Infertility treatment for time intercourse

I am seeing a fertility doctor, we are not doing IUI and IVF, we want only doing natural intercourse. Because of my age, 42.5 now, so what I need is the medication to boost my chance to ovulate.

The doctor prescribed clomid, gonal-f, ovidrel and prometrium. and they required office visit to monitor and trigger ovulation.

My insurance doesn't cover any infertility treatment, since I am doing natural intercourse, I asked the nurse that  triggering ovulation and monitor not necessary for me and I could use OPK and temperature monitoring. This way I can reduce the cost to minimum

But she said "that's how we do this".

I haven't consulted a second clinic yet, I just wonder from specialist perspective, is this doctor doing and scribing all necessary or some can be omitted to reduce my cost?

Thank you.

[Risa615]

In order to use prescriptions like Clomid, they need to see you before cycle 3 to determine you do not have cyst and then they allow Clomid.  You could skip the ultersound  which they do mid cycle to check follicles and see if you get pregnant the first cycle like you are suggesting.  You could try a few cycles with only the ultersound in the beginning.  Some people on this site try it that way.  After a few months, if you are not pregnant, then I would suggest you do the mid cycle check up to see if you do have good size follicles and possibly due HCG trigger.

Good luck,
Risa

[claireub]

Risa,

Thanks so much for the reply.

I visited them in October for first time, and they require a LOT of test, HSG was the one held me so long because I couldn't afford it then, they won't start treatment until all blood work, test, mammogram done. now finally I have all the test done so they give me clomid starting cd3, Gonal-F on day 9, and Ovidrel and Prometrium.

I read Ovidrel will trigger the release of egg. I questioned the nurse since I only do intercourse and no need to trigger, if we do intercourse every two days within the time window, we will be able to cover the day of ovulation.  (I have been monitoring myself for few months with OPK and temperature recording and my period is very regular) , but all she said was "that's how we do this", no explanation for the absolute necessity of  Ovidrel.

I know they need patient to visit the office for monitoring so they can charge money,  but I am not retrieving eggs and triggering the egg is not necessary for me and using the expensive drug is a waste.

If not "the way we do it", but "the way best for the patient", will the following be the option: (since my doctor would not advise me)

finish clomid (today cd4 and 2nd on clomid), inject Gonal-f on cd9 and take prometrium when I observe the temperature rises.  omit Ovidrel.

I am afraid to go against the doctor's advice because I am afraid to make mistake. But I feel this clinic seems care more about how they can charge than how I can afford, so seeking the advice from other expert here rather than my doctor.

Thanks again.

[Risa615]

Claire,
Yep, those test take time and for some money.  Good that you did them all so you know what you are dealing with.

The trigger really shouldn't be used unless you know you have at least one follicle ready, so they you would need an ultrasound.  The trigger helps release more than one egg, and forces early ovulation.  I hardly do the trigger since I too ovulate without issues.  I am 41 by the way and have been ttc for 2.5 years with RE office.

I think you should try your way for 3 cycles and then if still not pregnant, then you could go for a mid cycle check up and possibly trigger.

Risa

[docsaf]

When I first started using fertility meds, I still used the OPK b/c I wanted to make sure that the RE did not miss anything. The meds made me produce a higher level of the hormones than normal and the CBE registered HIGH for a much longer window than my usual. When I ran out of the CBE strips, I used the OPK strips. Those indicated I O'd before I actually did. My RE told me that sometimes these tests only look for an increase in 1 hormone level and the fertility meds will cause this since you are producing a lot of eggs, even if none are ready to be released.

[claireub]

Since I am not doing IUI or IVF, I am not retrieving eggs.

As long as I have used clomid and Gonal-F, the follicle will release once it grows mature even I don't trigger it, right?

I think the trigger is only for the convenience to retrieving eggs or to do IUI since you need to go to doctor's office to do so and that time need to be controlled. If we have intercourse at home every two days, we don't see the absolute necessity of monitoring and trigger.

The problem is the clinic won't make any money by just giving me prescription and I monitoring on my own. My problem is I don't have insurance to cover the treatment and I have been on furlough for a while and possible will lose job.

I wish I could find a clinic who is really thinking for the patience's good, not just making money.

[docsaf]

Ask your RE if you will release the eggs. One month I over-responded to Follistim (an injectable) and the RE considered canceling the iui. He was concerned if I took the ovidrel trigger that I would release too many eggs. I did not want to waste the cyle so me and my DH planned to bd instead. He said that the Follistim not only stimulates some hormones but suppresses others and i would not release any follicles if I did not take the ovidrel trigger. I don't think clomid by itself works the same way.

[Risa615]

Claire,
At our age, we don't know if we release an egg each month, so the trigger is actually a good idea especially because it helps release more than one egg increases our chances of conceiving.  It helps pin down ovulation for sure.  Since we are over 40, it is much more difficult for us to release eggs and ovulate to conceive. Trigger just helps the process even if you are just ttc naturally, so you are not correct.  I don't know how long you have been trying, but like I said, if Clomid doesn't work for 3 cycles, I would do the trigger after a monitored cycle.  Hopefully Clomid is the help you needed, but sometimes more is needed. You can read lots of posting to get an idea of what we have all gone through.
Sending you baby dust,
Risa

[BeeHappy76]

I agree with Risa and docsaf, and just wanted to add my own experience. I never ovulated naturally on meds even though I have a regular cycle and ovulate on my own when not on meds. My RE told me that the fertility drugs can suppress the LH surge, which prevents natural ovulation from happening. I was just doing timed intercourse as well but needed the trigger to ovulate at all (just 1 follicle). I think this is more of an issue with injectables. If you want to avoid monitoring and trigger, you could ask your RE if clomid alone is an option.