How can I get Clomid?

[CrispyFB]

Have been TTC our last for over a year now. I'm lucky enough to have private health insurance and I managed to get my GP to refer me to a private consultant under the guise of "irregular/painful periods" which is true, to be fair. I was honest with the consultant over TTC and I managed an HSG/lap with ovarian drilling under my insurance, but that's about as far as we can go before obviously the insurer will stop paying.

For the record, everything checks out (bloods, HSG etc) aside from lowish progesterone on my part (a level of 28 at 7dpo) which probably explains the spotting from 5 days before AF, and low morph (3%) but a very high count on DH's.

She wants me to go on Clomid probably in August, which I'm fine with trying, but without the insurance helping out, it's going to be really expensive especially if she wants to do scans as well.

Given we already have children, is there a way of getting Clomid on the NHS and who would prescribe it? Would they want to do scans etc too? I'd hope my borderline progesterone would be a good enough clinical reason for it.

[lozster]

GP's used to be able to prescribe Clomid but I believe that this has now been stopped and only fertility clinics can prescribe it. This is partly as in theory you should be scanned regularly - a fact that escaped my clinic for six months. If I recall, previous children only excludes you from IVF not Clomid. Clomid is, in the big scheme of things, a cheap drug hence the NHS seems to over prescribe (IMHO) but the scans will cost. I think you will need to return to your GP, report back on the private consultant's verdict (they may have written anyway) and get an NHS referral.

[AttilaTheMeerkat]

What did the lap find if anything?. This is often done when endometriosis is suspected (a common cause of very painful periods).

Did you ever have a day 2 test done, if so what did that show?.

You seem to be going backwards now treatment wise as clomid is usually the first treatment option given and prescribed. HSG and lap are usually done later on in treatment if needed.

Low morphology can also be a problem in ttc; more analysis of your man should be done in any case to see if there are definitive male factor issues.

You need a firm diagnosis first and foremost, not necessarily clomid. It should be given only where there is definitive proof that ovulation is not happening regularly if at all. Also clomid is quite powerful stuff and you should be monitored whilst on it. No monitoring is unacceptable and should be challenged.

[lozster]

Hsg would normally be pre clomid. No point ovulating if tubes are blocked and clomid is limited in terms of lifetime dose so best not to waste rounds.

[Hoophopes]

Hi, no IUI or IVF on NHS if you have children but you may be prescribed a certain number of months of cloned if the NHS thinks there is a medical reason for it. A gp should not prescribe it due to monitoring needed etc. you would need a referral which can take up to 18 weeks and you may not be prescribed treatment the first time you see an NHS consultant as they may well want to carry out tests to see whether there is a medical reason etc so it will take many months before any treatment. Not all clinics will scan every month either , some cycles may not have regular monitoring at all from my own experience anyway.

[CrispyFB]

Thank you everyone!

I vaguely recalled hearing of GPs prescribing Clomid and I wondered if they still did or not as the idea of never monitored cycles sounded risky to me as well.

My lap/HSG came back completely clear which was a bit of a surprise - I was so sure it was the two gynae surgeries I'd had since conceiving my son, or a return of the mild endo I had a few years back (which was lasered off in 2007) behind it all.

My day 2 tests all came back completely fine, no signs of PCOS etc either and a good FSH, and I've also had things like testosterone (low, but in range), vit D (very healthy!) and prolactin (low, but in range) tested too. Still waiting on the results of an AMH test which seem to have gone AWOL.. having since read how hard it is to get AMH tested on the NHS I am sceptical if I'll ever see them!

I used to have no problems conceiving - hanging onto them was the tricky part with a less than stellar success rate getting out the first trimester, and high risk pregnancies after that for other factors. That has all changed this time around yet the only thing that is different was the surgeries, which were both pregnancy related including an unavoidable ELCS for medical reasons.

DH has had two SAs so far, around six weeks apart (one private as we didn't want to wait, and one NHS) and both reported fundamentally the same thing. They said his volume and motility more than made up for the morphology. DH is very unwilling to try supplements unless they've been backed up by rigorous unbiased research. He takes 2g vit C but will take nothing else.

My private consultant says she cannot see any reason why we haven't conceived given past history and all our results, and it's a genuine mystery to her. Me too. I'm 37 now for the record, but started TTC again when I was still 35. DH is four years younger. My maternal family has a history of later menopause (and also later babies) and the environmental factors are favourable for a later menopause too, so I don't think it's age-related particularly.

I get the feeling she's offering Clomid because she's all out of ideas - she was sure we would have conceived since the lap in April and told me to come back in August not expecting to see me I think. Well, one cycle left and I don't rate our chances. We're not prepared to do IUI or IVF (don't have the money for it for starters) so Clomid or similar is pretty much where it has to end.

TTC is putting a huge strain on our lives and our marriage so as we are already blessed with children we've put an end point of Christmas on it, which will be nearly two years TTC. So I guess in terms of sanity it may work out better to just spend the money on the private appointments than wait six months for an NHS referral and prescription then several months after that of attempts.

[Hoophopes]

Hi I totally hear you say how ttc takes its strain. Took us years to conceive our ds. The only comment I gp have is SA's are generally 3 months apart due to sperm renewing themselves every three months. We had low sperm/poor morphology and antibody issues and with supplements and repeat SA's we saw a big increase in his levels so my also sceptical dh did change his mind and kept taking his Menevit ( what our private clinic suggested as one tablet that had all the supplements in he needed... Had to rider from abroad but not ££).

I am not too sure why clomid is prescribed. I would doubt whether it would be prescribed if you yourself medically have no fertility issues on the NHS. Not sure if anyone else has with already having proven fertility.

However having done private and NHS the NhS does not move at the speed of private so if you want NHS treatment I would suggest ask for referral now and be prepared to have to wait.

[maybemyrtle]

Hi, just jumping on to strongly urge you to ask your GP about Clomid. Mine prescribed it to me after 2 cycles of day 21 bloods showed I wasn't ovulating, although I could only have 3 cycles of clomid before being referred to fertility consultant. My GP arranged monitoring for the first cycle - I had an ultrasound and day 21 bloods. I also had day 21 bloods this 3rd and final cycle because I was convinced it wasn't working, turns out this cycle I fell pregnant.

I suspect, like so many things, it depends on your area and your GP. Good luck.

[AttilaTheMeerkat]

Crispy

Your other option here is to seek a second opinion; think you are right in thinking that your current gynae cons has simply run out of ideas and is thus suggesting clomid for that sole reason. Would not take clomid on that basis at all.

[CrispyFB]

Thank you all!

Hoophopes - yep, we're thinking of another SA at some point soon, especially as DH has been on the Vit C for a while. Given it took six weeks to get an appointment last time for an NHS SA, we should probably start things going asap for that one! I've not heard of Menevit - it looks interesting although I'm surprised it has such low Vit C unless the other vitamins work well as antioxidants too. Given nothing aside from lowish progesterone has come up for me, I am really beginning to wonder if it is on DH's side now. Yet we've still conceived before and nothing has changed with him either

maybemyrtle - thank you for that! I might give my GP a go then, just in case. So much does depend on an individual GP, it really does. I have had such varied experiences over the years.

Attila - I'm not sure we could afford a second opinion privately (as insurance obviously wouldn't pay for anything fertility-related) I wonder how amenable the NHS would be for a second opinion with them given I already have a private referral.

In the US women tend to go see a Reproductive Endocrinologist which given my bits check out physically makes me think an RE would be more useful for all the hormone stuff - what's the UK equivalent of that? As I think the main issue with my gynae is that she's, well, a gynae. She has already uttered the immortal words about ovulating on day 14 which is hilarious to somebody like me who has only managed that once in seven years of charting and my average is day 20 with supplements up to the eyeballs!

Anyway, if I could somehow get a referral to somebody like that (perhaps I could given I do still have the irregular painful spotting-filled cycles) it would be brilliant. I live in Hertfordshire but can reach London easily if anyone has any recommendations, whether NHS or perhaps I can still "blag" it with my insurer (Cigna), I don't know.. I have no idea what they think about second opinions.