Almost 40, one miscarriage, 6 months on clomid... possibly I.U.I next...?

[beanieb]

Hi all.

I am going to be 40 next year and am seeking some advice on if I should give up trying to get pregnant. I suppose I want positive stories from people who might be able to keep me going.

I have been trying for over two years and in that time have had an HSG (all fine), several blood tests (ok for my age) and was put on Clomid for 6 months. I DO ovulate already. I miscarried in June after the first round of Clomid. Next month is my last month on Clomid.

I have an appointment with the consultant who prescribed the clomid (At IVF Wales) at the end of this month to talk about our options.

Our next step, I think, will be IUI. This we will be funding ourselves and I know the success rate is very low and lower still in older women.

Can anyone please give me hope or advice. What do I need to ask my consultant, what do I need to insist on them doing?

Also any stories of IUI success, infact any info on what it actually entails would be gratefully received.

Thank you.

The first question I would ask is whether you have been given a firm diagnosis of the subfertility problem.

Has your man been tested to date?. He should be tested as a matter of course. If this has not been done recently I'd be asking them why this is.

When were your last lot of blood tests done; anything done over 6 months ago should be discounted. You need up to date test results.

Has your actual egg quality/reserve been assessed properly?. Is this why clomid was actually given to you?.

Any treatment option should be properly explained to you along with exactly why this is being suggested.

Has the cons actually suggested IUI as a possible option?. You are right in thinking that it can have a low success rate.

You should as a couple be seeing the (ideally same) cons and or his team on a regular basis as this is good for continuity of care. Infrequent appts are not good practice.

Would suggest that you both attend this appt if at all possible. Write down anything you want to ask well ahead of time (no question is daft), get your man to ask lots of questions too and take notes. You do not want to leave any appt thinking, "oh I should have asked about xyz etc".

Hi there.

My diagnosis was unexplained infertility. I know that this is no diagnosis at all but as they can find nothing wrong with eiter of us despite all the tests I am not sure really what else I should be insisting on.

My DH did a sperm test just before the clomid was prescribed so about 8 months ago.

My latest 21 day test was about 3 weeks aco and came back ok - or at least the GP surgery told me it was 'normal'
Yes I had an AMH (?) test which told me my egg reserve was ok for my age.

Basically I was offered Clomid or straight onto IUI so I chose Clomid as it was free with the intention to then go onto IUI if that did not help.

The consultant has seen us together once and just me once. She is quite business like. I have seen Nurses at the IVF clinic more regularly. I didn't see my consultant after my miscarriage. I feel like I want to bring this up with her.

We are going together but really not sure what to ask at all. I kind of put faith in the consultants to do the right thing to help us get pregnant. Any advice on what to ask/how to insist on stuff would be useful. I feel like perhaps I am not being demanding enough.

hopeful bump for anyone who might have some positive stuff to say about I.U.I.

Hi Beanie

You're right - unexplained subfertility is actually no diagnosis at all. All this means is that they have failed to find out what is wrong. Sometimes it is a "diagnosis" given to patients when the couple has not been adequately investigated.

Will post up a list of tests that are often missed out and you can ask about those too.

You certainly need up to date semen analysis results - the last one done is now out of date. Such tests too should be done regularly and more than once.

What exactly was your day 21 result, was it over 30?.

If anything you should be fully under the care of the gynaes at hospital, your GP surgery should be having nothing to do with your test results.

Was wondering exactly why you were given clomid in the first instance if tests have proved regular ovulation. Clomid is more helpful if there are ovulatory problems.
Even then it is not always successfully used.

Do bring up the subject of your previous miscarriage with her particularly if you now feel able to talk about it. It will help you.

I'd be asking the cons about the actual pros and cons of IUI in terms of whether she feels it is the best way forward. Should more semen analysis be done?. And the biggie - does she feel you have both been adequately investigated. To be given a dx of unexplained is doing no-one here any favours at all.

Write down anything you want to ask well ahead of time, am glad to read that you will both be attending the forthcoming appt.

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

Best of luck, keep us posted.

The most common tests that tend to be omitted are:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up tests and velocity testing. However, when they are done, they often uncover a hidden cause for the suppposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries.

Any test result from beyond the past 6 months should be discounted.

It has been 6 years since I took Clomid (and had fertility treatment), so I know things have moved on scientifically since then.

However, the key bit of information for me on each cycle was my FSH number. If it was trending high that month, we didn't proceed with Clomid as there was virtually no point.

Do you know your FSH number?