Worried about Clomid prescription

[Antia88]

Hi! This is my first question on Mumsnet :) I hope someone can help me out...

I'm 35 years old, no kids, no previous pregnancies and I've been trying for almost 2 years to get pregnant without any success. My husband is my age. We both tested everything that was offered to us by the NHS: blood tests, hormone tests, day21 progesterone test, HyCoSy tube test, sperm test and AMH test. Everything came back with good results and therefore my infertility is seen as "unexplained".
I've been pushing for ages to get on the IVF waiting list but, as you probably know, it's taking ages to even get on it..
Last week I finally got a hospital appointment in the women's hospital to have a consultation about putting me on the waiting list. The doctor that I was supposed to see was sick, so they told me I would get a replacement doctor, but also a gynecologist.
When me and my husband met her, she seemed annoyed and rushed, she kept talking to my husband and not to me, and wouldn't let me finish my questions but immediately talk over me.

Eventually the doctor said that she could prescribe Clomid and that this would help me get pregnant faster although there was "a small risk for conceiving twins and a medium risk for getting ovarian cysts". I asked if she knew the percentages of getting twins and she said she didn't know but she thought they were low. She then said she would give me 50mg for 6 months and I should come again if I didn't get pregnant in 6 months... She was fully aware that I ovulate every month.

When we got home we googled what Clomid was and I was shocked to find out that according to studies the risk of twins is above 12%, especially for women who ovulate every month. I also read that Clomid very rarely gets prescribed for unexplained infertility, and that doctors usually make the women who take Clomid, come in every month for ultrasound scans, to check how many follicles have grown, in order to avoid falling pregnant with triplets or quadruplets...

I know some women might not appreciate this, but although I would love to get pregnant, I really want to limit the chances of twins, as I believe that we wouldn't have the financial stability or the family support, to work that out. We both work for the public sector, rent a flat and our families live 9 hours drive away...
I know there is always a risk of conceiving twins, but over 12% seems a very high chance to me, and after reading up on Clomid and the risks of taking it, if you ovulate normally, I kind of believe it would be irresponsible for me to take it.

We still haven't made our minds up, and my husband and me are still talking it through, but I got a really bad feeling from that doctor and feel like she just prescribed something so that I would shut up about the IVF waiting list.

I appreciate any advice or personal experiences with taking Clomid, although having regular ovulations! Thank you 🤗

Hey - sorry I am not an expert in this subject by any means but isn't the chance of twins through ivf a similar rate?

Hi! As of the NHS statistics for IVF in Britain in 2019, the percentage of conceiving twins fell to 6%.

Right, I am in aus and twin rate for ivf if showing a lot higher and Clomid/Femara with the lowest rates.

Both routes have twin risk so I don't think I'd put off using that medication just on that basis alone personally.

The other stuff sounds shabby practise though and definitely would want another opinion. Any chance you can get an appointment with original doctor ?

Clomid is often used for women with PCOS, who as you say don't ovulate. In recent years, there is a newer drug being used called Letrozole, which does the same in terms of forcing ovulation but has a much smaller risk of twins. I conceived DD using letrozole - i was scanned every other day until the point of ovulation and told if it was looking like an increased chance of two eggs being released, so felt very well looked after (NHS London hospital). Only on the 3rd cycle was i allowed to not be monitored as by then my doctor and i were happy that the dose was correct and it was working effectively.

I know there will be lots of women on MN who have used Clomid without monitoring, but frankly, given it also has a slight increased chance of ovarian cancer if taken for more than 12 cycles, i agree that i wouldn't want to take it for 6 months without any monitoring at all to see if it was making a difference.

Once you are in the system, you usually get an email address to make contact with the team in the clinic. Can you drop them a line and ask if someone is available to discuss your concerns? I always found that they were pretty good at responding to queries. You might be able to get a phone appt and talk it through with a different doctor.

@Mangotango39 Also not an expert but i think the risk of twins with IVF in the UK is lower because it's no longer recommended to implant multiple embryos in one cycle here. I think in other parts of the world, they are still happy to implant multiple embryos which would impact the stats?

Thanks so much for your answer! I never heard of Letrozole but found really good stuff about it. Can I ask you how long you took it before you got pregnant? And did you ovulate normally before they prescribed it to you?

I live in rural Somerset (cause my husband is in the forces), and the healthcare here is in no way to the same standard as you would receive in the big cities, unfortunately...

So I tried to call and ask for another appointment with the consultant, to ask if I could have scans to monitor the intake of Clomid (or Letrozole) and they just said they will see if they have availability. But the secretary also said that they don't have a single fertility specialist in the whole hospital and that she doubts that they will offer me any scans... I'm so fed up with the postcode lottery affecting the standard of good quality healthcare :(

Hey OP! Just my personal experience. I too ovulate every month and after 20 months of TTC and a diagnosis of unexplained infertility I was prescribed Clomid by a private specialist.

He explained it as "more targets for the sperm to hit". He gave me a 6 months supply, same dose as you.

They did a blood test month 1 to confirm it worked, but no other monitoring. You could do the blood test yourself through Superdrug; it's just a day 21 Progesterone test.

I fell pregnant on the 2nd month so it was definitely worthwhile for me.

I read it was only about a 6-8% of twins.

I also struggled to get pregnant for a couple of years. We had some NHS tests but as it was the height of covid, we couldn't have them all and so it was recommended I take clomid in the meantime (because of NHS delays, I actually ended up going private to get the clomid prescription quicker). I was also ovulating monthly but was told it would increase the chances of a better quality egg being released and there was no harm in giving it a go, even if ovulating anyway. I was told there was a slightly higher chance of a multiple pregnancy, but I had scans for the first 2 cycles to check the dose was ok and I didn't have too many mature eggs (I later found out I should have only been scanned on the first cycle and the scan on the second cycle was an admin error). Both times they were satisfied that the chance of multiple pregnancy was low so I was ok to continue.

I did get pregnant on the fourth cycle with clomid and was given an early scan to check if it was a multiple pregnancy (it wasn't). I sadly lost the baby, having a MMC at 10.5 weeks however. After 2 more early losses (natural pregnancies), I then started on letrozole. As I had now gotten pregnant, my private consultant thought it was worth a go before moving to IVF. I didn't have any scans before ovulation with letrozole. I got pregnant on the first cycle (another MMC) and then again on the second cycle. Again, I had early scans with both of these to check for multiple pregnancy (and also because of my miscarriage history). The 2nd letrozole cycle was successful and, after 4.5 years trying for a baby, it resulted in my (nearly) 6 month old son who is currently snoozing away in my lap.

I was also worried about having a multiple pregnancy when using medication (for me it was more about the risks involved in multiple pregnancies given my recurrent miscarriage history), but felt reassured by having the scans before ovulation to check for mature eggs and grateful for the early scans when pregnant. Everyone has different experiences and what is right for one person isn't necessarily right for the next, but for me it was definitely worth doing medicated cycles. Wishing you lots of luck on this journey, whatever you decide.

It took me 3 letrozole cycles - first cycle was lowest dose and the scanning showed i didnt ovulate, second cycle was an increased dose which the scanning showed i did ovulate but we didn't get pregnant that month. Third cycle was same dose as second cycle, i was allowed to do it unmonitored as the second cycle had worked, and it was the one that worked!

Prior to taking the letrozole, i had been taking metformin for 18months, which is sometimes prescribed to women with PCOS as it can help with regulating cycles. I was having periods but didnt get pregnant in that time so the doctors think i probably wasnt ovulating regularly, even though the ovulation tests were showing that i was ovulating. Something like only 1 blood test out of 3 months showed any ovulation.

Im sorry you are having such a tough time with the hospital. I grew up in a rural area and can very much empathise. DH says we arent moving out of London until we've finished our family due to the postcode lottery. It absolutely isn't fair.

Not me but a friend took clomid and fell pregnant with twins (one twin sadly didn't make it though)

My sister has pcos and a clomid child. She didn't need it for her second dc.

I have one naturally conceived dc then unexplained secondary infertility (although I do have polycystic ovaries). Had a naturally conceived early loss then nothing for ages. Tried clomid (over stimulated me massively and I think thinned my lining), tied tamoxifen (can't remember why it didn't work now, then letrazole. Then 5 ivf transfers. Then surgery to remove an adhesion (wish they'd checked for this properly in the first place) then naturally pregnant pretty quickly twice but lost both early on. Pregnant through ivf transfer but lost that. Then back on letrazole and fell pregnant on the 4th cycle. I'm 9 weeks so still early days, but this is kind of the furthest I've got. I have a scan on cd 11 the ish and for these 4 cycles each time I've had 3 follicles looking like they'd be ovulating and then taken a trigger shot cd 14/15 ish depending on their size. They wouldn't let me ttc if more than 3 I think. Letrazole does have a lower risk of multiples. If they won't scan you you could always find a medical imaging clinic to do a transvaginal scan or alternatively do a progesterone test on cd21, that should
Give a rough indication of how many you ovulated. That's how my clomid overstimulation one was found. It's been a 5 1/4 year process for me so far and I've found all the waiting for things absolute torture.

Hi everyone , can I join in please 😊 I’m 38 been Ttc for 18 months now 😔with no luck. All tests have come back normal, my partner already has 2 kids but I have none and not even a sniff of a pregnancy. My cycles are super regular 27/28 days, and I’m due to start clomid in July. Any success stories to give me some hope? Xx

Hey girls. Does a fertility specialist have to prescribe clomid or can a GP?

Hi all can I join in please 🙋🏽‍♀️
New to mumsnet and been researching alot on clomid. Ive got clomid prescribed from abroad as the NHS has alot of delays, tbh even getting an appointment with my GP is near enough impossible.
Ive been prescribed 50mg days 3-7 but havent started yet (taking a break from ttc) and also the husband is still living abroad.
Im thinking to start July/Aug time butt in all honesty feel very nervous about it all. Im 27 I have irregular periods ranging from 28-51 days and I ovulate just not often enough so Clomid was reccomended. Has anyone gone down the private route? Did you check ovulation via ovulation strips or private follicular scans?

@Barney2009 Im also thinking to start in July/August. It helps when theres others on a similar journey roughly around the same time. Hoping we can be there for each other as support on this journey. xx

@Huriya yes let’s keep in touch to see how we’re getting on. I really need to change my mind set about it all, as feeling like it’s just not going to happen for us. How are you feeling?

Hi ladies, please don't waste your money on ovulation sticks. If you are being prescribed clomid, you should be having tracking scans. I had them even on the NHS. Its not worth the risk of a) not knowing if you are actually ovulating and therefore wasting multiple cycles at the same dose without success (especially with the long term risks associated with ovulation induction), and b) the risk of multiples or even worse OHSS.

I conceived DD1 on letrozole (similar drug to clomid but newer and more effective) after many years of heartache. We are about to go for DD2. We also thought it was a really long waiting list but once our GP actually made the referral, it was 2months for first fertility clinic appt, then all the tests on both sides again (i have confirmed PCOS but to check no other issues have come up since DD1) and next appt is in July. So actually not that long to wait in the grand scheme of things. So do keep pushing to be seen / scanned.

@Barney2009 Yess PM me x
So far I feel okay, trying not to stress about it all. The more you think the more anxious youre going to feel. I pray and hope it is a blessing that you will be able to enjoy xx

What dose has the dr prescribed you?

My sister had unexplained infertility. They tried for 8 years. She was prescribed clomid and got pregnant 2 months later. Just a single baby. She had got to the point she would have taken anything. Her second child was conceived with no help on the second month attempt.