QuestionI am a 36 year old female that has been trying to conceive for 2.5 years now. We began our journey by taking temps, charting and trying to figure out when I was ovulating, which never looked apparent to me. I have two children from a previous relationship, who are now 18 and 16 and had no problem getting pregnant with either of them. My husband went for a semen analysis and it came back normal. We then went to see a specialist who did an HSG that came back as one fallopian tube being open and the other coming back as inconclusive as the dr didnt want to inject anymore dye as it was causing me great pain. Our blood work was confusing as the dr told me that part of it came back as being that I wasnt ovulating and the other came back saying I was??? We are now on our 3rd month of clomid which has been very emotional for me as last month I had a 1.5 day period and this month my period came on day 19 vs day 26 like every month when I wasn't taking clomid. I have a drs appt on Wed and am wondering if I should ask to be upped to 100mg of clomid for my next cycle or if we should just take the next steps in fertility treatment. It is simply heartbreaking each month that we aren't getting pregnant.
Thank you.
AnswerHello Amanda from Canada,
You have to keep in mind that you were very young when you had your previous children and in your peak fertile years. Your fertility has now decreased by more than 50% based on your age. As a consequence it is more difficult for you to become pregnant by natural means because the age issue is a decline in egg quality. One way that we try to overcome this is by getting you to ovulate more than one egg at a time and that would be using fertility medications. The goal is to get you to ovulate 3-4 eggs at a time. I doubt that 50mg of Clomid would be sufficient for that. You would probably need to use 150mg or more.
There is another issue, however, and that is the suspicious findings with your tube. It could imply that there is some tubal abnormality, like blockage going on, which would take away the chances for a "natural" pregnancy. The tubes need to be normal for a natural pregnancy to occur.
So at this point you have two options: you could either move to IUI (insemination) which is where fertility drugs are used to ovulate 3-4 eggs and the sperm is injected into the uterus at the time of ovulation (which is timed by using ultrasound surveillance) for a pregnancy rate of 12-15% per month, or you could go directly to IVF where stronger medications are used to extract multiple eggs (10-20) and grow embryos which are replaced into the uterus. In our program you would have a 64% chance of pregnancy per month. With the age issue and tubal issue combined, I would recommend the latter.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
