QuestionI have PCOS and have been trying to conceive using 100mg Clomid CD5-9. I got pregant in December and then miscarried in February. My RE is now recommending injectables with timed intercourse, but he did not mention injectables with IUI. Why would that be? My husband has not been tested, so we are not sure of the motility/morphology of his sperm.
AnswerHello Jodi from the U.S.,
If you were successful with Clomid 100 mg, then why change to injectables? That is a fairly low dose of Clomid that you used. Clomid can be used up to 250mg, and most PCOD patients will require the higher doses to adequately respond, if they are going to respond. It sounds like you might have a mild case of PCOD so it may work for you. In addition, Clomid is much much less expensive than the injectables. In addition, if you are a true PCOD, then the injectables may not be the optimal treatment because most PCO patients tend to over-stimulate with the injectables. With ovulation induction or IUI, we can only allow up to 3 ovulatory follicles because the number of eggs that reach the tubes and uterus are not controllable and we don't want to produce a super-multiple pregnancy. With PCOD patients on injectables, the ovaries tend to be super-sensitive to these medications and produce more than 10 ovulatory sized follicles. So in most of these cases, the cycle has to be cancelled or converted to an IVF cycle. For this reason, I don't usually use injectables with my PCO patients. With this problem and the added cost of the medication, if my PCO patient does not respond to high dose Clomid or Femara or a combination with injectables, then I recommend that they proceed directly to IVF. The combination protocol I use is to start with high dose Clomid (250mg) then add some low dose Follistim (injectable) right after and continue until the follicles are ovulatory sized. See my blog on how I do ovulation induction cycles (womenshealthandfertility.blog.com)
There are basically three levels of treatments with infertility: Ovulation induction (OI) with intercourse, OI with IUI and IVF. Most fertility specialists will work their way up through the options unless there is a problem that necessitates moving to a particular one. Because you got pregnant previously, your doc is probably assuming that the sperm is normal and IUI is not necessary. A semen analysis should have already been done, besides. But, if you want to move to IUI because of the increased chances of pregnancy per cycle, then you should just tell your doc that you want that option. After all, you are the consumer.
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 follow me on Facebook at http://bit.ly/9Iw9oV
