QuestionDr. I'm 36 my hubby is 43.We have been trying for baby #2 for over a year now with no luck. We went to r.e. and had a fertility workup. No problems hsg came back fine same with semen analysis
as well as transvaginal ultrasound.The dr. finally gave be clomid which I just started a few days ago. I have had 2 miscarriages prior to birth of my 10 year old daughter.One pregnancy which resulted in miscarriage was a set of twins. Now that I'm taking clomid what is the likelyhood if I get pregnant would I have of carrying twins again?
AnswerHello Dawn from the U.S.,
The risk of twins with Clomid is 12% per cycle. In addition, since you had spontaneous twins before, there is a genetic/family predisposition for you as well.
I presume that you didn't have a laparoscopy done. In many cases where the patient has been pregnant before and the evaluation is negative, we will do a laparoscopy to look at the pelvis. This is looking for abnormalities such as endometriosis or scar tissue. In many of these cases, endometriosis is found and treated at the time of the surgery. Sometimes that is all that needs to be done, whereas, sometimes it means a higher level of treatment is required.
Just adding Clomid to your cycles is called "superovulation". He is trying to get you to ovulate more than one egg at at time to increase your chances. Age is a factor for you (because you are over 35 years old), and this is one way to increase the chances in older women. I would recommend that you try IUI with this as well. That will give you the maximum natural chance of pregnancy. With IUI you would have a 12-15% chance of pregnancy per cycle, whereas with just intercourse it will be 10-12%. Also, if the IUI does not work by four attempts, that means that there is something more going on that is not being treated and we generally recommend proceeding to IVF. Many patients will forgo the laparoscopy for the trial of IUI and if it doesn't work proceed to IVF. Laparoscopy is not required if you are not going to try a natural method because IVF bypasses the natural steps. This would be the most aggressive and time efficient strategy. Keep in mind that time is against you so you want to try to get pregnant as soon as you can.
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
