QuestionHi. I am from calgary. I am a 30 yr female diagnosed with unexplained infertility. All tests including hsg, husband's sperm analysis and laparascopy have been complete. The only unusual thing found in the laparoscopy was that my right ovary is extremely close to my uterus. I am on my second IUI for which I will know the results next week. I ovulate on my own but have been taking clomid for the last 3 months. This last IUI I had 1 follicle that was 24mm and the other 2 at 14 and 17mm.
My question is if I should bother trying super ovulation if this IUI fails or if I should move directly onto IVF? My RE does not want to increase my clomid dose and I am told that I need a break from clomid for at least 2 months prior to further treatment.
Thank you for your time.
AnswerHello Asma from Canada,
Super-ovulation is defined as inducing the ovulation of more than one egg per cycle. So, essentially you are doing that with Clomid (or should be). IUI increases pregnancy rates by inducing the ovulation of 2-3 eggs per cycle. In fact, there was a recent study confirming that rates did not increase unless 3 eggs were ovulated. It does not matter whether you use Clomid, Letrozole or injectables. As long as you are ovulating three eggs per cycle, and the IUI is being timed well (i.e. by ultrasound and HCG), then your chances should be 24% per cycle in your age group. In the U.S., studies have shown that if this is the case, and you don't achieve pregnancy by four attempts, then the chances of pregnancy drop significantly and so IVF is recommended from that point.
In addition, Clomid should not be used on a monthly basis because it has additive estrogen receptor blocking properties that lead to poor uterine lining development. It does not require two months to recover. One month should suffice. Alternatively, your doctor could switch to using Letrozole, which has less receptor blocking properties so that you could continue on a consecutive month schedule or to injectables as well. Finally, clomid can be used in doses up to 250 mg per day (5 tablets).
I hope this gives you the information you were requesting.
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
