Clomid not affective with high BMI?

dodiedon · 09-04-2007, 08:37 PM

I was told that after a certain BMI over 33 that ovulation drugs don't work. My BMI is 35 which means that I have to lose 40lbs. I am 41 and just found out that I may not be ovulating. I lost a lot of weight and have seen it creep back on due to stress and the depression caused by infertility and a failed adoption. The clinic where i am going for infertility wants to start me on weight loss classes which means more time off work to go to all these classes. Can someone tell me if they've heard anything about weight in relation to Ovulation drugs effectiveness. I've invested so much time here starting the test all over again somewhere else is daunting.

Thanks.

CrystalAZ · 09-04-2007, 10:12 PM

(barge)

I have a BMI of about 35 and Clomid worked excellently for me - for the first time in my life, I ovulated like a champ.

Unfortunately I later discovered that my tubes were blocked so it was all for naught - but it DID work.

Crystal

txblue · 09-08-2007, 02:05 PM

That is ridiculous - I've seen Clomid be effective in people who weigh 300 pounds and ineffective for people who weigh 150. Weight is certainly not the only factor...not even the most important.

I have a high BMI and Clomid and injectables did not work for me, but I've seen them work for many overweight people.

JulieB2 · 09-08-2007, 10:44 PM

Bologna.....

Whoever told you that, was either Fat phobic or just ignorant....

I weighed 340 when i got pg with my dd. I got pg on 150mg of clomid, second month.

Good luck and if that was a dr telling you that...fire them...

txblue · 09-09-2007, 12:57 AM

Hey Julie, did you try 100mg before going to 150? What kind of response did you have? Did you ovulate at all without Clomid? My RE seemed reluctant to go above 100mg but it did absolutely nothing for me. Injectables also didn't work, so I'm guessing Clomid wouldn't, but I'm about to go back after a TTC break so I've been considering my options.

I completely agree about firing the fat-phobic doctor, by the way. My RE would be THRILLED with a 35 BMI.

JulieB2 · 09-09-2007, 07:02 AM

txblue,

I didn't have any response to 100mg of clomid. Even on the 150 I didn't ovulate until around cd 21/22. I really thought that it was a bust and stopped temping and everything.

I don't ovulate on my own at all unfortunately. Gotta love PCOS.

My RE that i have now has no problem with going up to 250mg (which is what my dosage is now when cycling.) He is trying to get me to ovulate on cd 14-15, his rationale is that the earlier you ovulate the better quality egg you produce. Old eggs = less chance of pregnancy or higher risk of miscarriage.

I have not done the 250 yet, only 200, and it moved me MUCH closer to cd 14. I also trigger with HCG and am monitored by u/s. I am thinking we will cycle again in october/november. The main concern with clomid is lining issues or CM issues. I have never experienced those either. My lining is usually pretty fluffy (15mm or so by trigger). I'd say if you have no problems with lining or CM you should be able to move up dosage and get a response. Femera also seems to be a pretty good drug for ovulation induction. People who don't respond to clomid sometimes have better response to that.

Also, are you on metformin? This might also increase your sensitivity to clomid and doing a month or two of metformin before and during a clomid cycle can produce a much better response.

Good luck! If i can answer any more questions, let me know

nathansmommy · 09-09-2007, 07:42 AM

My female RE in Houston has a philosophy that she will "provide help and hope to all infertile patients." She has never mentioned weight issues to me at all (I have PCOS and Endo). The only thing she has said is that studies have found women with higher BMI's need more hcg to trigger ovulation, so I have been doing a double dose of hcg trigger (20,000 IU) before my IUI. Here is a portion of an article I found on the web: "The levels of hCG that get into the bloodstream are affected by the dose of hCG given and the weight or body mass of the woman taking it. Heavier women have lower hCG levels than lighter women even if they take the same dose. For this reason, we alter the dose of the hCG trigger based on the body mass index of the woman."

I took clomid for six months with no luck. I was said to be clomid resistant, so I had to move on to injectibles. My RE also recommended IUI in my case due to both the PCOS and Endo. I am happy to report that it was successful on the first try after my lap surgery six years ago, and I have a 5 year old DS. I am currently TTC my second through the same protocol.

If a Reproductive Endocrinologist told me I had to lose weight before starting treatment, or that it would not be effective....I would find another doctor. That is insane! I have seen Clomid and/or injectibles work for all of my friends who suffer from PCOS or higher BMI's. Don't let that doctor discourage you....move on and find another doctor who is normal and not afraid of us women with higher BMI's! Good luck!

txblue · 09-09-2007, 08:14 AM

I'm not on Metformin. I have never been diagnosed with PCOS, because I don't have cysts...but I do have every symptom I've ever seen of insulin resistance, so I'm wondering if Metformin would be helpful for me. I'm seeing a new doctor (primary, not RE) on Tuesday and I'm really hoping to have some extra tests done. I have lost some weight since last time I saw the RE but I'm still hovering around 285. After trying injectables (Repronex) for a few months and only ovulating once, the RE felt I would have better absorption if I lost weight. I'm skeptical since I never ovulated regularly even when I was over 100 pounds smaller than I am now, but I have tried.

I also always used u/s monitoring, trigger and IUI, plus donor sperm. Thanks for letting me know about your experience...I'll add it to my defense of reasons why I want to go even more aggressive than before.

(dodie, sorry to hijack your thread! but maybe the additional info is helpful for you...?)

hatzy · 09-13-2007, 12:02 PM

nathansmommy: That HCG is definitely true. When I did IVF #1 last year, they did blood work after the trigger and called me and said although you did get some HCG in your system, they wanted me to do another 10,000 units. I am convinced that this is why after seeing 12+ follies all along, they only retreived 4. I mentioned it to my RE afterwards and he said it was possible, but not likely, but he'll consider upping the trigger amount next time. **** right he will.

Can you give the url for that article you quoted?

nathansmommy · 09-13-2007, 02:29 PM

hatzy - The info. I quoted came from a RE doctor's website, http://www.ivf1.com/ivf-hcg-trigger. My RE obviously follows the same protocol, but she doesn't have that detailed info. posted on her website-she just explained it to me in person.

Another article I read indicates the same thing,
http://cat.inist.fr/?aModele=afficheN&cpsidt=952749

I did a search for "hcg and bmi" and a lot of research articles came up about this subject. It definitely makes sense to me. You mentioned your dr. made you do a second dose of hcg after some bloodwork--my RE said she just gives the double dose up front to avoid having to do a second one later (based on patient BMI). Good luck!

09-04-2007, 08:37 PM	#1 (permalink)
dodiedon 0-99 post 2 of hearts Join Date: Apr 2006 Location: California Posts: 83	Clomid not affective with high BMI? I was told that after a certain BMI over 33 that ovulation drugs don't work. My BMI is 35 which means that I have to lose 40lbs. I am 41 and just found out that I may not be ovulating. I lost a lot of weight and have seen it creep back on due to stress and the depression caused by infertility and a failed adoption. The clinic where i am going for infertility wants to start me on weight loss classes which means more time off work to go to all these classes. Can someone tell me if they've heard anything about weight in relation to Ovulation drugs effectiveness. I've invested so much time here starting the test all over again somewhere else is daunting. Thanks.

09-08-2007, 10:44 PM	#4 (permalink)
JulieB2 1000-4999 post queen of hearts Join Date: Jan 2002 Location: Ohio Posts: 1,607 Blog Entries: 10	Bologna..... Whoever told you that, was either Fat phobic or just ignorant.... I weighed 340 when i got pg with my dd. I got pg on 150mg of clomid, second month. Good luck and if that was a dr telling you that...fire them... __________________ Julie My one and only beautiful dd

09-09-2007, 07:02 AM	#6 (permalink)
JulieB2 1000-4999 post queen of hearts Join Date: Jan 2002 Location: Ohio Posts: 1,607 Blog Entries: 10	txblue, I didn't have any response to 100mg of clomid. Even on the 150 I didn't ovulate until around cd 21/22. I really thought that it was a bust and stopped temping and everything. I don't ovulate on my own at all unfortunately. Gotta love PCOS. My RE that i have now has no problem with going up to 250mg (which is what my dosage is now when cycling.) He is trying to get me to ovulate on cd 14-15, his rationale is that the earlier you ovulate the better quality egg you produce. Old eggs = less chance of pregnancy or higher risk of miscarriage. I have not done the 250 yet, only 200, and it moved me MUCH closer to cd 14. I also trigger with HCG and am monitored by u/s. I am thinking we will cycle again in october/november. The main concern with clomid is lining issues or CM issues. I have never experienced those either. My lining is usually pretty fluffy (15mm or so by trigger). I'd say if you have no problems with lining or CM you should be able to move up dosage and get a response. Femera also seems to be a pretty good drug for ovulation induction. People who don't respond to clomid sometimes have better response to that. Also, are you on metformin? This might also increase your sensitivity to clomid and doing a month or two of metformin before and during a clomid cycle can produce a much better response. Good luck! If i can answer any more questions, let me know __________________ Julie My one and only beautiful dd

09-13-2007, 12:02 PM	#9 (permalink)
hatzy 300-399 post 5 of hearts Join Date: Aug 2006 Location: Commack, ny Posts: 376	nathansmommy: That HCG is definitely true. When I did IVF #1 last year, they did blood work after the trigger and called me and said although you did get some HCG in your system, they wanted me to do another 10,000 units. I am convinced that this is why after seeing 12+ follies all along, they only retreived 4. I mentioned it to my RE afterwards and he said it was possible, but not likely, but he'll consider upping the trigger amount next time. **** right he will. Can you give the url for that article you quoted? __________________ Me: 38 DH: 38 PCOS and overweight 10/20/03 Second trimester loss - IC or Preterm Labor - jury still out 5 IUIs + Clomid + Metformin = BFNs; IVF #1 Nov. '06 BFN, IVF#2 July '08 - BFN IVF#3 Nov. '08 BFN New Doc 4/09 - DX- immune issues and clotting disorder IVF#4 7/09 BFP! beta #1 10dp3dt-76 beta #2 12dp3dt- 133 beta #3 16dp3dt- 702! m/c 8/8/09

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09-04-2007, 10:12 PM	#2 (permalink)
CrystalAZ 10000-15000 post ace of hearts Join Date: Nov 2004 Location: Phoenix AZ & Flagstaff, AZ Posts: 10,835 Blog Entries: 455	(barge) I have a BMI of about 35 and Clomid worked excellently for me - for the first time in my life, I ovulated like a champ. Unfortunately I later discovered that my tubes were blocked so it was all for naught - but it DID work. Crystal

09-08-2007, 02:05 PM	#3 (permalink)
txblue Registered User Join Date: Sep 2005 Location: Texas Posts: 115	That is ridiculous - I've seen Clomid be effective in people who weigh 300 pounds and ineffective for people who weigh 150. Weight is certainly not the only factor...not even the most important. I have a high BMI and Clomid and injectables did not work for me, but I've seen them work for many overweight people.

09-09-2007, 12:57 AM	#5 (permalink)
txblue Registered User Join Date: Sep 2005 Location: Texas Posts: 115	Hey Julie, did you try 100mg before going to 150? What kind of response did you have? Did you ovulate at all without Clomid? My RE seemed reluctant to go above 100mg but it did absolutely nothing for me. Injectables also didn't work, so I'm guessing Clomid wouldn't, but I'm about to go back after a TTC break so I've been considering my options. I completely agree about firing the fat-phobic doctor, by the way. My RE would be THRILLED with a 35 BMI.

09-09-2007, 07:42 AM	#7 (permalink)
nathansmommy 0-99 post 2 of hearts Join Date: Aug 2007 Location: Texas Posts: 86	My female RE in Houston has a philosophy that she will "provide help and hope to all infertile patients." She has never mentioned weight issues to me at all (I have PCOS and Endo). The only thing she has said is that studies have found women with higher BMI's need more hcg to trigger ovulation, so I have been doing a double dose of hcg trigger (20,000 IU) before my IUI. Here is a portion of an article I found on the web: "The levels of hCG that get into the bloodstream are affected by the dose of hCG given and the weight or body mass of the woman taking it. Heavier women have lower hCG levels than lighter women even if they take the same dose. For this reason, we alter the dose of the hCG trigger based on the body mass index of the woman." I took clomid for six months with no luck. I was said to be clomid resistant, so I had to move on to injectibles. My RE also recommended IUI in my case due to both the PCOS and Endo. I am happy to report that it was successful on the first try after my lap surgery six years ago, and I have a 5 year old DS. I am currently TTC my second through the same protocol. If a Reproductive Endocrinologist told me I had to lose weight before starting treatment, or that it would not be effective....I would find another doctor. That is insane! I have seen Clomid and/or injectibles work for all of my friends who suffer from PCOS or higher BMI's. Don't let that doctor discourage you....move on and find another doctor who is normal and not afraid of us women with higher BMI's! Good luck!

09-09-2007, 08:14 AM	#8 (permalink)
txblue Registered User Join Date: Sep 2005 Location: Texas Posts: 115	I'm not on Metformin. I have never been diagnosed with PCOS, because I don't have cysts...but I do have every symptom I've ever seen of insulin resistance, so I'm wondering if Metformin would be helpful for me. I'm seeing a new doctor (primary, not RE) on Tuesday and I'm really hoping to have some extra tests done. I have lost some weight since last time I saw the RE but I'm still hovering around 285. After trying injectables (Repronex) for a few months and only ovulating once, the RE felt I would have better absorption if I lost weight. I'm skeptical since I never ovulated regularly even when I was over 100 pounds smaller than I am now, but I have tried. I also always used u/s monitoring, trigger and IUI, plus donor sperm. Thanks for letting me know about your experience...I'll add it to my defense of reasons why I want to go even more aggressive than before. (dodie, sorry to hijack your thread! but maybe the additional info is helpful for you...?)

09-13-2007, 02:29 PM	#10 (permalink)
nathansmommy 0-99 post 2 of hearts Join Date: Aug 2007 Location: Texas Posts: 86	hatzy - The info. I quoted came from a RE doctor's website, http://www.ivf1.com/ivf-hcg-trigger. My RE obviously follows the same protocol, but she doesn't have that detailed info. posted on her website-she just explained it to me in person. Another article I read indicates the same thing, http://cat.inist.fr/?aModele=afficheN&cpsidt=952749 I did a search for "hcg and bmi" and a lot of research articles came up about this subject. It definitely makes sense to me. You mentioned your dr. made you do a second dose of hcg after some bloodwork--my RE said she just gives the double dose up front to avoid having to do a second one later (based on patient BMI). Good luck!