What do I do?

[tinkerbelle]

I've been dx with pcos and in Dec started clomid. I took clomid 100mg cd3-7 and then Estrace days 8-12. What is happening is I am now on CD 54 I've tried OPK, BBT (which doesn't work for me. My BBT varies every day so I don't have consistent temps to track). I did the opk for 12-13 days, Days 13-25(ish) none of the test came back +. I talked to the nurse and she told me that I could have missed the O or possibly it hadn't happened yet but said if it was her that she wouldn't continue testing since the ones that my Dr. told me to get were pretty expensive so i quit testing. I talked to my nurse this morning to see where we go from here and she said to wait 14 days after the last day of unprotected sex so that we know for sure that i'm not preg. after that we'll go through the Clomid again just this next time 150 mg a day instead of 100. Wouldn't you know, after I talked to my nurse this morning I started having discharge. Can anyone give me some input on what to do?

[Jennicadd]

Tinkerbelle-

A couple of things... all doctors are different, but...

1. You might ask about metformin (Glucophage). From what I understand it is the latest and greatest way to "treat" PCOS. I have been taking 1500 mg for 4 months and can tell a huge difference in how I feel.

2. My dr. will not let me go past 40 days.. if the pg test is BFN. When day 40 hits he puts me on provera which causes AF if you truely are not pg.

3. Some people don't O each cycle...even with clomid.

Hope this helps.

Keep us posted on what is going on.
Jennifer

[ECS1070]

Hi Tinkerbelle...Jennifer gave some great advice. I've had PCOS since I was a teenager and when dh and I started trying to conceive 10 years ago all they knew to do back then was pump you as full of clomid as you could stand and hope for the best. What we didn't know back then was about the insulin resistance factor and I never responded to clomid alone, even after 6 cycles of it. Doctors are now prescribing metformin (glucophage) to help with the insulin resistance issues that so many PCOS women have and many women are responding very well to it, me included. I now have regular cycles, something that has never happened before. And I ovulated this month after a second round of clomid, I think this might be the first time I have ever ovulated in my life that I know of. Don't know yet if I'm pregnant but I'll find out this week, I'm on cycle day 33 with no signs of AF in sight. I'm on 2000mg of metformin and took 100mg of clomid this cycle. If you are not on metformin (glucophage) it is definitely worth your time to talk to your doctor about it. I wish I had known about it years ago when I took all those cycles of just clomid, which was a complete waste of time. All it got me was 10 years older and the only child I have has 4 legs and drools and sheds all over everything. :-) But I'm feeling very encouraged with the metformin/clomid combination. If you are not satisfied with your doctor I HIGHLY encourage you to find another one that takes your fertility issues as seriously as you do. A reproductive endocrinologist is also the best way to go if you have PCOS. Insulin resistance is not always easy to test for but most women with PCOS do have some sort of insulin resistance issues. Take care of you and do keep us posted on how you are doing.

Beth
ttc # 1
PCOS / insulin resistance

[bebe72]

I guess my first question is .. is your doctor monitoring you with u/s to see how your ovaries are responding to 100 mg of clomid? If she/he isn't.. they should be. I wouldn't let them increase your meds unless you KNOW that your ovaries aren't responding well or you could end up with too many follicles. I know this very well because I was on 13+ cycles of clomid .. eventually 150 mg myself. After 3-4 cycles of using clomid without success you should take a break at the very least or reconsider using another medication if you aren't responding. I do not know if you know this but clomid can cause your uterine lining to thin (had this happen to me as well). Estrace is helpful in thickening up the lining but the clomid may work against it.

As for BBT.. are you sure you are doing it correctly? I know that sounds stupid but it never worked for me either (had the same issues of my temps being all over the place). After many years of ttc.. I finally found out I was not doing it correctly. If you have any questions the ladies on the BBT bb are helpful. As for OPKs... I think it's most likely you have not surged (ovulated). Women with PCOS can have false surges (positive OPKs) as they can have higher levels of the hormone it tests for. I doubt if you are testing from CD 13 - CD 25 and not getting a surge that you are missing O. Most likely you have not released an egg.

Which leads me to my next point. If your doctor is monitoring you via u/s.. she/he should be able to tell if your follicles are growing to maturity. It's possible they are not reaching maturity AND/OR not releasing on their own (I had this problem myself). If that is the case and the follicles aren't releasing on their own .. they will collapse and be useless. That is why a HCG trigger shot is important. Your RE should be monitoring you on the clomid.. watching your follicles grow to optimum size and giving you the trigger shot to induce ovulation. With this method there is less money/time spent on OPKs. You are not left testing for weeks looking for O .. as you will O 24-36 hours after the shot.

If you have been diagnosed with PCOS.. I too would recommend looking into Glucophage XR (or generic Metformin CR). It can do wonders in helping with several symptoms of PCOS. While it is NOT a fertility drug.. it can help regulate the body's functions and help your cycles become regular with ovulation. (Studies show better results of clomid when used with metformin than if clomid is used alone.)

I hope this helps and isn't too overwhelming. Hang in there. Good luck!

[tinkerbelle]

I am on metformin. 1000 mgs for the first 7 days and then 1500 mg after that. I was off of the metformin for a couple weeks and have started back up this week. My dr hasn't had me come in for any u/s at all. I didn't realize that it was that important but after reading so much about them on this site I think on the next round of Clomid I will be having her checking with u/s. On which cycle day do they normally do a u/s? I'm not sure if my insurance will pay for the u/s. They won't pay anything on my clomid, its' all out of pocket costs for me and my husband so I'm not sure if they will because the u/s is for infertility. Oh, the wonderful loop holes that they find, and I work for them! I don't have an RE right now. My dr and I were going to see how I responded to the Met before I went to a RE. Maybe this is something that I should do either way though the way it sounds, huh?!

[bebe72]

I should say every doctor does things differently. Some choose to just try to treat without knowing what they are treating or how well their "therapy" is working. I had two doctors that did this with me. I was on 13+ cycles of clomid without monitoring. I never responded well to clomid as I never got pg on it. I wasted 2 years of ttc because my doctor wasn't monitoring how I was responding.

We also paid for ALL of our IF treatment out of pocket. Our insurance didn't cover anything. But once we got into an RE (and 4 cycles later I was pg with my first DD).. he worked with us. Charged us less than what they charge insurance companies. It took us til when our first DD was almost 2 before what we owed was paid off. Just in time to TTC for baby #2. In any case.. I know it's tough. But worth every penny. I personally would not take fertility medication without being monitored. It really can help pinpoint how you are responding to the meds (they can do this through u/s and bloodwork) and it can also help pinpoint how close you are to ovulation by the size of your follicles. An HCG shot will induce ovulation .. so you don't have wonder if those eggs ever released. And lastly.. you don't want to end up with HOM (higher order multiples) and with taking fertility meds .. there is the risk. Doctors will tell you the risk is very low with clomid but beware.. PCOSers can sometimes respond TOO well to IF meds. (There have been cases here at FT with women conceiving triplets and quads on clomid.)

I would recommend seeing a specialist. I love my OB/GYN who helped me through almost a year of ttc (and two pgs).. but it wasn't his specialty.. so although he was doing what he thought was helpful.. it was not enough. I got in to see my RE and it was a world of difference with the information I received as well as the treatment. It wasn't until we saw the RE (almost 4 yrs into ttc for baby #1) did we find out DH had some IF issues as well. He was the FIRST doctor in almost 4 yrs to introduce metformin to me which made a HUGE difference for me. It was through seeking treatment with him did I see all the things other doctors had neglected and missed.

But this isn't about me. I just want to share some wisdom of my own experiences with you. If you decide to talk to your doctor about monitoring you u/s are usually done around CD 10/11 to see how your follicles are developing. Then again depending how well they are growing.. maybe closer to CD 12. When they see your follicles are mature.. they can give you the HCG shot.. and you will ovulate 24-36 hours after. Gives you a good valid window for BMS.

I hope that helps some. I know ttc is a rough road. You have lots of support here.