Hi Jue Jue, in Lesley Regan's book she says ..."clomiphene is invariably unsucessful in treating women over the age of 40 years when there is no evidence to suggest they are not ovulating. Indeed, in this situation it is likely that the ony result will be the occasional release of an abnormal egg, which if it does get fertilised, will not implant or will miscarry soon after." It's on page 213 if you want to take a peek in the book shop. She's an expert on miscarriage but the book is full of other useful info. After chlomid I was put on Gonal and my new consultant says now that that also is not useful if you are ovulating naturally. My previous consultant who put me on the Gonal told me I wasn't getting pregnant because I wasn't ovulating, but I've since found out that I am ovulating in every cycle, he didn't bother to give me any scans to check that. I did get pregnant on the Gonal though, but it was slow-developing and miscarried.
My answer would be that over 40 you really need to get a move on and use the 'big guns' as it were to get more bang for your buck.
My advice would be to move straight to iui with ivf doses of stims. meds (e.g. gonal f, menopur etc). Use exactly the same meds. protocol as ivf but for iui. This gives you a better chance than clomid IMHO.
What is your antral follicle count? Your hormone profile (FSH, E2, LH, etc)? Have you had these done recently? This information will help your clinic plan an appropriate protocol for you.
It is recommended that over 40s do not use clomid and that if they do, it should be for no more than 3 months.
Here is a question and answer about clomid and iui from Geoffrey Sher one of the top fertility doctors in the US (SIRM clinic). It may help you.
My advice. Go to a very good clinic with good live birth rates from over 40 women. Have all appropriate checks beforehand. (e.g. uterus, tubes, thyroid, clotting, infection, karyotype etc). Try iui no more than 2 more times with full ivf stims. meds (including orgalutran and trigger) and move on to ivf (again at a top clinic). This is the only way to maximise your chances as time is critical for you.
Each step I take brings with it so much to understand and anyalyse , it is incredible as I am sure you have all learnt by now, so thanks for the responses.
"To give a normally ovulating woman Clomiphene in the knowledge that she will, in any case, only release one egg at a time defies all logic".
This statement is of course worrying for me.
First iui was natural, it was without tests well except for general bloods. As result was a BFN, read up on clomid thought this was the way to go so spoke with the doctor yesterda (not for very long I might add ) and she said " i hear you're thinking about clomid and hcg shot", i said "Yes What do you think" and she replied, "Yes I think you should go for it". just got prescription. And now I see the above, so confusing really.
I requested fsh day 3 awaiting this result
Progesterone day 21 came in at 29.1 and she says prolactin fine as was fsh for that cycle day.
She says there is no reason to suspect am not ovulating but i only had one scan which was on day 9 , 2 ovaries each 13mm and lining I think at 0.9 on that day also. Asked do i need to have any additional scans and she said no. and advised i go in for iui 3 days later, but lh did not show until 4 days later so went in 5 days after the scan. My period is usually 27 to 28 days .
How can i be sure i have ovulated i assume it is from a scan? And what is an antral follicle count never heard of it, it was never mentioned to me at all.
I would love to go to the top clinic here but canot afford can afford 2 more iuis just about and that was with a loan.
Could do another natural iui next week but really , is there any point i feel if progesterone a little on the low side?
Just feel have wasted a whole cycle. clinic are really beginning to annoy me now as they just are not thinking about my age. Sorry feeling a little low and angry at the same time today.
There does seem to be much info out there to suggest clomid and being over 40 is a no no but it doesnt actually say why this is the case. Age and progeserone being a little on the low side seem to be main factors for me.
Maybe will see what FSH day 3 and that may help decide.
Jue jue we're talked before on the IUI boards so you know I have a lot of scans, that's the only way I was able to find out that I was ovulating despite what my consultant told me. You had a scan which showed you have two follicles (you meant that, didn't you, not ovaries?) and the only way to find out whether you've ovulated is to have one on a later date . For instance I had one on day 11 and there was one follicle, on day 12 it was gone, - because I had ovulated. Maybe there's another way to know, I don't know. RE Chlomid, that's not true about the number of eggs, I had 6 on both chlomid cycles, my issue with it is the way in which it works does not (apparently) increase the pregnancy rates in over 40's. I think if you are ovulating you have a chance with IUI, after all that's why I'm doing it! Re Daisy, I agree with Daisy that it may be worth trying with Gonal, but I wouldn't go for ivf levels personally, it may not be necessary, it depends on your response. I usually get five follicles on 75iui of Gonal and that is plenty because they like to give you the shot when a single follicle gets to 18mm, so you aren't going to 'use' the other ones anyway. All you want is one or two, more than that at 18mm and they will probaby refuse to do the IUI because of the risk of multiples.
Regarding progesterone, if it's on the low side you can ask for pessaries, lots of women take them .
yes i recall chatting previously, but to be honest i find it incredibly difficult to keep up with everyone on here, it aint easy with
so many different treatments views etc. I did ask my doctor about ways to increase progesterone and she said there is nothing out there that is proved to increase it so will do a little more research on the pessaries. thanks for that
Was she talking about increasing it naturally? Because i thought everyone took it after ET in IVf, usually via injections, that's what I've been given for this, my first cycle. But for stimulated IUI/ timed cycles I was given pessaries. Lack of progesterone is a really big deal so it's commonly prescribed.
We are talking about two separate issues here. The progesteron test you had (which was 29.1) was a day 21 test to see if you are ovulating.
The progesterone issue that urbangirl is talking about is extra progesterone support which is give as standard during an ivf cycle after embryo transfer (ET). This is because the body does not naturally produced enought progesterone to support a pg in an ivf cycle post embryo transfer and you need extra.
Some clinic add extra progesterone support after insemination with an IUI cycle, just for a belt and braces approach. However, with IUI, the body should produce natural progesterone to support pg.
I see. so progesterone should be ok at 29.1. am wondering now with that info should i go ahead and do another natural iui next week as have to wait for next cycle to introduce clomid. What do you think Daisy? if you dont mind me asking, i just hate to waste a month without treatment.
Well the month you were tested presumably showed you did ovulate? That's all it tells you.
If I were you, I would invest the money in a medicated iui. Just using FSH injectibles. Forget the clomid and just move straight on to medicated iui. Natural iui a waste of time at your age IMHO. You need to get a move on with stronger treatment.
What are your options with the clinic you are at now? What are their success rates with women over 40 on iui protocol? You need to get this info. Knowledge is power and unfortunately in this situation the learning curve is steep without much time to waste.
Are your tubes clear? Is your uterus ok (no polyps/fibroids)? These are essential for iui.
Have you had your thyroid tested recently?
You need to do an iui cycle when you have good FSH/E2 results to maximise the effect of the stimulating meds (your FSH levels may fluctuate month to month). So you need all this information to make an informed choice rather than rushing blindly into another natural cycle.
IMHO it is important to prepare as much as possible and use your money on a cycle where your chances are highest. This means good as possible FSH/E2 taken on day 2-4 of cycle. Then start you with highish dose of FSH injectibles plus shot to delay ovulation then trigger shot and progesterone pessaries post insemination for extra support.
Will your clinic do a cycle like this for you?? Can you discuss this with them now?
I would also post your questions on the IUI board for more info. But over 40, you need to be thinking about a plan b asap. (e.g. ivf etc).
I agree with Daisyg.
When I asked my doc about clomid he said the big problem with clomid is that it also thins your womb lining - and that is something you DON'T want at 40+. (I looked in to one of the US protocols of 'mini ivf' which uses clomid for older ladies.. and they don't use it for iui, and when they do it for ivf they don't put the embryos back in that cycle, but wait for the next cycle so that the lining is back to normal)
Ovulation test kits fro the chemists will tell you when you are ovulating. They are pretty accurate and tell you before the ovulation - which is rather more useful than after
Are you seeing an actual fertility doctor? If not then you ought to immediately.
I am continually shocked at GP's recommendations for fertility tests / treatment and how they treat people aged 40 and over as if they had all the time in the world (I am still smarting from the 9 months wasted due to just plain wrong advice from my GP when I was 40 (oh how often I wish I could have those 9 months back!))
Elcf has hit the nail on the head. If you are not with a fertility clinic now then you are wasting time. GPs are not qualified to treat you effectively. Save your money and invest in iui with a top fertility clinic...
Well have decided to mail my clinic with a few queries alright , need to requeste oestadil and amh levels it seems and yes they
are fertility experts in their field.
A polyp was discovered during my last iui treatment and i have been referred to the hospital for removal. I am a little worried about it as I have a history of cin grade 3. Not sure how long I will be waiting but hopefully not too long.
To be honest I ve decided I wont be doing IVF so sticking with iui and that will be it, if it does not work.
Daisy what do fsh injrectibles do and if i dont take the clomid would a hcg injection on its own be any good. Will ask my clinic this anyhow tomorrow and see what they say. Hopefully i will be able to sit down again and review.
Sorry not much time to answer this am, so quick...
Clomid and FSH are ways of medically stimulating your ovaries to produce more follicles and therefore potentially increase your chances of getting more egg for release and fertilisiation and higher chance of pg.
At your age, clomid can have a negative effect. FSH is a less harsh drug which may stimulate your ovaries more effectively to produce more follicles and potentially increase your chances.
Pointless taking hcg on it's own because without extra medical stimulation (e.g. FSH meds) your ovaries may or may not only produce one egg and this does not increase your chances at all. You are over 40 and your chances of a live birth are already low. You need to have fairly high power protocol in order to try and get pg. Rest is a waste of your time and money.
List your questions and send email to clinic. Include all suggestions on this thread and see what they say. Ask them what success with LIVE BIRTHS they have had via IUI and IVF over 40 at their clinic. This is important to find out whether they are the right clinic for you. If they have never had any live births over 40 - I would walk away from them right now.
The clinic nurse rang me today and we chatted about treatment etc. She told me the doctors at the clinic are not fertility specalists , that they are expert with iui only and prescribe clomid and hcg injection but not fsh injectables. that i could be referred elsewhere if i felt i needed a stimulated cycle, pity this wasnt explained at the initial consulation.
Not impressed because at my very first meeting i told the doc i had looked at other clinics and basically asked her if this one would be able to do all possible to achieve pregnancy. It was never explained to me that I could be referred on somewhere else, basically they are expert with iui one doctor not too keen on clomid but other doc was ok to prescribe it.
~all i know is that i feel i have wasted money , i have tried to drag information out of them
When i asked about clomid originally and enquired about coming in to discuss she said there was not need.
also they did the iui knowing there was a polyp there and are now asking for polyp to be removed before next treatment. Feel like asking for a refund to be perfectly honest.
Fertility specalist thats a good one!
Daisy G thanks for advising me to ask further questions.
Went to another clinic for a consultation and really did not like the guy's manner at all.
Anyhow had to put that aside and be objective.
he says clinic have no breakdown for women of 40 plus doing iui.
He is recomending tamox and fsh injectibles for 2 cycles and then would recommend ivf (which defo cant do cause cannot afford).
wasnt really interested in by hormone results and says the clinic have stopped doing fsh day 3 and focus on amh. I feel they can say whatever they want and clealry profit is a reason they are set up these private clinics. no regulation in ireland so it is extremely difficult. Only a handful of clinics
He was not very optimistic for me AND worst sperm is ordered "usually" from Denmark and takes 2 months.
Thinking will stay with clinic i started with for another cycle and go with the clomid and hcg. i was checking out another site and some women over 40 are using clomid. I asked him about using it and got no direct answer.
Here is my advice. Do not go for a cycle now. Wait until you have the sperm and have a definite answer about whether to operate on your polyp which could cause failure and/or miscarriage. If you cycle now you are wasting your money. 2 months in the scheme of this will make no difference.
You need to find out what you E2 is as it affects FSH measurement. They should have tested for this at same time as FSH/LH. Your FSH at 10 is normal for your age and does not mean you cannot get pg. It means you may need higher doses if FSH stims. meds in an iui or ivf cycle.
Your FSH/E2 does fluctuate each cycle, so you may find a better result on another cycle. However, your age is the critical factor and FSH tells you nothing about the quality of your eggs or whether or not you can ge pg, only how hard your body has to work to produce follices/eggs.
I agree that you should do max. 2 iuis then move to IVF if possible. Is there any chance of your going to another clinic like the Lister in London? You would really increase your chances.
If as you say, you can only afford iuis, then you need to get the best value and chance possible. That may mean waiting (a short while) until all this is sorted and you are at the best possible place.
You have to be assertive and proactive in this business of getting pg at your age. It is a steep learning curve I know.
Your fertility doctor is recommending tamoxifen and FSH for iui. I would go with this but use high doses of FSH plus ovulation suppression injection and hcg trigger (just like an ivf cycle). Can you ask about this?? It is not good news that their over 40 results are not available.
I would also ask this doctor what their results are (for all ages) for tamoxifen/iui protocol and ask if you can do an ivf protocol but using IUI instead.
I assume your fallopian tubes are clear and uterus ok (apart from polyp which you need an answer on). Is your thyroid ok?
Your other clinic is a waste of time (clomid/hcg) do not bother with it. Use your money where it matters, either by travelling to the Lister, or at the new clinic plus an ivf cycle if you can.
Sorry to be harsh, but you need to be very assertive about this.