Next steps after clomid

[Hillsview]

Hi everyone,

I've just finished my sixth month of Clomid (no pregnancy) and wanted to ask what other people's next steps were.

I was prescribed Clomid via a private clinic due to COVID creating long wait times on the NHS. This was after fertility tests after 16 months TTC I was monitored with scans in the first Clomid cycle and ovulation was confirmed. I then used at home testing the next five months and got confirmation of ovulation each cycle.

I'm 32 and my partner is 34, i've been diagnosed with unexplained infertility, and the only thing identified was my irregular cycles (which is why I went on Clomid) but PCOS was ruled out. All other scans and tests have been clear

Is it likely we'll now go to IUI/IVF? Or will they try other things? NHS have said they won't see us until at least June so I want to progress things with the private clinic as I turn 33 in the next few months, but then worried I'll loose NHS funding.

Any tips or advice if you've been in a similar situation would be great.

Thanks so much!

Hi

How irregular are your cycles?.

Unexplained infertility is infact no diagnosis at all, all this means is that they have failed to find out what is wrong. Often it is a "diagnosis" given to couples when they have not been adequately investigated.

re your comment:-
" I was monitored with scans in the first Clomid cycle and ovulation was confirmed. I then used at home testing the next five months and got confirmation of ovulation each cycle".

You should have really been monitored like you were in the first month. If you used for instance OPKs in those five cycles the use of clomid can affect the results of such tests and give you a misleading result. Clomid encourages more luteinising hormone (LH) to be produced and the kit could have read this increased level.

You need a diagnosis first and foremost and to date sadly you do not have this. I would be asking them a lot of questions now, not least of all why there is no diagnosis.

What tests have been performed on both of you during this last six months?. Anything done over six months ago should be discounted, you both need up to date test results. How helpful too have you found the private clinic to date; I ask as some of their treatment can be poor as well as expensive.

I am 33 and last year I had 6 months of clomid with no success. Like you I have follicle tracking the first month and then a blood test to confirm ovulation. We were then left to it for the other 5 months. My cycles got shorter and shorter each cycle so I am sure that despite positive ovulation tests I only ovulate the first 2 months. We were then offered 3 rounds of medicated IUI and/or 1 IVF. If we declined the IUI and went for the IVF we would have forfeited our chance of the IUI (although I think this is different depending on where you live). We were told we would have to have 1 month break each IUI - so it would take 6 months in total. I had clomid again, menopur injections every other day, all the follicle scans again, then I was booked in for the IUI and had the trigger shot. I didn't have a blood test to confirm ovulation which I thought was strange. Whilst having my first IUI the nurses told me I could go straight into the second round if needed. Much to my surprise it did work and I gave birth to my little boy in November 2020. I was devastated when my 6 months of clomid didn't work but I am so thankful to our NHS. I would pursue treatment on the NHS if you can. Good luck! X

I would wait it out for NHS, June isn’t that far away.
Give yourself a break, get your head together and ready to start treatment

Hi @AttilaTheMeerkat

Thanks for responding! I've included a bit more info below.

My cycles ranged from 27 to 47 but Clomid has brought them back to around 29-30 days now. I've had hormone/egg reserve bloods, 'day 21' to check ovulation, ultrasound and HSG and all came back clear. Apart from the day 21 suggesting I hadn't ovulated but this done on a long cycle so the timing was off. My bloods were done over six months ago so would need to get these booked again. My partner has had a sperm analysis and all came back normal.

The private clinic have been good so far, but I'm keen to stay with NHS so I think it might be a case of just sitting and waiting until June. I guess I should see it as a bit of a break.

Hi

Its not long now till June so I would wait until then.

Clomid's main job is to make the ovaries work harder, its often prescribed to women with ovulation problems.

Re the blood tests there should also be day 2 tests done to compare your LH level against that of FSH. If the cycle is irregular the clinic can go by calendar days i.e the second of each month. I would certainly have a day 2 test along with an updated day 21 test. Your man should have a repeated semen analysis.

In the meantime write down any questions you want to ask them going forward; no question is daft. I would also try to get him to go with you to your next appointment, such can cause considerable nerves and he can also ask questions as well as give moral support.

@DisneyGirl2387 thanks so much for sharing your experience. That's really useful to hear what happened after Clomid and that you were in a similar boat with monitoring. So happy to hear about the arrival of your little boy, congratulations!

I think as you and other posters have said, it sounds like I should wait until June for my next NHS appointment rather than run back to the private clinic to save a month or two. I guess I'm a bit naive in seeing them as the same thing, when at the end of the day private clinics are commercial so will be profit driven so may try and push treatments that aren't necessarily needed.

I would not accept the unexplained infertility diagnosis if you can afford it, because there are atleast self funded tests a Specialist could offer you to rule out further causes of infertility and potentially help you conceive sooner.

I would also recommend a second (comprehensive) semen sample just to be certain.

2 years ttc is a long time.... for everything to be just normal.

I don't know the UK system, but it may be worthwhile getting a second opinion and the extra tests at your own cost to improve your chances of NHS funded IUI and IVF.