How long should I use Clomid before I switch to Injectables/IUI?

Most pregnancies resulting from the use of Clomid occur within 4-5 months of treatment. Some studies indicate that most of these are within the first 3 months of treatment. Most Reproductive Endocrinologists will recommend switching to injectable medications after 3-4 Clomid cycles, or a maximum of 6 cycles for patients who are anovulatory.

For anovulatory patients, treatment starts once an ovulatory dose of Clomid is established. If ovulation does not occur using a maximum dose of 200 mg/day, switching to injectable medications should be considered.

How many times should I try IUI before moving on to IVF?

After 3-4 cycles of injectable medications with IUI, the chance of a successful IUI cycle is reduced significantly. IVF treatment would be the next consideration.

If I have PCOS, can I get pregnant?

Yes, patients with PCOS can get pregnant, but usually require our assistance. Patients with PCOS need a full hormonal evaluation to determine which medication(s) may be most appropriate for treatment. For most patients, Clomiphene Citrate (Clomid) is first line treatment to grow and ovulate an egg. If this medication does not work, other strategies can then be used. Of note, patients with PCOS have a higher incidence of miscarriages.

I produce many eggs with IVF stimulation, is this unsafe?

Patients with PCOS have a tendency to produce many follicles (egg sacs), when undergoing IVF stimulation. When undergoing stimulation, we try to obtain 10-20 follicles, but not so many that the patient is at high risk of severe hyperstimulation syndrome (OHSS). Hyperstimulation syndrome occurs in almost all patients undergoing IVF, in a mild to moderate form. Severe hyperstimulation occurs in 1-2% of IVF patients. We can manage most symptoms of hyperstimulation by performing office procedures (fluid hydration, pain medications, removing fluid from belly). Very rarely does a patient have to be admitted to the hospital.

We now know that a hydrosalpinx (dilated and blocked fallopian tube) will decrease pregnancy chances. Most studies indicate a 50% decrease in pregnancy chance. However, if the hydrosalpinx is/are removed, or if the proximal portion of the tube is clipped (like a tubal ligation), then pregnancy chances are restored. This surgery can usually be done laparoscopically; most general gynecologists can do this surgery.