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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?

 

 

 

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