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Infertility

2 cycles clomid, 4 cycles of injection

05/07/2008

Question:

dear doctor, i am 36 years old and have been trying to conceive for more than 3 years now. i have irregular menstruation and from 2nd year college i had taken provera pills to regulate it but to no avail ( i think i have migraines due to this!). now my doctor prescribed duphaston but still i don`t menstruate unless i drink this (or maybe i am just trying to regulate it by takng them if i dont get my period after 30 days) although i do pregnancy checking first.thats my menstrual history. my doctor says i have pco, i was given metformin and also folic acid. i also had my fallopian tubes checked (they injected dye) and they said they were ok. i already had 2 cycles of clomiphene but no positive results. i had 4 cycles of injection(i forgot thename) but the doc said this will help the follicles to mature and once they mature i will be injected with hcg so the eggs will come out from the ovaries (thats how i understood it. i had those injections but the follicles didnt mature- only up to 14mm. once it grew to 16mm.but when they took my bloods for estriol (??) it shot up to 14,000. so they didnt inject me with hcg coz i could end up having burst ovaries. my husband has normal sperm count. ivf here is so expensive thus am still trying for these injections. doctor what do you think is wrong? is there any step more before ivf?

Answer:

It appears that your diagnosis is PCOS.  Because you have numerous follicles, stimulation with fertility shots without doing IVF becomes more difficult, as you can overstimulate.  Therefore, IVF would be the best choice.

An intermediate step would be to try a combination of pills (either letrozole or clomiphene citrate) plus shots.  This can help to decrease the overall amount of stimulation.  Your physician can discuss this with you further.

For more information:

Go to the Infertility health topic, where you can:

Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati