NHS won't prescribe me clomid

[strangeasangels]

Hi all, I have been TTC for almost 2 years now (I'm almost 33). Have spent the past year having blood tests, a scan and hubby had his sperm tested (he's fine). Finally had my first appointment with a consultant on 24th November.

Sadly he told me they won't help unless I lose weight. My BMI at the appointment was 39. It was pretty soul crushing, having waited so long for the appointment and finally felt I was getting somewhere.

Anyway I joined slimming world immediately and have lost a stone since the appointment. BMI is now 36. To be honest I knew full well I was too fat for IVF but had expected them to at least give me a Fallopian tube scan and prescribe clomid. I didn't know how much I weighed but I am 5'10 and have a large frame, so even when I was a size 12 and at my thinnest my BMI was overweight.

Anyway, it has taken almost a month for me to get into the mental state where I feel I can post on here! I have a friend at work going through the same thing but she's been TTC a year less and now got clomid, I am so scared she'll be telling me she's pregnant any time soon (I know this makes me a bitch, I'd be happy for her obviously but I know I would feel terrible).

I am pretty sure I am not ovulating because I am overweight and have too much oestrogen and no progesterone. Scan showed I don't have PCOS/endo. I was on the pill for 13 solid years and can't help feeling that could be a factor too.

Anyway.... My question is, how do I get clomid as I think that could work for me? Would a private clinic help me or am I still too fat? Does anyone have any recommendations of this? I have another 4 stone to go and I don't feel I can cope with such a long wait again for the NHS.

Thank you if you made it this far! :)

[SoonToBeSix]

Your bmi is still very high it would be irresponsible to get pregnant as you would be so high risk. Could you spend the next year losing weight and get to 24.9 you may well not need any fertility treatment once you are a healthy weight.

[Cantbelieveimdoingthisagain]

strange read up on soy isoflavones, Angus castus and acupuncture. There's a lot out there that you don't need a doctors script for!!

[AttilaTheMeerkat]

You also need a diagnosis first and foremost.

Weight in itself should not be a barrier to you receiving treatment. Are you also a candidate to take Metformin?. I would look at NICE's guidelines on fertility treatment.

You also need blood tests to give an accurate picture of what your hormone levels are like; when were the last ones done?. Cystic follicles associated with PCO can and do disappear only to be replaced by further cystic follicles so regular scanning is also necessary.

There is no evidence to suggest that the pill is responsible for failure to ovulate and the fact that you've been on the pill for a very long time would not have caused this to happen. What the pill can do though is mask symptoms of underlying problems.

Endometriosis is not picked up by ultrasound scans as the endometrical deposits are too small to be seen on such equipment.

Clomid should be given with a degree of caution to patients in any case as it is quite powerful stuff. Its also not suitable for everyone to take because it can raise hormone levels markedly (impeding fertilisation).

I would stay away from anything that is marketed as natural because "natural" does not always mean safe. Also in some cases Agnus castus can make things a lot worse particularly if there are hormonal problems. If you really want to use such products I would suggest you seek the advice of a properly qualified medical herbalist before doing so rather than going into somewhere like Holland and Barrett.

[Legodino]

You need a day 21 progesterone test from your GP to work out if you're ovulating.

[Legodino]

I have known NHS clinics make larger people slim down to get clomid. However it's worth emailing and asking private clinics because they often have more options and are more willing.

[Legodino]

Or while you are loosing weight try acupuncture.

[AuntieStella]

Well done on the weight loss so far!

Have you been given a BMI target at which other options become available? I know it's not what you want to hear, but BMI over 30 is associated with higher rates of complications and poor outcomes.

You may be able to secure clomid from a private practice, regardless of your weight. But do pause to think about whether it might indeed be better to be at a healthy weight for that. Not because you're being told to, but because you want as many things in your favour as possible when you try next steps.

How much more to loose to get below 30?

[naty1]

I agree with a lot of PP. Bmi of 39 is pretty high. But you are doing so well.
Certainly for ivf the bmi limit in my PCT was 30 and they showed a chart about how different bmis affected ivf success.
Its quite true you could start to ovulate after the weight loss. There is no reason to assume it has to be pcos (unless you have other symptoms)
I would probably concentrate on the weight loss for a few months then try some blood tests day 3, day 21, thyroid etc testosterone.
I suspect you would be high risk (cons care) for pg if you were successful now and higher risk for numerous pg related issues. But also pg is so bad for your body (ive now got piles etc) and extra 3 stone say you really dont want that on joints etc.
if you spend money privately and are unsuccessful on clomid you might feel annoyed and that the weight loss beforehand could make the difference.
Im a little surprised if you knew the rules you didnt start looking at bmi while waiting for appt. i have pcos and as soon as diagnosed i obsessed a bit about weight loss (think i had bmi 23 maybe). But i think the diagnosis made the difference for me as i could see it was the only thing i could do.
It does seem a bit harsh of them to 'blame' the weight as its not conclusive that it is the cause for you and especially as my DP had bmi of 30 and MFI but they never even weighed him despite weight affecting male fertility too.
What did they say? Refer back after weight loss or would they immediately prescribe clomid?

[strangeasangels]

Hiya all, thanks for your help. Soontobesix, a BMI of under 25 is unrealistic - as I mentioned in my post, even at a fit and healthy size 12 my BMI was overweight (27) according to the BMI scale.

In respect of losing weight beforehand, my GP didn't mention it when referring and I know I sound stupid, but tbh I am 5'10 and a size 18 so although I knew I was overweight, I didn't know that my BMI was so high (in denial?). I was hoping it was under 30 (I only bought scales after the consultant appointment - gp never weighed me). So it was a long cruel wait really.

I have had oestrogen, testosterone, progesterone (twice) all measured (multiple times) and they also tested for diabetes, liver function, thyroid. Gp was very thorough except for telling me to lose weight!!! So although it is my fault it is upsetting and annoying to have lost the time. Tests (and scan) all normal except low (almost nonexistent) progesterone - and I have never had a positive ovulation test.

Tbh all the stress of a full time job, London commute and 2 years of TTC has probably increased my BMI by 10 points if I'm honest - I was probably below 30 when I started out. Hence even more frustration - I followed the guidelines and waited a year before seeing my doctor but I wish I hadn't.

I need to lose 1 stone 5lb to get to under 35, which appears to be the limit if you pay privately, I don't want to do that if it's pointless though. 4 stone to be under 30 which is a lot :(

It's not so much the weight loss but the time ticking away :(

I think, based on what has happened to my friend who is similar to me but less overweight and TTC a year less (in a different PCT), the next thing is to be prescribed clomid.

[naty1]

I think GP should have looked up the requirements or referred you to them if they knew enough to say you needed to lose weight.

Do you know what your thyroid was - tsh. It can affect periods, progesterone levels.
And also are you sure the prog test were on the right cycle day? (Im sure you are but just in case). Its day 21 but that should be at least 7 days after ovulation and 7 before period starts
Say you have a 35 day cycle you might want to test day 28 as you may only ovulate day 21. (Average 14 day luteal phase- however if you are getting low pg its possible your luteal phase is very short (mine was like 10 days)
Tsh around 1 is apparently best for conception (but normally gp will say 4.2 is fine). And fertility clinic wanted it under 2.5.
So its worth getting/ looking at a printout of the results. Especially if you have any symptoms of hypothyroidism.

[nc060]

I have a 3 month old baby conceived through clomid, I had to lose 3 stone before the NHS would prescribe it. I was told at my initial appointment that Clomid is less effective with a higher BMI. I hope that gives a bit more clarity as to why they have asked you to lose weight xx

[SilverStars]

Hi, NHS have BMI as a guideline for IUI/IVF. My private clinic had a limit of 35 for private patients if that helps. It is great the NHs funds infertility to some extend but it is limited by a range if factors ( one cycle where I live if neither partner had a child for eg, BMI of both partners below 30, no smoking etc). BMI below 30 is said to be ideal for natural conception and increased BMI may be a cause of infertility. I am not saying I am agreeing with using BMI but results show success rates are better if lower BMI. If you had clomid at BMI of 39 and it did not work then you would have used up the set cycles the NHS allows it.

I agree a diagnosis would help. For instance our diagnosis meant that clomid would have been no use and wasted valuable time.

Did the consultant say what your BMI had to be for NHS clomid?

Definitely worth seeking private referral. Most clinics have their fees on the website. Many accept NHS results if you have a print out of recent ones which reduces costs.

[naty1]

Interesting they never weighed Dp as his weight wasnt a criteria. I was concerned they might as hes on the edge.

[SilverStars]

Dh was only weighed before we had IVF ( weight not an issue). Even though we are both non smokers we had to blow into a tube to prove it. Guess just as each area has different funding rules so they vary in how they implement them.

[Roxy1212]

I have to slim down from a BMI of 42 to 30 (currently at 39!) before I can get Clomid but I am going on Metformin which should help - is that an option for you? I don't know about how well that would work if you don't have PCOS.

You used to be able to get it here with a BMI of 35 but they found that it just wasn't successful so they lowered it to 30 - it's REALLY frustrating and I totally get that but there's nothing you can do, best to focus on the difficult task of losing weight and just keep TTCing until you can get the Clomid - sorry that's not very helpful :(

[onthematleavecountdown]

Clomid at your weight at the moment is pointless. How do you even know you need it without having had your tubes checked? Your inability to get og might simply be down to the massive amount of excess weight you are carrying. The more weight you carry the higher the risk of miscarriage, still birth, diabetes and even just getting pregnant. I'm not trying to be nasty and maybe I am a little harsh but I've been there, bought the tshirt.

First stop comparing yourself to your friend. Everyone's diagnosis is different. I started at BMI of 34 and rightly so the nhs told me to come back when I was down to 30. I lost the weight and had ivf. It worked. I am fitter, healthier and stronger than I was when I was bigger, but I have gestational diabetes. Prob due to still being classed as obese.

I would get my BMI as close to 30 as possible before doing anything. Fat affects so many processes in our bodies, why do clomid or other drugs when you have a lower risk of it working, give yourself the best chance you can!

In your year of tests and waiting for the appt I can't believe no one spoke to you about your weight??

[Sarahsquarer]

Hi, well done on your weight loss!
I'm in a similar boat, Ttc 2yrs. Blood tests showed something amiss with my lh and fsh levels. The others are fine. Dye test fine. I'm a healthy size. Will let you know what I'm told at my next appointment on Tues, probably to go for more tests!
Feeling the frustration!

[meadowlark3]

Please don't buy Clomid online without having a way to monitor your ovaries!

[Squishedstrawberry4]

So have you had day 21 progesterone texts? What were your results? Get hold of all your results and either loose weight or go private.

[Squishedstrawberry4]

If you're having clomid, you could just stick to having day 21 progesterone texts rather then scans.

[MadeForThis]

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