Womens Health

When Clomid Fails

Clomid is a popular fertility drug that helps induce ovulation. The data is already in and the drug has a decent success rate—assuming your problem has to do with ovulatory dysfunction. Clomid is also inexpensive, doesn't consume massive amounts of time and resources, and isn't painful—unless you become the unfortunate victim of the side effect known as ovarian hyperstimulation syndrome (OHSS). But what happens when Clomid fails?

Happy to Continue

When doctors prescribe Clomid, they give the lowest possible dose, and see how it goes. If Clomid fails the first time, the doctor will increase your dose and have you try for another cycle. Most doctors are willing to up the dose to a maximum of 200-250 milligrams and shoot for 4-6 cycles. Patients are glad to keep trying and avoid the more expensive, more invasive procedures.

Clomid does its thing by fooling your estrogen receptors into thinking your estrogen levels are low. Your hypothalamus struggles to produce more gonadotropin releasing hormones (GnRH), stimulating your pituitary gland to increase your follicle stimulating hormones (FSH). The idea is to get your body to make follicles which can mature into eggs and this about sums up the process of ovulation, the first step in getting pregnant. So Clomid only works for women with ovulatory issues.

If Clomid is going to work, 75% of the time it does its thing within the first three or four cycles. 80% of women who are treated with Clomid will ovulate, and 40% of those who ovulate will go on to conceive. Most doctors won't start you on the drug unless your partner first has a semen analysis performed.

IUI and Injectables

So, you've taken Clomid, three cycles have come and gone. Now what? The first step is to add something to the routine. Your doctor may decide to add intrauterine insemination (IUI) to the Clomid routine and let you try for another three cycles. Or the doctor may decide to try direct stimulation of the ovaries with an injectable, for instance Bravelle, Ovidrelle, or Follistim, which come, of course, with their own list of undesirable side effects. The main thing with all of these drugs is to make sure your doctor is monitoring your status. All of these drugs, including Clomid, can cause birth defects, if you continue to take them once you conceive.

Though the protocol varies, if all of the above efforts fail to put a baby in your arms, your doctor may recommend in vitro fertilization as a next step. Of course, every couple is different and your doctor is going to base your treatment protocol on the specifics of your case.

Breast Cancer Drugs?

Newer to the scene are two breast cancer drugs which are gaining in popularity as alternatives to Clomid: Tamoxifen and Femara. These have a good reputation for being helpful for women with a larger percentage of body fat. These drugs are similar to the injectable medications in that they give direct stimulation to the ovaries. There's a further benefit in that these drugs leave the body faster than Clomid, which serves to minimize the chances of birth defects incurred from continued treatment during early pregnancy; before you know you have conceived.

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