Fertility Clinic - am I expecting too much?

[BrassicaBabe]

I'm not sure if I'm not expecting enough and getting crap treatment from my NHS fertility clinic, or I'm a control freak and I'm expecting too much. (I am a control freak by the way )

DH and I have been TTC for 8 months. (I'm an old git at 37 and a half ) I was presrcibed 4 months of 50mg clomid by the fertility consultant following GP referral and blood tests, and given a follow up appointment for January 2011! I'm not being monitored but having CD21 blood tests to test the effectiveness of the Clomid.

Month one at 50mg clomid (days 2-6), the result of the day 21 progesterone test was low at 19 so my dose was increased to 100mg. I've been light bleeding (rather than spotting) for 4 days so far from CD8 to CD12 and ongoing. I managed to speak to the cons today.

An abridged converstaion between me and the consultant:
Q: Why am I bleeding? A: I don't know. Maybe because you didn't ovulate last month
Q: Can I get pg this month while bleeding? A: Maybe, but less likely
Q: why have I had 3 positive days of OPKs when the last clomid was 4 days before the first + and 8 days since today's positive OPK? A: I don't know, the body is just a funny thing sometimes. Not everything can be explained.
Q: Is the bleeding likely to happen again next month? A: Don't know we'll have to see.

So we've left it that I'm going to take have the day 21 blood test this month, phone for the result and carry on with the 100mg clomid next month assuming I'm not pg this month.

I'm trying not to write "war and peace" but I hope I've included all the relevant information.

My Chart

We are lucky that we can afford private treatment should it be needed. I have asked the consultant to ensure he tells me if he feels we'd be better served paying for treatment, but he doesn't think they would do anything different at this stage.

Do I just need to chill out?!

Thanks

when dealing with fertility treatment there is an awful lot of, "well, that could be x or it could be y, let's just see what happens next week/month etc" so on that side I'd say your consultant is being fair.

But, if you can afford private, ditch the NHS immediately in my mind and find yourself a private doctor. Going private will ensure that they pay more attention to your isues and are more likely to respond when you have a question or problem. I got pregnant on Clomid and I wasn't monitored - but that was only after I'd had a couple of ultrasound scans to make sure things were okay. When I went to the NHS while on the Clomid, the doctor there raised her eyebrows in shock that I hadn't had a full battery of tests and blood work done practically daily.

The problem with the NHS fertility clinics is that they get a little sterile IMO. They forget you're a real person who has real problems and worries. To them, you're just one of thousands of women they're trying to help and if you're at the beginning of the process their attitude is "jsut get on with it and leave us to more important things".

Thanks Bling

I think I'm going to give the clomid 100mg another month, hope the bleeding doesn't return and that day21 test are favourable. If they aren't good and consultant remains vauge then off to see someone privately for us.

So that leaves about 6 weeks for me to try to chill the feck out!!

Sounds just like my experience of them. Considering they specialise in that one area, they don't seem very equipped at answering our questions. I was also prescribed clomid with no monitoring but I fell pg on the first round of 50mg. Good luck with your next round.

If you can afford to go privately for treatment (ie can afford £10-15k for a course of treatment) then go for it asap. Though do check the success stats on the HFEA website if just picking a clinic at random.

The fertility world is fairly small, so many of the consultants know one another. You may even end up with the same consultant.

Bin 'em off and go private, especially if ideally you want more than one child. Fertility nose dives with age so if you want to get two children in before the age of say, 40, you'll need something a whole lot more aggressive than vague clomid prescribing, and by the sounds of it, very limited monitoring, on days which would only apply if your cycle is bang on 28 days. Sorry not to be more positive. I agree with Ladymuck, research the private clinics carefully - they are not all equal. £10-£15k is, I think, rather on the steep side although you might end up paying that at ARGC if you've got lots of complicated bloodwork. (I've had 2 cycles there, both successful and I'd say nearer £8.5k is more like it.)

£10-15k is based on needing 3+ cycles of treatment - not everyone is lucky first time.

Brassica

Hmmm at your clinic.

Have you actually been given a diagnosis of the underlying problem?. If not it was poor practice to put you on clomid beforehand; this is usually given to women who present with ovulation problems. You need a diagnosis first and foremost.

I had an idea of what your chart looked like before I saw it; are your periods irregular by chance?. Your chart is akin to the Rocky Mountains and is impossible to determine ovulation if it is happening at all. Charting is of NO benefit at all if periods are irregular!.

Please do NOT use opk's if you are taking clomid; the clomid encourages LH to be produced and the kit is likely reading this. Small wonder therefore you have multiple positive results, bin the OPKs as of now. The bleeding to me is more concerning; the cause of this needs to be determined by them.

Also clomid is quite powerful stuff; a day 21 test alone is not enough in terms of monitoring (blood tests and internal ultrasounds should also be done here; the blood tests because clomid can increase LH levels markedly which can impede fertilisation, the ultrasounds to see whether an egg is actually leaving the ovary).

In these early stages at least you are safer going under the NHS. If you go private do bear in mind that not all private treatment is at all good and it can work out very expensive indeed. You must do your researches thoroughly before handing over your hard earnt cash, certainly visit more than one clinic.

It may be that you may not need IVF at all.
Something else to bear in mind.

BTW if your man has not been tested to date he should be (and more than once as well). It is little point solely treating the woman only to discover say a year down the line that the man has male factor problems; both of you should therefore be tested in tandem.

I agree with Attila - what diagnosis have you been given? I've went privately for DS1 for IF investigations and for ovulation induction (Clomid + HCG shot with monitoring). The investigations all in was 500GBP and 1 round of ovulation induction was 200GBP at a Harley St place - Create Clinic. They were pretty good, I was happy with the service but I think there might be better out there for specialist IF services - e.g. if you were going IVF you might want to look at success rates.

Anyway...I think you'd want to be monitored - not just have a bit of b/w at the end. The monitoring helps to see what eggs there are, when they're likely to pop (HCG helps them to pop...so that's great to have too) and checks the lining of your uterus to make sure its thick enough to sustain a pg.

Clomid can tend to thin the uterine lining and so can have a negative effect on your overall ability to get pg. And increasing the dose can serve to make that worse. Mine was thinner on Clomid and at the bottom end of what was considered OK, but I managed to get pg with DS1.

Also you should be monitored for hyperstimulation cos that is quite dangerous.

I went with the NHS for DS2 and they still did the Clomid + HCG and monitoring and got pg with that too.

I didn't know about the mutiple +OPKs and Clomid increasing production of LH. I always got multiple +OPK with or without Clomid. I wondered whether the egg just wouldn't release - but having the HCG shot would help with that.

Having gone privately and with the NHS I would say that I had to 'fight' to get Clomid on the NHS (my consultant didn't think it would work - let me try it to pacify me!) but private would have a discussion about my options. Private certainly wouldn't do anything just because I was paying unless it was medically relevant, but at least you knew that cost effectiveness wasn't in the equation.

Thanks guys. I really appreciate your input.

I haven't had an official diagnosis, but I guess it's for non-ovulation.

Attilla my periods have been nicely regular 26-27 days since coming off the pill 9 months ago. In the first 2 months after coming off the pill I had bleeding mid-cycle. So the GP tested day 21 which showed I wasn't ovulating. Hence the referal to the Clinic. He put me on clomid straight away. But I've had to request subsequent day 21 tests (I left the clinic with a prescription for clomid and an appointment for Jan 2011)

DH has been tested. While I don't have the figures (GP spoke directly to him and typical bloke he didn't ask too many questions) but the results were "fine".

I just can't put down the OPKs though. I know, I know But may as well be honest I'd be interested to know more about "clomid can increase LH levels markedly which can impede fertilisation". Have you got a link to more info? Information is power My reading suggests that OPKs are ok 3 days after the last comid dose. So I'm concerned that the levels are still high enough for a positive OPK.

I've had a quick look on the HFEA website. It looks like a scarey place with shed loads of information!! I'm going to camp out there for a bit....

Right, my plans now are:
A) have cd21 test done this cycle. If it's favourable give NHS clomid another month's go, hope that bleeding doesn't recur. (PlanA.1 , if bleeding recurs go private)
B) have cd21 test done this cycle. If it's unfavourable, head down the private route gaining at least more information, handholding and monitoring.

Thanks again for your vaulable opinions and thoughts

hey Brassica....though 'this looks an interesting thread' .

I have given you my two pennies worth a thousand times on this topic.

Just a word of warning to those not previously bored by my fertility clinic rants...private does in no way gaurantee service. I am finding you need to be ridiculous clued up as to what you want and bolshy bordering on obsitinate when speaking to doctors.

x

Not a link as such but this is taken from a leaflet given to me in hospital about PCOS.

"However, whilst clomid is a useful drug for many women with subfertility problems, it is not always suitable for those with polycystic ovaries because it can cause an exaggerated rise in blood levels of LH which could impede fertilisation or increase the chance of miscarriage. So if clomid has not been successful in women with PCO within 6 months, more investigations and alternative treatments are usually called for".

Brassica, you need a dx first and foremost. Its not on at all that you've been given quite a powerful drug treatment without this beforehand. Clomid is certainly not suitable for all women to take (I was not given clomid due to my sky high LH levels; he said it would not help me).

Be very wary of using the OPKs if you are on clomid; they are actually not helping you at all here.

You will need to be persistant in order to get answers.

Good luck!.