Question for Doctor / What next???

[Lexi72]

Hi, I want to know what your suggestion might be on what to do next.  I have one 2 1/2 year old daughter and she was conceived with no problems.  I am 35 and my husband is 39 we tried to conceive for about 6 months and nothing happened.  I went to my OBGYN and we figured out that I was not ovulating every month so we did Clomid for 3 months and I ovulated 2 of the 3 times.  The OBGYN refered us to an RE.  Both my husband and I had all the testing including semen analysis (normal), I had the tube test (normal) all the blood work (normal), ultrasounds (normal) so the plan was to do Clomid days 3-7 then one shot of Menopur and then Ovidrel to trigger after ultrasound to see how many follicles I had.  We did that for 2 trys and then decided to do Clomid days 3-7 then Menopur days 6-10 and then ultrasound on day 12 and then was told when to do trigger.  Oh and with all these cycles of Clomid and injectibles we were doing IUI.  Every time they say you are doing so well and you have ideal follicles and still nothing.  Last Tuesday I had another IUI with the same protocol, Clomid 3-7 then Menopur 6-10, ultrasound followed by another 2 days of Menopur and then trigger and IUI.  They said I responded so well this time as always and I am in the 2 week wait now.  What my question is what shpuld we do if this cycle does not work?  Should we try straight injectibles.  What if my follicles are not big enough.  They say 14mm or higher is ok but I have read that higher is better.  I just need some guidance on what to do next.  I have also been tested for PCOS and my insulin resistence tests both times were within normal limits although I do have some symptoms of PCOS, but the RE said that I don't need to worry about that because there is no problem with that.  Please give us some advice as to what to do next.  Thanks in advance.

[Lexi72]

Oh TLC37 I am so sorry to hear about your loss.  I hope that you will be able to find out all the answers as to why.  I will be thinking about you.  Let me know what happens.  You sort of lose touch with people on the forum but I keep in touch with a couple and would love to stay in touch with you.  

As for me I went to another Reproductive Endocrinologist, he has the best pregnancy success rate in Georgia.  After looking at all my labs he thought that I needed to be put on Metformin for a few months and see what haapens.  So far as a result I have lost weight which I needed to lose about 20-25 lbs to be what i need to be for my height.  I never dropped the weight after my daughter.  Then I will see him back and he will check my insulin levels and see what to do from there.  He said it seems to him that the Metformin with maybe Clomid (maybe) will do the trick.  He said the only thing that has changed since I had my daughter has been my weight and that made my PCOS kick in with the insulin levels.  He said we have time to do IVF but he does not want to jump the gun unless I insist.

Let me know what is going on with you.

Hugs

[TLC37]

What did you decide to do? We just lost our baby at 9w. Not sure why yet, just had the D&C today. I actually had forgot about this post & board, I found my profile again after seeking more info on another topic!

Good luck!

[Shayne Plosker, MD]

Dear Lexi72-

This sounds like a total of four cycles of fertility drugs with IUI? If so, I would recommend that you consider IVF since fertility drugs and IUI, if they are going to work, will do so in the first 3-4 tries. I do not think there is benefit to straight injectables with IUI over your combination regimen.

[Lexi72]

Hi TLC37,

Thank you for your response my FSH and LH are normal and I am maybe 10 lbs over weight so I don't think that is a problem.  I guess I don't know if we should keep putting money into IUI or just move to IVF.  My RE said I have a much higher chance and I am a great candidate but they also say everything looks great every cycle.  So I guess there is a decision to make. Just not sure which way to go.

[TLC37]

I use injectables + IUI to get pregnant. Took 5 tries with #1, and it worked after using glucophage orally with injectables on the fifth cycle only. Second time took one try, also on glucophage that cycle. Third pregnancy, tried injectables plus IUI three times, failed. Fourth time worked after glucophage included in cycle. I have never been diagnosed with PCOS (I have low FSH and LH actually) but am overweight AND glucose intolerant. Also, my doc says 14 mm is fine, but we've been shooting for over 17mm. With my previous pregnancies, a different doc was shooting for over 18 mm.