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so confused - 1st time clomid, 5 follies, what to do?
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so confused - 1st time clomid, 5 follies, what to do?

hi ~
i have been TTC for 5 months only, and I am 40 turning 41 (yes, I am starting late!)
I know there is risk at an older age, so I went to an RE for a check-up just to know what was what - and found out all the negative statistics etc about TTC over 40.
I have been nervous to try the infertility treatments, mostly because I have very regular 27-28 day cycles, and have not been trying for very long yet, and don't want to mess anything up. My Day 2 FSh, E levels are fine, my day 21 progesterone is high,
So I tried for 5 months naturally but have not gotten pregnant yet, thought that might be expected. I heard it takes longer at an older age.
The RE convinced me that at my age I should really step things up, so I tried clomid for the first time this cycle - even though I already ovulate. They explained perhaps I could "superovulate" and if I could get two follicles with eggs I could double my chances from 5% to maybe 10%
I asked what happens if I get too many follicles, and they said it was so unlikely at my age, probably I would still only get the one! They also told me that they usually don't recommend clomid for older women who are less responsive (older than 37-38), that I should probably go straight to IVF - but if i wanted to try it for a short spell I could.  
So I tried the 100 mg from days 3 - 7. Today, on day 9 I went for an ultrasound and of the larger follicles they found 5 large follicles! Yikes!
So they want me to trigger tomorrow on day 10
I don't know what to do  - i usually ovulate between days 13 and 14 each month. Day 10 trigger would have me ovulate day 11 and I feel like my body is not ready.
My lining is still thin at day 9, and my cervix has not reached it's show position yet - it is only starting to change, and my CF usually gets egg white around day 12 as well.  
They want me to trigger asap to try to get the largest two to ovulate and avoid the rest I guess -
but they also keep telling me that at my age only 1 in 5 eggs are probably fertilizable anyway, and that the chance of multiples are really,really low. But then again, they told me I probably wouldn't respond to meds either.
So why trigger? Why not wait until natural surge and have a better chance? I definately do not want a multiple pregnancy risk - but at the same time - if i trigger too soon, I am afraid that my lining might not be good for implantation and sperm wil not be able to swim up without the CF and so I will be dependant on hoping that the egg that comes out is not too immature and that they time an IUI correctly.
What should I do?
Is this cycle a bust and I sit it out - seems wasteful?
Should I go for trigger tomorrow (more drugs in my body) and do an IUI with a very early ovulation and hope that my body will be ready?
Or should I go with my body's LH surge, and have sex and hope that it is true what they say about the unlikelihood of multiples at my age?
The statistics seem much more likely that none will take!

Any experience? I would so appreciate any help making a decision - I don't want to go against the doctor's advice but I also really want to trust myself...
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Avatar_f_tn
What are the sizes of the follicles? Did you ask why they want to trigger now?
If the bigger follicles are 20 mm or so, they may be afraid that you will ovulate prematurely (ie, before the iui). Did they do a blood test checking your Estrogen level and your LH level--that info along with the size of the follicles tells the dr if you are ready for the trigger shot.
You could use an over the counter ovulation predictor kit but certain medications will make it not be accurate (not sure about clomid).
I am 40 1/2 and have had three failed iuis and two failed ivf s (on my third right now which is likely to be cancelled due to low estrogen levels, even though I have 7 great-looking follicles. I got pregnant on my own twice last year (in between treatment cycles) but miscarried both times.
My advice to you is if it doesn't work this time, get aggressive. When I started trying I was 39 and had a great antral follicle count and good FSH. I felt like I had lots of time. Then from one month to another (about 2 months after I turned 40, I went from 14 antral follicles to 9 and my FSH shot up to 11.7.  I wish I had jumped to ivf after my first failed iui. I know it seems like a big step, but at our age we do not have time to waste. Things can turn on    
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Avatar_f_tn
Thank you for the thought out response - it does feel very difficult to make choices on how fast to move forward, so your experience is very helpful. I wish you the absolute best with this current cycle - calm, peaceful and fruitful thoughts.

I ended up doing the HCG shot this morning, the consensus of the drs and nurses was to do it -
The larger follicle was 20 mm and the next two 17.5 mm and the next two 16 mm and 14.5 mm. They thought if i waited a day more the two smaller would catch up and they would not want to do an iui (although obviously we could try on our own).
I did not have an LH surge yet (I don't know how it is affected on clomid cycles but i otherwise get it on day 12) but my estrogen was nearing 1000 so they did not want to have it go higher.

I am still feeling mixed about that choice,
I felt like - just don't add any more drugs to this mix and let nature play out, but in the end i opted to take the shot after all.

I have a friend who just got a surprise pregnant at 45 (she was not trying to but was not careful one time). She does not have any other children. So who knows?
  

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1272624_tn?1395437957
Hi, I am 44 and on my way home from Iui#2, I had 7 follicles on day 9, on day 10 and did iui on day 11, due to the fact that your using meds your lh surge has been replaced by hcg shot, also your follicles mature 1-2mm per day until ovulation that occurs 24-36 hrs after hcg trigger. You are 4 years younger than me, I believe we are all not the same, they said that I would not make many eggs, but I a great producer. We did ivf in May and I made 18 follicle. Unfortunately we can not afford ivf and are going backwards according to some. I had my tubes untied in September so we could do IUI or natural. It's much cheaper! I know we are all different, so follow your heart! When we did our ivf my RE was so afraid to tranfsfer 4, we only transferred 3, but got a BFN. They told me if I was your age they would have cancelled my IUI, but I think maybe because my AMH is 5.6 at 44, and fsh is 7.0. And that I had 4 pregnancies naturally in my 20's. Good luck to you, I believe that there are many variables to us as woman over 40, I hate when they lump us together! Who knows what will happen, I'm ok with twins, but what if all of them take...it's in GODS hands now!
Hugs and BABY DUST!
Melanie
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Avatar_f_tn
Hi Melanie ~
Thank you for writing!
I wish you luck with the IUI!
Wow, 18 follicles, i can't imagine having that many at once lol!

I realized today that mostly these infertility treatment options are not based on working to harmonize with the individual body -  they are working to override the body system. So this is why it is less important what usually happens in each person's natural cycle - and probably partly why I keep getting quoted statistics for what is expected for my age group when I ask questions about what my body is doing.
but meanwhile I am still not convinced that it was not too early for trigger, but I guess I will know in two weeks what the effect was!

Anyways, I will keep trying for a while yet. All the best to you.

C


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Avatar_f_tn
We might have a shorter cycle (sometimes longer cycle) with drugs compare to nature way.  As long as the follicles reach to certain size like 17-20mm, we should have the trigger.  Each follicle does not guarantee have one egg, maybe none, and rarely more than one.  I failed 5IUIs and cancel one IUI due to 7 follicles (I just want 3 follicle each IUI cycle)I'm so regrette on that decision and  think I should not waste my time at first.  I started IVF when I was 38 and now turn 40 to have my first 6month old son.  I produce about 14-20 follicles  and put back 5-8embryos each cycle depend on the fertilize rate (become more aggressive after many failed cycle).  I got pg almost each cycle with singleton only....but MC or ectopic.  So  I think 5 follicle is a very good number to start with IUI.  I wish you the best and get a Positive in another 2 week.
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Avatar_f_tn
Hi,

Thank you for writing and for the very helpful information!
Since the doc's triggered me early, i will have two or maybe three follicles mature and lose the other two. I wanted to wait a day or two more and trigger on my natural surge day and for them all to catch up! After all, they spent so much time telling me how few of my eggs would be viable! Oh well, I am still hopeful. Trying not to doubt, to steer the mind positive.

And congratulations on the 6 month old!
How many cycles of IVF did you go through?

C
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Avatar_f_tn
Keep in mind sometimes if you wait to long the eggs will be overcooked.  At this point we obviously think we know our body but just keep in mind they are taking blood to monitor when we will ovulate.  There is a reason we are going to see them.  We have not been able to get ourselves pregnant...maybe they know something????  (I Hope) LOL  
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