clomid - increased likliehood of twins/multiple conception?

[lozster]

After a first visit to a fertility clinic I have been prescribed clomid - or rather I have the prescription and will get it if a hysterosalpingogram shows no problems. I have been instructed to take it for 5 cycles and I will not be monitored during this time. I did ask the registrar whether clomid is likely to result in multiple eggs being released and a higher chance of twins or more. She didn't seem too concerned about this but I got the feeling that the clinic is more interested in achieving a pregnancy at all than how many eggs are fertilised. I feel anxious as I know that I don't want multiples but I feel - how can I put this? - ungrateful? Am I right to be concerned about this or am I missing the point/trying to control too much? I do recognise that there is always a chance of twins or more naturally but I'd like to know how much more of a chance there is with Clomid.

I think you are completely right to ask this question.

I think it also depends on the cause of your infertility. Below is a link to a Cochrane review for unexplained infertility. Cochrane reviews are generally highly regarded.

www.ncbi.nlm.nih.gov/pubmed/20091498

this Cochrane review looks specifically at the rate of multiple births

www.ncbi.nlm.nih.gov/pubmed/18598609

The results if you have PCOS are different.

Hope these links help and good luck with your treatment.

AUTHORS' CONCLUSIONS: There is no evidence of clinical benefit of clomiphene citrate for unexplained fertility.

Wow - that's quite damning isn't it? Not what I wanted to hear. I'm going to have to do some more googling.

I know - I was pretty shocked as well.

However there is clear evidence of benefit if you have polycystic ovaries.

HI Jaybird - unfortunately (IYSWIM!)I don't have polycystic ovaries, my failure to ovulate is undiagnosed and I've found another paper from a Scottish university backing this one. So, now I'm wondering why on earth I should take this?? Wish I had known about this before going to the fertility clinic. I guess like most medical issues it's not a cut and dried case, more data may be needed etc, but heck, it doesn't look good.

There's an irony here isn't there given my concern about multiples!

I don't know the stats but i've had clomid twice and 2 singular pregnancies. Good luck :)

hi ladies
i don't know much about clomid, i'm afraid, but just thought i'd throw in that my best mate took it for about 6 months as she has PCOS. she's now expecting triplets. all going well so far (about 5 mths) - bit of a shock to the system! just think of it as an instant family if it happens to you - you'd get them all out of the way at once!

don't know how frequent it is, and her gynaecologist did say he'd never seen it before, so i wouldn't worry too much.

good luck x

Lozster, I've always been told that you MUST be scanned on at least the first clomid-stimulated cycle, and ideally every cycle, in case you over-respond, because of the risk of multiples - as you suspected.

Suedehead, I think it's a bit glib to describe triplets as "an instant family". The OP has stated that she has concerns about multiple pregnancy, and I would agree that she has good reason to feel that way - twin pregnancies carry a greater risk of complications, both for the babies and the mother, and triplet pregnancies even more so.

runlyrarun - sorry, maybe i was being glib. i think i'm just so worried for her that everything won't be perfect, that i'm working on the positive reinforcement thing. yes, it will be difficult, and there are far more risks of complications, but i think that you just have to deal with what you've got, even if that's more than you anticipated.

i've admitted i don't know much about clomid - this is my only experience of it. the OP asked whether people have heard of multiples, so that's all i was saying. her consultants have never seen it before so it can't be that common, and it may not be connected to the clomid at all. sorry if i've offended anyone - i know TTC is difficult for us all.

good luck to everyone on this post x

No offence taken - in fact I was a tad worried when posting about offending others who do have twins and more! However, I really don't want an increased risk (I know there is always a chance even if natural) of 2+ and my partner definitely does not. I guess it's just a personal thing.

I've been whiling away some time frettingandworrying googling about all this and have found some info (remember this is internet 'facts' so not verified). Apparently the odds are 7% of having x2 which is apparently 10% more chance than in natural conception, and the odds of x3 are miniscule. However, the HFAE have set a target for fertility clinics to achieve 76% single births - there are numerous pages on the perils of multiples - not very comforting if you are in that position but there we go!

For me, I think the problem is going to be the opposite - there seems to be a body of peer reviewed publications suggesting that Clomid only works in PCOS not with undiagnosed non-ovulation. So that would be a multiple of 0 for me :(

Not that it doesn't work exactly, but that you don't achieve more live births than might naturally occur.

Just to say, I have twins (naturally). It was a huge shock at the time (unplanned pregnancy which was an accident on a ski-ing holiday). However, although the baby bit was hard work, my two were very easy and I was up less than many of friends with singletons (possibly because they initially had to share a cot). that said, breast feeding two at a time makes you feel rather bovine

The terrible twos were terrible, but it is also a delicious age. After that it was significantly easier than two kids of different ages - same friends, same birthday parties to take them to and only one party to organise, one parents evening, one school sports day, one school play, always have someone to play with and pretty evenly matched when they fight, so it tends to sort itself out.

It is more expensive because you cannot hand stuff down

Not sure how you cope with triplets, but as far as twins go, you have two arms, two knees and two boobs, so don't panic.

Not sure where you are, but I have great respect for Prof Ledger (in Sheffield I think)if you want a second opinion.

I have two good friends who have been prescribed clomid, but both have PCOS not unexplained infertility.

One is currently in first trimester of singleton pregnancy, one has twin baby girls!

I wasn't ovulating and conceived on my first round of clomid so don't write it off as a waste of time. No multiple here thank goodness.

:) Jaybird at your twin description of the advantages of being evenly matched in a fight! Not liking your anecdotal odds PYT but liking your case study weepootle. Shame I can't pick and choose my evidence.

news.bbc.co.uk/1/hi/7547400.stm

Here's a link to an overview of the paper for anyone who is interested - the full paper is around on the web if you search too but I have lost it!

I took Clomid for 3 rounds and then fell pregnant. I had a singleton but I wass concerned about the "twin risk" too as I have fraternal twin brothers and its fraternal twins that run in families, not identicals.

The risk is there but hey, what will be will be!

I'm sorry for being over sensitive suedehead, particularly given that this isn't my thread . I see where you are coming from with the positive thinking.

That BBC link is very interesting indeed, lozster. I have been offered neither clomid nor IUI, but instead referred for IVF as first line treatment. I couldn't understand why my doc wasn't following NICE guidelines (ie clomid then IUI then IVF), but it makes sense now - those guidelines were published in 2004, 4 years before this research.

"AUTHORS' CONCLUSIONS: There is no evidence of clinical benefit of clomiphene citrate for unexplained fertility."

I take it this should read 'infertility'? Bit of a dodgy place for a typo! FWIW, several people I know with unexplained infertility have conceived with clomid; many of them on the first go and 1 of whom just gave birth to twins.

I've just been prescribed 3 months' worth of clomid for the first time (the lowest dose of 50mg), although I haven't started taking it yet, and my gynae told me it would increase my risk of twins five-fold. So, he explained that prior to the clomid my chance of conceiving twins was 1 in 80, whereas now it's apparently 1 in 16!

I didn't mention that I also have fraternal twins in my family over the last two generations, so I'm slightly concerned that I will be giving birth to a litter in a box under the stairs! Having said that, I've reached a stage where some babies will be better than none. I have no doubt that it would be very difficult, but we can't control the outcome of pregnancy in terms of multiples with or without clomid, so I guess it's a risk we have to take. Fully understand your concern though, and I'm surprised they aren't scanning you, at least on the first cycle. Aside from anything else, the frequent monitoring tells them if the dosage you are on is working. There's no point taking it for 5 months (as far as I'm aware most doctors only prescribe it for 6 in total) if the dose you are on is not sufficient to induce ovulation.

I haven't been prescribed clomid yet - it is one of the options. When I saw the consultant I was all ready to fight for monitoring. The NICE guidelines clearly say that there is a risk of overstimulation, so to have an ultrasound at least during the first cycle. However, the risk of overstimulation of the ovaries isn't just about multiple births. I really can't remember what he said, but he clearly said overstimulation of ovaries has other associated risks. Though to be fair, the risk with clomid was small - worse when you have injections for IVF, etc.

Sorry - that was a ramble. Not sure if that was helpful at all.

I think you are referring to ovarian hyperstimulation syndrome, Miffles?

ah...yes...maybe you're right. We only saw consultant today, but he gave us so much info I was in shock, so clearly remembered some of the info wrong! Ignore me, everyone.

Hi Lozster, I have twins and am not offended at all! Multiple pregancies are more risky than most people realise - my DH spent most of my pregnancy terrified. However other than being extremely sick my whole pregnancy (and who knows if that was a twin thing)and VERY big and somewhat sore I had a normal pregnancy and my children were born (late!) and perfectly healthy.

There is a bit of paradox being a multiples Mum, when they are tiny lots of people say either 'ooooh I always wanted twins' to which you think 'have you no idea how HARD this is?' or they say 'twins what a nightmare' and you think' how DARE they say that about my beautiful babies!

As Jaybird37 said earlier it is hard in the early days (and if you have family who can help with the housework that is a godsend)but I found after the first year it has got easier every month. People often say how do you cope, but you just do.

Twin Mums in our local multiples club all tend to be quite relaxed (you let go of lots of stress if you know you are NEVER going to be on time, or baby sick free!)and thin (no time to eat when they are babies and lots of running about when they are toddlers!) I breast fed my twins and am 4 dress sizes smaller and much healthier than before I got pregnant.

In conclusion, yes you are really only designed to have one baby at time so that is obviously the best way but my husband and I (and lots of other mutiples parents we know) feel secretly sorry for singleton parents.... imagine only having one baby, how boring! Good Luck whatever happens!!