Question:
Dear Dr. Ramirez,
I have been married 17 years, we have had unprotected intercourse for that long. About 10 years ago I went through a year of testing to find out that because of higher than normal testoterone levels my cycle is off kilter and I would not conceive. I went on three rounds of Clomid and still my cycle never evened out and no eggs. Now at 37, for the last year my cycle has started and is becoming actually fairly regular monthly. Without sounding completely brainless, is there a chance my body would be starting to regulate itself enough that I might ovulate, and at this point do you think clomid may help my chances of pregnancy? Is there something I can do to maybe help it along, or am I destined never to ovulate?
Answer:
Hello Shari,
You have or had a disorder called "polycystic ovarian disease". This is an ovulatory dysfunction whereby the ovary does not ovulate on a regular basis. Because the ovary is dysfunctioning, it does not produce the appropriate levels of female hormone so that the male hormone, testosterone, becomes elevated. Most of the patients with this disorder do not respond to Clomid. The appropriate next step would have been to use injectable medications and/or proceed to IVF.
Based on your age, and history, I would recommend that you go directly to IVF. You still have a good chance of pregnancy at your current age, but the chances are decreasing significantly each year. Right now, you have a 40 - 50% chance of pregnancy with each IVF cycle. At age 40, that reduces to 27%.
Certainly, if your cycles have become more regular, then that indicates that you are ovulating. Clomid would help in that case to increase the number of eggs that you ovulate, which is what you want to overcome the age factor. You want to ovulate 3-5 eggs per cycle. If your cycles are not regular, that is 28-30 days each month, then forget the Clomid and proceed to IVF. You have been married a long time to not have had children. Now you are running out of time. You need to be more aggressive if you want to have a child from your own eggs.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
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