Saturday, September 15, 2007

Life After Clomid

Since Clomid wasn’t working for us, my RE presented us with two options: move on to injectable drugs in conjunction with IUI, or go straight to IVF. There were a few things for us to consider before deciding which path to take:

1. The Odds. My RE has told me that with IUI, you have a 25% chance of conceiving—the same chance as any couple trying to conceive the usual way. With IVF, the odds go up, and you have a 40% chance of conceiving (though I’ve seen lower statistics online). IVF definitely wins this one. (Score: IVF=1, IUI=0).

2. The Cost. My health insurance only covers diagnostic testing, and not any “procreative management”. Each injectable/IUI cycle costs about $2000 (depending on the dosage, etc), while IVF is at least $10,000/cycle. Since this would be all out of pocket, IUI handily wins this battle. (Score: IVF=1, IUI=1).

3. The Invasiveness Factor. With IVF, you produce lots of eggs, which are then harvested in a pretty invasive procedure which requires anesthesia. With IUI, the dosage of the drug is modulated, so fewer eggs are produced, and there’s no harvest required. Another win for IUI (Score: IVF=1, IUI=2).

4. The Clumping. At our one and only IUI, when they processed my husband’s semen, they saw agglutination, or clumping. My RE worried that this would impede our chances of success with IUI, and we would have to directly move on to IVF. So she sent my husband back for another semen analysis, where they would process the sample as they would for IUI and see if the agglutination returned. His sperm didn’t clump, so we were cleared to go ahead with the IUI. (Score: IVF=1, IUI=3).

It’s IUI for the win!

My general fear of IVF also played into this decision. In my mind, IVF is our last resort, and if it fails, then we’ve reached the end of the line. I know that we’re getting closer and closer to that line, but I’m still trying to keep it at bay.

Sunday, September 2, 2007

Clomid Resistance

When I first saw an OB/GYN to discuss why I wasn’t ovulating, she immediately suggested that I go on Clomid. She herself had taken Clomid to get pregnant, and she was sure it would work for me. This was in October 2004, and we had been trying to get pregnant for about 4 months.

I was hesitant to rush right into Clomid. I felt like it was a quick fix (ha!) that didn’t actually address the issue that I didn’t have regular cycles. I had read a little bit about how Metformin helped regulate the cycles of women with PCOS and asked my doctor if we could try that first. I wasn’t glucose intolerant, so she wouldn’t give me Metformin. It was Clomid or nothing.

In hindsight, I should have either sucked it up and taken the Clomid, or looked for another doctor. But there was a lot going on in our lives at that time. I had been looking for a job for nearly a year, and we were contemplating picking up and moving across the country (which we did 6 months later). I wasn’t ready for Clomid yet. I remember thinking, “What if she’s wrong? What if it doesn’t work? Then what?”

I finally succumbed to the allure of Clomid in the summer of 2006. My new OB/GYN had let me test drive the Metformin for a few months, and it didn’t take, so I decided it was time to give Clomid a spin. We did four Clomid cycles—I ovulated (but didn’t conceive) the first time out, and then never again. She kindly let me know that I needed the help of a reproductive endocrinologist.

My RE decided we should do a high dose of Clomid, with monitoring of my follicles by ultrasound. Again, I ovulated on our first try and again didn’t conceive, even with IUI. My subsequent Clomid cycles resulted in follicles that never got big enough to trigger ovulation. After three tries, my RE recommended that we move on to injectables.

Do I regret not going on Clomid earlier? A little. Maybe we would have figured out that it wasn’t going to work, and we’d have found success with another protocol sooner. But as I said, I just wasn’t ready yet. I was grateful to find a doctor that was willing to try the Metformin before moving on to Clomid. I think that being part of that decision made me feel a little more in control of the situation. I may have delayed the inevitable, but at least it was my choice.