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Archive for the ‘conceiving with clomid’ tag

Is Clomid for You?

By David Kreiner MD

January 16th, 2014 at 6:51 pm

 

 

It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them.

Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.

Infertility patients — those under 35 having one year of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment.

Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.

Clomid and Your Cervical Mucus

Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.

Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white-like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.

However, when the uterine lining or endometrium is affected by the anti-estrogenic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.

Side Effects

Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.

Limit Your Clomid Cycles

Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.

Success rates

For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.

In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at Long Island IVF.

Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.

Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.

* * * * * * ** * *

Did you start out with Clomid? Did you have success with it or did you move on to IVF?

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Infertility Podcast Series: Journey to the Crib: Chapter 15 Intrauterine Insemination

By David Kreiner MD

June 3rd, 2013 at 8:52 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fifteen: Intrauterine Insemination. You, the listener, are invited to ask questions and make comments and Dr. Kreiner will respond.  You can access the podcast here: http://podcast.longislandivf.com/?p=98

 Intrauterine Insemination

Intrauterine Insemination, or IUI, involves preparing the sperm usually by a washing procedure removing prostaglandins and debris that would otherwise cause severe cramping when the sperm is introduced into the uterine cavity.  Since clomid, an anti-estrogen, can thicken the cervical mucus and create a cervical barrier to the sperm, IUI is a valuable adjuvant to clomid therapy.

The disadvantage of IUI is that as many eggs as you ovulate can fertilize and implant.  In cases where multiple eggs are developed in ovarian hyperstimulation therapy like clomid and FSH (bravelle, menopur, gonal F, Follistim) the risk of multiple pregnancy occurring is enhanced.  The increase in pregnancy rate from this therapy as well as the increased risks associated with IUIs needs to be compared with the relatively superior success rate from In Vitro Fertilization where a single embryo transfer may be performed and excess embryos cryopreserved for a subsequent cycle.  If costs of the treatments are a consideration, such reduced-cost procedures like Minimal Stimulation IVF or Micro-IVF may prove to be a cost effective alternative to IUI when insurance does not cover the IUIs.

Interestingly, not all insurance companies have caught on to this issue of a higher risk of multiple pregnancy with IUI associated with clomid or FSH.  Some require patients to go through a minimum number of IUIs prior to covering the more effective and safer IVF.

Ironically, a multiple pregnancy will cost the insurance company far more than if they had covered IVF.

Worth repeating from the last podcast on clomid therapy: For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative.

* * * * * * **  * * * *

Was this helpful in answering your questions about Intrauterine Insemination?

Please share your thoughts about this podcast here. And ask any questions.

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Infertility Podcast Series: Journey to the Crib: Chapter 14 Trying to Conceive with Clomid Therapy

By David Kreiner, MD

May 27th, 2013 at 9:06 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fourteen: Trying to Conceive with Clomid Therapy. You, the listener, are invited to ask questions and make comments. Dr. Kreiner will answer. You can access the podcast here: http://podcast.longislandivf.com/?p=95

 

Trying to Conceive with Clomid Therapy

Clomid, the best known brand of the fertility pill clomiphene citrate, is the therapy most commonly prescribed for patients suffering from infertility.  It is often prescribed by a patient’s primary gynecologist, sometimes with no diagnostic testing performed. 

Clomid is an antiestrogen and works by decreasing the effective negative feedback of estrogen on the pituitary gland resulting in a rise in gonadotropins, Follicle Stimulating Hormone(FSH) and Luteinizing Hormone (LH).  These in turn stimulate the ovaries usually resulting in the maturation and development of one or more eggs.  For couples whose only problem is ovulation, this offers a 20% chance of pregnancy each month.  Ovulatory patients and those with other infertility issues have a lesser chance for success with the drug. 

Since Clomid has anti-estrogenic properties, it may cause a thickening or drying up of the cervical mucus which may prevent sperm from penetrating the cervical canal and reaching the ovulated egg in the fallopian tube as it needs to do to fertilize it.  This is why we recommend performing intrauterine inseminations (IUI) concurrent with Clomid therapy.

Additionally, the Clomid may thin out the endometrial lining so this should be monitored.  Since the egg does not typically last more than 8-12 hours, we monitor patients with hormone blood tests and ultrasound and then trigger ovulation with Human Chorionic Gonadotropin (HCG) to ensure that the sperm will reach the egg in the fallopian tube.  We will test women to ensure that their tubes are open and check the sperm to make sure that it is adequate as well for fertilization.

As Clomid offers– at best– a 50% pregnancy rate for women who do not ovulate and less for those who do, we do not recommend persevering with Clomid therapy too long, especially for our women over 35 years of age or those couples with other associated fertility factors. Fortunately, we have more successful, aggressive treatment available that may be recommended depending on age, duration and causes of infertility. 

For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative.

* * * * * * **  * * * *

Was this helpful in answering your questions about Clomid therapy?  Please share your thoughts about this podcast here. And ask any questions.

no comments

Is Clomid for You?

By David Kreiner MD

January 17th, 2013 at 8:45 pm

It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them.

Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.

Infertility patients — those under 35 having one year of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment.

Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.

Clomid and Your Cervical Mucus

Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.

Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white-like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.

However, when the uterine lining or endometrium is affected by the anti-estrogenic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.

Side Effects

Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.

Limit Your Clomid Cycles

Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.

Success rates

For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.

In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at Long Island IVF.

Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.

Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.

* * * * * * ** * *

Did you start out with Clomid? Did you have success with it or did you move on to IVF?

 

 

 

1 comment

Infertility Podcast Series: Journey to the Crib: Chapter 14 Trying to Conceive with Clomid Therapy

By David Kreiner MD

June 21st, 2012 at 8:43 pm

 

Welcome to the Journey to the CribPodcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fourteen: Trying to Conceive with Clomid Therapy. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=95

Trying to Conceive with Clomid Therapy

Clomid, the best known brand of the fertility pill clomiphene citrate, is the therapy most commonly prescribed for patients suffering from infertility.  It is often prescribed by a patient’s primary gynecologist, sometimes with no diagnostic testing performed. 

Clomid is an antiestrogen and works by decreasing the effective negative feedback of estrogen on the pituitary gland resulting in a rise in gonadotropins, Follicle Stimulating Hormone(FSH) and Luteinizing Hormone (LH).  These in turn stimulate the ovaries usually resulting in the maturation and development of one or more eggs.  For couples whose only problem is ovulation, this offers a 20% chance of pregnancy each month.  Ovulatory patients and those with other infertility issues have a lesser chance for success with the drug.  

Since Clomid has anti-estrogenic properties, it may cause a thickening or drying up of the cervical mucus which may prevent sperm from penetrating the cervical canal and reaching the ovulated egg in the fallopian tube as it needs to do to fertilize it.  This is why we recommend performing intrauterine inseminations (IUI) concurrent with Clomid therapy. 

Additionally, the Clomid may thin out the endometrial lining so this should be monitored.  Since the egg does not typically last more than 8-12 hours, we monitor patients with hormone blood tests and ultrasound and then trigger ovulation with Human Chorionic Gonadotropin (HCG) to ensure that the sperm will reach the egg in the fallopian tube.  We will test women to ensure that their tubes are open and check the sperm to make sure that it is adequate as well for fertilization. 

As Clomid offers– at best– a 50% pregnancy rate for women who do not ovulate and less for those who do, we do not recommend persevering with Clomid therapy too long, especially for our women over 35 years of age or those couples with other associated fertility factors. Fortunately, we have more successful, aggressive treatment available that may be recommended depending on age, duration and causes of infertility.  

For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative. 

* * * * * * **  * * * *

Was this helpful in answering your questions about Clomid therapy? Are you aware that Long Island IVF is giving away a free basic Micro-IVF cycle? Check out the contest here: http://bit.ly/LHbmQR 

Please share your thoughts about this podcast here. And ask any questions.

no comments

Pixie Dust…and Baby Dust…From Heaven

By C. Tolliver

July 26th, 2011 at 12:00 am

The following essay was one of the winning entries from our first contest in April. The writer has given us permission to reprint it here. In the interim, she has conceived and is currently pregnant in her first trimester. We all wish her the best for a healthy, happy, and uneventful pregnancy!

I always had a very special mother/daughter relationship with my mom. She wasn’t just my mom, but my best friend. She was a very unique and special woman to a lot of people. Imagine everything a mother should be and that was her. She was everybody’s favorite aunt and she babysat for everybody’s kids in the family and the neighborhood. All my friends wanted to hang out at my house because she was so much fun.

She loved all things Disney, insanely decorated the entire house for every holiday, planned the most amazing parties, and always had a smile for everyone and a twinkle in her eye. She was the kind of woman who stayed up all night in the hospital when anyone she knew had their babies and then went into their homes before they were released and cleaned their house, set up the bassinet and baby supplies, and left them a meal for their first night home. She loved her life. As I got older, I started to look at her not just as a mom or a friend but also as a role model of the type of wife and mother I wanted to be.

One of her many dreams was for me to get married and have children so she could be a grandma. As a little girl, I always wanted to be a bride and mommy. It always amazed me that my mother had that same kind of passion and that she wished that for me. I guess wishing those amazing dreams for your children is something you can’t really understand until you’re a mom.

I was only nineteen when my mother was diagnosed with multiple myeloma, a blood/bone cancer, and had just begun my freshmen year of college. I decided to drop out of school and move back so that I could be home to take care of my mother. I couldn’t bear the thought of not being there for her every need. She always put my needs before hers. She was always there for me. It was my turn to help her now.

As I watched my mom slowly lose her 4 year battle, I made the wrong decision to marry, as planning my wedding seemed to give her something to live for. Unfortunately, she never made it to the wedding and passed away seven weeks earlier. In my grief, I kept going through with everything knowing that this wedding was something my mother always wanted for me and I knew she would be there in spirit making sure every detail was just the way she always dreamed it would be.

It wasn’t until months later when trying to conceive unsuccessfully with an unsupportive man that I realized I made a mistake. I later learned that he fathered a child with someone else, and right then the seed was planted that maybe there was something wrong with me… and it has haunted me ever since.

A few years later I was lucky to find and marry my soul mate, a man with a son of his own who is now five. I love and care for him as if he were my own and wish he lived with us full time. Nine months into our marriage we decided to start trying to have a baby. Still in the back of my mind was the idea that something may be wrong, but I went into baby-making with him hopeful… since he too had already fathered a child easily.

Of course I was looking for all of those signs like every woman does when they’re trying to conceive and I had none but I still thought maybe it was just too early and then… I got my period. What a bummer, but there was always next month. Right? So we kept trying month after month with negative results and wacky cycles and we finally decided to meet with my OBGYN.

After several tests it came up that I have PCOS. After talking with each other and the doctor we decide to start on our first cycle of Clomid. Again, I get psyched because now at this point I am thinking this has to work, my husband already has a kid so he has to be fertile and now I know I have PCOS which causes me not to ovulate and this medicine is going to help that so we are in.

So, we’re getting excited, everything is going smoothly I was having some early pregnancy signs and then…once again I get my period and learn what I thought were early pregnancy signs were just symptoms from the medicine. We currently are in our second month of Clomid and as it turns out my results this month are negative and the medicine didn’t even work. At this point we are bummed, we thought the medicine was supposed to help me ovulate and its not even working and who knows, maybe I will get it next week or the week after but without going bankrupt from ovulating strips how else am I supposed to figure out when I am ovulating?

At what point do we decide to move on to a fertility doctor? What kind of expenses is this going to become? We are already struggling with money; we live in a two bedroom apartment and pay a mortgage payment in child support. How we can afford infertility treatments?

My stepson asks when he is going to have a sister or a brother. He prays to God every night to send him a baby sister or brother and he thinks I can’t have a baby because I am not a mommy. This kills me. I cannot wait until the day comes when I can give him the exciting news that he is going to be a big brother and I will be the mommy.

It is hard for me every day of my life not having my mom, but it is especially hard now going through the ups and downs of infertility. So many times I want to pick up a phone and just call knowing she would support whatever it was that I had to say or just hug me and tell me everything will be okay. There’s something about a mother’s hug that just gives you that much more support. I just want that mother/child bond back in my life and the only way it can happen for me is having my own child to love and care for the way my mother taught me to.

Winning a free IVF cycle would make both my …and my mom’s… dream come true. And if it’s divinely possible to do so, I have no doubt that my mom will be looking over that Petri dish and guiding the doctor’s hand when the time comes.

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