Wednesday, June 15, 2005

Plans and priorities

We’re on a cycle of mandatory rest, which is giving me time to research and gather information about our options prior to our next meeting with the RE (at the end of the month). To recap, I’ve done two cycles of Clomid (one at 100mg, one at 150mg) and two Clomid/IUIs (both at 150mg). On my most recent cycle, I had one nice follicle. One. (Yeah, yeah, I know it only takes one, but given how things are going, I think I might feel better with two or even three.)

I suspect the clinic’s next option will be Letrazole (aka Femara - but my clinic doesn’t use name brand drugs most of the time) with an IUI. I’ve heard positive things about the Femara from people who have used it, but part of me is still wondering if it’s a waste of time. I suspect the clinic will want me to try another two cycles on the Femara before moving on.

The last time I saw her, I asked the RE at what point they’d move to injectables - and she responded that she’d hesitate to use injectables with me because with the PCOS I would run a high risk of hyperstimulation. Which I suppose is reasonable - if it’s true. But I know I’ve read about PCOSers getting pregnant after injectables, so I’m not sure about all of this. And on Clomid I’ve only ever gotten 1-2 follicles. So it seems to me if they monitored me closely enough and didn’t just set some blind protocol, that it could work. But given the lag time with the evil-HMO’s lab results, they may not be able to provide the close monitoring I’d need.

Does anyone know anything about a Femara/injectables combo? I’ve read a couple of random posts on random message boards from people who were on some combination of the two - to boost the effectiveness of the Femara, maybe? (I think this is something my old clinic had suggested as a cost-cutting measure because I’d need fewer injectables this way.) So, has anyone done this?

And in the midst of all of this, we’ve started to have fairly serious conversations about IVF. I’ve been looking into the local clinics, and considering finances, and contemplating how much longer before we bring out the big guns. IVF has gone from this distant thing we might consider at some point, to a really viable plan that we might consider SOON.

I think all of the recent pregnancy announcements are getting to me (I got yet another on Friday). Sure, I think it would be great to get pregnant with as little medical intervention (and cost) as possible. But I’m worried that by the time we get there I’ll have completely lost my mind. So, when we meet with the RE at the end of the month, I think it will be a different kind of meeting - where I’m more focused (even relentless) in my questions and my search for a plan that makes sense FOR ME, now.


  1. Good plan Cass. Go in there and just ask away. If you can go in and establish a good case on why you want to move on to injectables then they're less likely to just say no.

    I have no experience with injectables, I'm still on the Clomid/IUI track. I only had one follicle too. I thought it was just me.

    Can't wait to hear what people will say in response to your question.

  2. Hi Cass,

    I've done three rounds of Clomid with very little success - only two ovulations - very late. I'm also PCO (not the syndrome, just the cystic ovaries), and am taking a cycle off to have an HSG and follow-up appt. with my RE. At my last appt., she said she thinks we should do a Clomid/injectables round next (and wants the HSG done first). When I asked about Lexapro, she indicated it worked very much like Clomid and given my poor response, didn't think it would work (for me). The research I've done indicates that adding a few injectables to the Clomid cycle is a fairly "safe" way to introduce injectables without over-stimulating. HOWEVER, I'm not finding a bunch of info., so I'll be very interested to see what kind of comments you get. My next RE appt. is in early July, and I plan to go in like you - direct questions - lots of them!! Good luck!

  3. Make a list to take with you...and make sure she answers ALL your questions. I am heading out to do that very thing in the a.m. I hope she gives you answers that help point you in the best direction for you.

  4. As a fellow PCOSer, that risk for hyperstim doesn't always happen. In fact I'm somewhat of a poor responder and need higher than normal doses of injectibles. In fact, if you're only making one follicle on 150mg of Clomid, I wouldn't worry too much about hyperstim if they are monitoring you closely. As for the femera thing, I have no experience about it, but some women on an MSN board I'm on have, it's invitation only. If you would like an invite, e-mail me and I'll ask the managers.

  5. I'm all for relentless questioning. And for using a break cycle to study up and discuss. H. had the brilliant idea of writing up a one-page bulletted summary of my test results, treatment history, etc. I think that was helpful in getting to the point. And making it clear that we weren't the sort of people who needed to be told to have sex around mid-cycle.

    Best of luck with the planning.

  6. Ditto on the data advice; I'm a data junkie, and my RE has "rewarded" me by letting me skip a few "steps" (tests, waiting, advice, etc.) b/c I'm so obnoxious with brining her all my data (we also did the list with bullets).

  7. I've just started Metformin with the objective being that I will start Letrozole/Femera injections soon prior to IUI #4. This is assuming I can stop being so friggin nauseated long enough to allow myself to be injected.

    Also, I think as long as you are closely monitored, that the danger of hyperstimulation can be minimised.

  8. I've done, I don't know, five or so injectable cycles. Yes, there is a chance of hyperstimulation. But most REs at this point have had experience with PCO patients. I'm not criticizing here but if your RE doesn't have experience with PCO patients, then maybe you should find one who does...

    With me personally, my RE preceded one cycle with Lupron, which brought me close to hyperstimulating. So they didn't do it the next two times (my IVFs). Then, my ovaries didn't respond that well to the Gonal F and Repronex, even on the max gonal F dosage for probably over a week.

    Ok. So why am I dumping my sad story on you? I guess because I find it helps sometimes to hear what other people have done.

    Like other commenters have said, do lots and lots of research. I had 3 doctors tell me to just continue doing IUIs. I was good and fed up and wanted to do IVF. Good thing. The IVFs haven't worked out either and the egg quality issue I'm having would not have been diagnosed if I had just continue doing another 2 or 3 IUIs.

    Good luck...

  9. Hi, I stumbled across your blog trying to do research on my own Clomid/injectable cycle coming up in Sept.

    I will be doing 50mg of Clomid from 3-7 and Bravelle injections on 9 and 11, probably with a HCG trigger on day 12. Of course this all depends on BW and U/S.

    What I was told is that this approach carries little chance for overstimulation. Because the clomid will produce the follicles, be it 1,2,3 or whatever, and then the injections will just mature and make them better quality. When you start with injections there is no way to tell how many mature eggs you will produce, or how many follicles will show up. I guess this is a better way to control your stimulation. I was given the option if I produced too many follies to turn it into an IVF, but this isn't financially possible for us right now.

    I wish you Luck on this Journey!