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TTC with clomid and gonal
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Megs0326 posted:
Hi all, My husband and I have been trying to conceive for over 2 years. We both have mild issues (my amh is 0.6 and his morphology is 13%). Tried 50mg clomid and 2 doses of gonal 150 units and got 5 huge (over 20mm each) follicles. They cancelled the IUI becuase of risk of multiples. Trying to decide if we should have a go of it at home and see what happens. I've also had a + OPK for the last 3 days. Has this happened to anyone else? But judging by the bad cramps I have today, I'm assuming that ovulation is in progress. If anyone is going thru the same things, I'd love to have someone to talk to!
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DUKE MEDICINE
David K Walmer, MD, PhD responded:
I have a couple of questions for you before I answer. How old are you? Was the morphology WHO criteria or Kruger strict? Are your cycles regular and predictable when you are not taking medications to stimulate ovulation? Each of these variables can play an important role in deciding what to do. I will look for your response later today or tomorrow.
 
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Megs0326 replied to David K Walmer, MD, PhD's response:
Thanks for the response. I am 31, and we conceived our first naturally about 5 years ago. I'm sure what standard was used to measure morphology, but it was determined using a Kruger test done in the office. My cycles have always been regular (although a few times they have been as short as 18 days, but have averaged 25-26 days when not on medication) and I have never missed a period except for my first pregnancy. I tried just 50mg of Clomid for 2 months and did not conceive. So, we tried Clomid 50mg with Gonal-f 150u and the Dr who did the ultrasound (not my regular RE) said that it was a little overkill and we should scale back next time. My confusion is that from what I've read 5 mature follicles is a good number. And, from what I understand, the chances of multiples are decreased if you don't do IUI or a trigger shot (HCG) which I have done neither this cycle., just ovulated naturally. So, wondering if there is still a likelihood of more than twins if we try at home, considering we haven't been able to get pregnant with just one follicle (or even more on Clomid) at home before.
 
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DUKE MEDICINE
David K Walmer, MD, PhD replied to Megs0326's response:
In your favor: At 31 years old, you are young. That said, recruiting 5 follicles might increase your risk of triplets (or more). I have seen many women go through 4-5 cycles with the out come, not pregnant x4 & then triplets or quadruplets. It seemingly didn't make sense but it isn't rare.
A little concerning: Your AMH (ovarian reserve) is lower than where it is for most 31 year old women so I am glad that you are being proactive in trying to get your family going. This and the 2 year history of infertility may indicate a slightly lower chance of multiples but it is hard to know for sure.
Using some type of ovulation induction is probably a good idea because the 25-26 days cycles are shorter than most normal ovulatory cycles. If you are not using hCG to trigger your ovulation you can see if the length of the luteal phase (urinary LH surge to 2t day of next menses) is 14 days or more. Short luteal phases may indicate an ovulation problem. You probably aren't there yet but if you don't get pregnant and are frustrated enough, IVF will give you the highest chance of conceiving and the lowest risk of high order multiple gestation. Some couples your age actually only choose to transfer one embryo these days to even reduce the risk of twins. It sounds like you are in pretty good hands from what you describe. Good luck!


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