedures. I was just hoping we wouldn't have to go the RE route since the closest one is probably an hour away and in no way covered by our insurance.

Unfortunately we were too late to do Clomid this cycle, so we're au natural for another month, but I have a prescription for 50 mg of Clomid CD5-9 as well as monitoring for the next cycle. Dr. B didn't say anything about increasing the dosage in later cycles, but I suppose we'll talk about that if this next cycle doesn't work out.

A few questions for you ladies:

1. CD 5-9 seemed really late to me, I've read that most women do CD 2-6 or 3-7. Any thoughts?

2. Dr. B said that Clomid will make you ovulate later in your cycle than your normally would, however, many ladies say they ovulate earlier. Any ladies who ovulate on their own and also take Clomid want to chime in?

3. I've heard that some ladies have better control of the side effects if they take Clomid at night instead of in the morning. Does anyone have experience of morning versus night side effects?

I guess our hopes are resting on the idea of Clomid working in the next couple of months, and if not, we're bringing out the big guns!







22 comments:

  1. I can't offer any wisdom, but just wanted to say hi and I'm thinking about you!

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    1. Thank you so much! I love your new blog design!

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  2. The first time I took clomid it was days 5-9. I found that I had more mature follicles (3) but they were smaller at 18-20. When I took it days 3-7 I had only one mature at 22 & 24 for cycles 2 & 3 respectfully. I found that taking clomid at bed time limited my side effects. I recommend trying it. Unless you get bad hot flashes at night. I found mine came during the day but were mild. I have no idea if I ever ovulated before clomid but I would always ovulate around day 18. But my cycles were shorter than without clomid so I am guessing I ovulated earlier with clomid. Good luck with your new plan. I pray it works. I hope IVF isn't ever needed but its good to know what you need and that you are in good hands.

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    1. Thanks for all of the tips, I'm definitely leaning towards taking Clomid at night. That's interesting that you had different results when you took the Clomid on different cycle days, I'm really curious to see how my body reacts to it.

      Thanks for the good wishes!

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  3. I am new to your blog, but I did 3 cycles clomid and ovulated everytime cd 3-7, ovulated on cd 21-22. Never got pregnant. Had hsg showed partial blocked tube and my doctor approached me and asked if I would be willing to do the laparoscopy to check for endo even though I have no symptoms of it. I was so hesitant to do it, but finally went ahead and she found 7 spots of endo on my ovaries and she believes that was the reason for my infertility. My tube was no longer blocked (she thinks the hsg had cleared it). I had the surgery in June and this is my 2nd cycle after the lap. My doctor is giving me one more cycle (i have been on femara for these cycles) on femara to get pregnant and if I don't I will be given a referral to an RE. I really hope clomid works for you! Keeping my fingers crossed for you!

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    1. I originally declined the lap until after a few cycles of Clomid, but I've had a few women tell me since then that they found endo without any signs, so now I'm second guessing my decision. Guess I'll have to talk to my husband about that.

      Good luck with this round of Femara, I hope that it works for you!

      Thanks for stopping by, I'm going to try and catch up on your blog this weekend!

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  4. 1. 5-9 and 3-7 are the most common CDs to take Clomid. From what I've read, there's really no difference. I took Clomid for 2 cycles, one of each schedule.

    2. It all depends on when you normally ovulate. You should ovulate about 5-10 days after your last dose. For me, it was day 10 the first cycle taking Clomid CD 5-9 (which put O day at CD 19, my normal time), and day 9 the second cycle taking Clomid 3-7 (which made me O on CD 16, early for me).

    3. I took Clomid at night from the beginning, so I can't compare. I didn't have bad hot flashes at all. However, I did have lots of warm flashes starting about a week afterthe last dose, lasting through the end of my cycle. From what I've read, that's fairly common, but not universal.

    Have you had an HSG? It's wise to make sure your tubes are open before taking Clomid, otherwise you're just wasting time and money.

    Also, I would recommend some monitoring. Clomid aggravated my endo (which I didn't know I had at the time, because I had no symptoms) and caused large cysts, one of which ruptured (worst pain of my life, and that includes a miscarriage, laparoscopy, and tonsillectomy). At minimum, you'll want to make sure you don't have a cyst at the start of your cycle; if you do, taking Clomid will only make it angrier. Just something to think about and maybe ask your OB. Lots of women take Clomid with no monitoring and have no problems, but after my experience, I advise to be safe rather than sorry.

    Good luck!

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    1. Thanks for all of the information! Yes, I had an HSG back in June, this was my first appointment with my OB/GYN after trying for three cycles naturally after the HSG. Both the doctor and Dr. B said my tubes look open and clear.

      Dr. B said something about monitoring. I was told to call when I start my cycle and set up a time, I'm assuming for a scan before I ovulate to make sure I don't have 10 follicles growing, but I'll ask about a scan to make sure I don't have any cysts. I'm prone to a lot of cysts, so having one rupture doesn't sound pleasent.

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  5. I think I did cd 3-7 (can't totally remember), but ovulated the exact same day I normally would. I ovulate fine by myself as well. Are you monitoring by ultrasound or just doing the smiley face pee stick thingies (I think that is a technical term)??

    Good luck!!! I did hate Clomid for the side effects, and have found more people have good luck in that area with Femara. Is that an option for you? (Also, the side effects weren't bad for me while actually taking the Clomid -- it was more the PMS symptoms I had that cycle before my period came. Hopefully that is a moot point since you'll be pregnant and won't have PMS symptoms :)

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    1. I love your enthusiasm! I'm going to be doing OPKs as well as monitoring. Dr. B didn't say when in my cycle I would be monitored, so that's something I have to ask when I call him on CD 1.

      I've heard so many horror stories on Clomid, but Femara wasn't offered to me. He mentioned that it's a drug that's used, but didn't say it was an option for me. If my first Clomid cycle doesn't work and I have horrible side effects, I'll push for Femara. I've also heard that Femara works better for women with PCOS, so I may bring that up as well.

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  6. I took Clomid 50mg the first cycle 5-9, ovulated on CD18 like always. Unsuccessful cycle. The second cycle I took it days 3-7 Ovulated on CD14.. BFP. I was also ovulating on my own.. just needed the "boost" I guess.

    I took it at night to avoid day time hot flashes. This helped a TON.

    GOOD LUCK :)

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    1. Hopefully I just need the Clomid for that extra boost as well. Thanks for the info and well wishes!

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  7. Hi Aislinn! I actually do have some input for your questions!

    1. I took Clomid 5-9 for one month, and then 3-7 for two months (not by doctor orders - just on my own decision).

    2. The first two cycles I took Clomid, I ovulated 2-3 days earlier than normal. The 3rd cycle, I ovulated later than I ever have.

    3. I never took Clomid in the morning because it was recommended to me from the beginning to take it at night to help with the side effects. My only side effect was headaches for a week during/after taking the meds.

    That may not help you much but I wanted you to know my experience! :)

    Best of luck with your decision! xoxo

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    1. Ugh headaches are something that I'm worried about. I'm already prone to them, so adding a medication that makes them worse sounds like a recipe for disaster, but anything for a baby, right? Thanks for the info!

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  8. No advice here, just hope! I hope to start Femera this cycle but I don't know when yet. Eek! Moving forward is nerve-wracking but EXCITING! :)

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    1. It is so nerve wracking but exciting! I'm questioning if I'm making the right decisions, but I'm excited to finally be doing something other than timing sex. I hope that Femara works for you!

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  9. The only thing I'd like to add to what these lovely ladies already said is just my own personal opinion... I would (and have been) try IUIs before jumping to IVF. My husbands sperm is great and IUIs for sure are much more successful when its a sperm issue however, they are so much more affordable and less invasive than IVF!! I personally decided it was worth giving IUIs a good chance of working before going the IVF route because how great would it be to not have to go there??!! Just my own choice but your Dr. can't refuse to try it first. It might work! My Dr. told us IUIs are most successful between the 3-6 time. I'm on number 5. I'm not very hopeful but I want to do a total of 7 just so I have peace of mind that I exhausted all other options before IVF. Good luck with Clomid...it wasn't so bad for me. Mostly hot flashes that seemed to start a few days after my last pill.

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    1. If Clomid doesn't work for us, I think that we'll be moving onto an RE no matter what. Dr. B has been wonderful in getting us this far, but I'm starting to want the opinion of a doctor that deals with IF for a living, not just an OB/GYN who has some knowledge. Once we get an RE, I'll bring up the idea of doing an IUI again and see what he/she says. I definitely feel like going from Clomid to IVF is a huge jump, and I'd personally like to try IUIs for a few cycles, so the RE will have to do a lot of convincing for us to jump right to IVF.

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  10. I usually took it 5-9. The last cycle I was on Clomid I did it 4-8 and did ovulate like 3 days earlier, but that was also the highest dose I was on so I'm not sure what causes the earlier ovulation. One piece of advice I have is to watch out for your CM, as Clomid can dry you out. If through monitoring and OPKs it looks like you'll O soon but you don't have fertile CM you can try taking mucinex or evening primrose oil to loosen things up. Also Clomid has a loooong half life. This means some of the Clomid from your first cycle will probably still be in your system for the next cycle. So you could have worse side effects in subsequent cycles even if you don't increase the dose. But hopefully you'll get your BFP and won't have to worry about that. :)

    I agree even if you don't have any symptoms of endo it's probably a good idea to check for it if this doesn't work. According to my doctor the stage of endo you have is not directly linked to the side effects you have. So someone with stage 4 could have little to no symptoms, but someone with stage 1 could feel like they're dying.

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    1. Thanks for the tips about the CM, that's something I'll watch out for. I didn't know about the half life of Clomid, that's interesting. Like you said, hopefully the first cycle will be the one and I won't have to worry about it ;-)

      After reading these comments, I'm questioning if we should do the lap earlier than later. The huge thing that's holding me back is that it would cost over $8,000 and I'm not sure if insurance would cover it. Something I need to look further into.

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  11. Hi, I'm here from ICLW. I always took clomid at night because it made me dizzy and messed up my vision. It worked out well for me taking it at night. As for how many rounds of clomid, I think 6 is excessive. It's not just about "messing up" your body, but the likelihood of success. Our RE said that if clomid is going to work, it will work in the first 1-3 cycles. If it doesn't work by then, clomid is not solving whatever the underlying problem is. And fwiw, I did ovulate on my own. Good luck!

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  12. Sorry for the late comment on this one. I've done seven Clomid cycles, three of which resulted in a pregnancy. One was TI, one was IUI, and one was done to ensure ovulation for and FET. Most of my cycles were CD4-8 or CD5-9. For my FET, I wanted later ovulation due to lab closure, so I did 5-9. Regarding ovulation days, I usually ovulated around CD17-19, which is later than I normally would. However, I did have one cycle where I ovulated around CD14, but I was traveling internationally so the time zone change probably screwed my body up! Regarding side effects, I didn't notice any, but I may have just been lucky!

    Good luck!

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