What happens next after Clomid doesn't work?

[JAYLIN]

I'm on my second month of clomid , 50m. I've got my prescription for next month for 100m. If that doesn't work my doc said to call her and she will refer me to a specialist.

I'm just wondering what happens next? Do they start running all sorts of test or do you start talking about IUI or AI?

Just wanting to know what the future may hold? (Plus crossing my finger we won't get to that point)

Thanks!

Oh, plus a totally unrelated question....I was in for my annual exam yesterday. I'm on CD 24. Would she have been able to tell if I was pregnant from the internal? (Sorry if this is a stupid question) would my cervix be closed at this point if I was pregnant?

[Scooter]

So it sounds like your regular ob/gyn has been prescribing you the clomid? Has he/she done any testing with you? Have you been give a diagnosis?

Basically, when you're referred to an RE, they do bloodwork and an HSG on you & an SA or two on your DH. They then give you a preliminary diagnosis and come up with a treatment plan. This plan could be to do further testing, treat an existing problem they found, or go straight into a treatment cycle.

Based on what your diagnosis is, you would probably go to one of three scenarios: medication with timed intercourse (what you're doing currently), medication with an IUI, or move directly to IVF. The specifics would be determined by your situation.

I'm not sure what you mean by "IUI or AI" because IUI is intrauterine insemination and AI is artificial insemination. They're the same thing. It sounds like you're concerned about moving from where you are on to ART (artificial reproductive techniques), which include IUIs and IVF. I understand that, because it was a big deal for us to make that step, too. But once we did it didnt seem like a big deal, and gave us our daughter. :) Hopefully you'll have the same luck, however you get there.

As for your question, how many dpo are you? Probably no more than a week after O? There's no way to tell ahead of time if you're pregnant so early. A beta is the earliest way you can get an answer. If it were as easy as checking your cervix, all the women on these boards who are being treated by REs would be beating down their doctors' doors a few days into the 2ww. ;)

[JAYLIN]

Scooter, thanks, that what I figured, I'm definately no more than 7dpo. There'd be alot of cervical checking going on if it were that easy, right? No more interpretting those line!

Anyway, to answer some questions, yes the clomid is from the OB. I've already had an HSG and DH had his SA. All were normal.

I just wasn't sure how quickly things move to the IUI stage.

It's been over a year since my last MC and since we've been trying. I've never had problems getting preg before (been preg 5 times) so it all seems so weird to me that now I can get pregnant. I guess that's all for the RE to figure out, right?

Thanks for you input!

[Scooter]

Well, if your bloodwork results also come back normal and there's no suspiscion of what the problem could be, it sounds like you'd probably end up with the "unexplained" diagnosis. In that case, the RE would most likely move you straight to IUIs. If the 100mg dosage of clomid works well for you, you may start on that, but there are other hormones they could try, as well.

On the other hand, if you've had multiple miscarriages they may diagnose you with RPL. And want to do some tests to find out why that's happening. If you have a history of m/cs, they may not be convinced that you haven't conceived in this last year, and want to check you for autoimmune issues & clotting disorders. In which case they may have you continue with the current protocol OR move you on to IUIs.

It's all a guess at this point, but I hope that helps you understand it better. :)

[gymwidow]

Scooter answered everything really well, but let me just add:

I started Clomid with my GYN, but moved to an RE in the same cycle so that I could have additional monitoring. The RE was able to confirm through u/s and bloodwork that I did in fact ovulate on Clomid, which was a question for me but might not be for you since you have previously been pregnant. An RE might be better able to determine whether you should consider IUI sooner rather than later, and help you evaluate all your options. Also, since you've had multiple pregnancy loss, an RE might be in a better position to help determine why that's happening and do what needs to be done to prevent it (like Scooter said).

For us, we added IUI in our third cycle on Clomid. Our reasoning was that we wanted to use every avenue open to us in order to maximize our chances of getting pregnant. The IUIs were covered by our insurance and were painless, so it was not too burdensome for us to do that. After three Clomid/IUI cycles, we took a break and then moved on to injectable meds with IUI. As we progressed through our journey, we eventually discovered that our best option was IVF and I'm now in my first IVF 2WW.

As far as your cervix, it closes up pretty tight after you O whether you're pregnant or not. Unfortunately, the only way to tell if you're pregnant is through a reliable HPT or a blood test.

Good luck!

[skb]

By now you've gathered that managment is different according to the person and the diagnosis. In our case we've been diagnosed "uexplained primary infertility" following bloodwork, ultrasound, HSG and SA. To this point I've been managed by my ObGyn. We did 6 cycles of 50mg clomid, follicle tracking via ultrasound and HCG trigger with timed intercourse. We did not achieve pregnancy and have been referred to a specialist for further investigation and IVF.

[Chelsea524]

I know this question may be premature, I'm on my second round of Clomid at 100 mg, last cycle I had no O, not a single tiny follie growing at all, I go in tomorrow for an u/s to see if this month it worked but I just have a gut feeling it didn't. We've been ttc for 10 months now with not a single O and I was just thinking the Clomid would be the cure but what if its not, what do you try next? Anyone that doesn't O on your own, what dose of Clomid worked or if it didn't work what did? I'm not even talking about getting a BFP, just Oing. I just want to know what to expect tomorrow from my dr if the Clomid didn't work.

[Scooter]

Someone asked a very similar question over in the rookie thread. I answered in post #34 there, maybe that will give you a starting point. :) If 100mg doesn't work, it doesn't mean clomid won't work at all for you.

[TazLuv]

Chelsea, we went on to injectibles after my doc gave up on Clomid. The injectibles ended up being too much and creating several month of overstimulation so we are now on a clomid/injectibles combo that finally got the O result they were looking for. Every doctor is different but injectibles are most likely you're next step.

[suzfuzsunflower]

Injectable drugs are probably the next step...but even those don't work sometimes.

I tried clomid and did not ovulate. I then moved onto injectable drugs and did not ovulate with those either. It's a miracle that I got pregnant.

[t3h_wookiee]

They may try Femara on you next, or move you up to 150mg of Clomid, or move on to injectibles. Good luck!

[sea74]

I had a doctor apt this morning and Dr. put me on 100mg of Clomid. He said we'd try this for 4-6 cycles and then probably to to IUI. However, I do ovulate on my own and we're using clomid for a "stronger O" and for progesterone issues.

[pocahontas]

Your RE may do what mine elected to do and combine Clomid AND injectibles. With this combo, they are able to grow more than one follie yet not overstim you because the injectible is just given once or twice a day or two after the last clomid is taken (as opposed to a purely injectible cycle where you may take injectibles for 5-6 days straight). In your situation a combo like this may make you O as opposed to just str8 Clomid alone...not sure. But if your dr is anything like mine...that's where you'll be headed next.

[Chelsea524]

Thanks everyone, I know wondering this stuff could be premature since this is only my second round of Clomid but I just wanted to know what could lie ahead. Thanks!!

[msnicolea]

I didn't Ovulate for months following a MC, went through 7-8 cycles of increasing doses of clomid, and just when I was about to quit, it kicked in. It doesn't work for everyone, so I'm not promising anything, but I just wanted to let you know that sometimes it just takes a little longer for some people!