Question:
I have been trying to conceive for two years. So far, I have done 12 total cycles of clomid. We hare having issues getting my follicles mature. I am now taking metformin daily, dexamethasone on CD 1-14, and clomid on days 3-9. I have ultrasounds on CD 14 and usually find immature follicles.
I am wondering, do all these meds seem excessive? All these meds are making me crazy! At what point should conceiving be considered not possible?
Answer:
Thank you for your question. You have already exceeded the number of cycles on Clomid (clomiphene) that is recommended by ASRM (American Society of Reproductive Medicine) and fertility experts. You need to move to something else. I presume you are seeing a General Ob/Gyn for your treatments. Find a fertility sub-specialist and transfer your care. At this point, you should be moving to IUI or IVF, and certainly the gonadotropins. NO MORE CLOMID.
It is this type of prolonged Clomid treatments that get Infertility specialists upset with general OB/GYN docs. All that are strictly recommended are 4-6 cycles at the most. Clomid will inhibit pregnancy after too many consecutive cycles. It works by blocking the estrogen receptors and tricking the brain into thinking it is not making enough estrogen. The brain then stimulates the ovaries harder. After a while, the Clomid will block all the estrogen receptors, which are required to produce adequate cervical mucous, adequate uterine lining and tubal motility. So in essence, it will be preventing pregnancy.
In terms of getting pregnant, it depends on many factors. I tell my patients that I can get anyone pregnant. The difference is what I have to do to get them pregnant. So, you have lots of other options. However, if you don't get out of your current situation with your current doctor, then you will be wasting a lot of time, just as you already have.
Good luck and keep trying, only not in this manner.
Sincerely,
Edward J. Ramirez, M.D.Executive
Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California
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