Risk of Multiples with Clomid + IUI (over age 35)

[Anonymous]

Possible case of secondary infertility here -- we conceived DC#1 on our own 3 years ago, but we're now having trouble conceiving DC#2.

We just met with an RE who suggested clomid + IUI as a possible first step to increase our odds this time around. We are very concerned about multiples, but he said it's not likely because I'm late 30s, and he's never had a multiples outcome from clomid + IUI for a woman over 35.

I trust his stats, but it makes me nervous. The point of clomid is to release more eggs. So I can't help but think I'm running a risk of multiples here. Anyone have relevant experience or insight?

[Anonymous]

As a parent of twins I can understand your worry. The reason we used IVF rather than IUI was because I was an over-responder to Clomid, and if we'd done an IUI there would have been a very strong chance of high order multiples. The way we knew NOT to inseminate was by being monitored in our RE's office. So, in my experience, I'd say go for it if the doc is monitoring your follicles so that you can know how you're responding to the meds.

[Anonymous]

You'll have an u/s that will show how many follicles (possible eggs) you'll have prior to the IUI. If you have too many, you can cancel the cycle. I only had one follicle during each of my three IUI/clomid cycles and I was 32 at the time.

If you want to be close to 100% sure of having a singleton you can either just do an IUI with one follicle or do IVF and do an elective single embryo transfer.

[Anonymous]

Well, it's ultimately your choice whether to do the IUI or cancel it, so if you get a lot of eggs you don't have to go through with it unless you want to. But you won't know how you'll respond unless you try.

[Anonymous]

Thanks everyone!

Here's where I'm a little stuck. I have regular 28 day cycles with OPK positives on days 11 and 12. I've always interpreted that to mean I'm likely releasing an egg each month. If so, what's the benefit of clomid, other than the possibility of multiple eggs?

The other thing I don't get is how he's had ZERO pregnancies with multiples for women over 35 with clomid + IUI. Is this because he cancelled the cycles where there were multiple follicles in play? Or because the eggs are just not great at our age, and the odds of two making it via IUI (vs IVF) are just very low?

[Anonymous]

This may be a little off topic, but I'm reading the book "Making Babies" and it talks about how so many doctors jump to prescribing fertility drugs without understanding the underlying cause of the fertility problem. If you are ovulating regularly, I can't understand why you would need clomid. Just my opinion.

[Anonymous]

Agree with PP. Many RE overprescribe clomid. I have a perfect 27-day cycle, ovulate every time and I was told by many doctors, clomid is not the answer for me.

[Anonymous]

I'm the 32 year-old PP who did Clomid. personally, I wish we had skipped that step, since it doesn't have a great success rate and is the only fertility drug associated with a cancer risk. The best thing about it is that Clomid/IUI is kinda like training wheels for IVF. it gets you used to monitoring and the idea of getting pregnant via a doctor's office. As Peggy Orenstein said, "Clomid was my gateway drug."

(this is not to alarm you about the cancer risk -- the risk may not be there at all and is mainly an issue if you stay on it for 6 months or more)

[Anonymous]

Hi there, I take it from context that you are being monitored while on Clomid? Going by stats alone is not very reassuring. What is important is how *your* body reacts to Clomid. If your RE is not going monitor you by ultrasound and just do IUI "blind," then you should switch REs. I don't know of any DC-based REs who do this, but I have heard they are out there. I did Clomid, but was not a candidate for IUI because I produced too many follicles. It sounds like you may want to talk further with this RE about what he believes is causing this secondary infertility and why Clomid + IUI would be a good option. If you and your husband haven't done any tests to narrow down the causes of infertility, that would be another red flag.

[Anonymous]

Anonymous wrote:Hi there, I take it from context that you are being monitored while on Clomid? Going by stats alone is not very reassuring. What is important is how *your* body reacts to Clomid. If your RE is not going monitor you by ultrasound and just do IUI "blind," then you should switch REs. I don't know of any DC-based REs who do this, but I have heard they are out there. I did Clomid, but was not a candidate for IUI because I produced too many follicles. It sounds like you may want to talk further with this RE about what he believes is causing this secondary infertility and why Clomid + IUI would be a good option. If you and your husband haven't done any tests to narrow down the causes of infertility, that would be another red flag.

Thanks -- this is helpful. The Clomid would definitely be monitored, and we all agreed we would readily cancel/sit out the cycle if I overreacted and produced too many follicles. We're also working on the testing. So far my blood tests and HSG were all normal (I had an ectopic four months ago, which is why I wanted the HSG to check the tubes.) Our next steps are a sperm test for DH and an internal sonogram with the RE to check my ovaries. Then maybe the monitored Clomid and IUI.

Anything else people would recommend based on their experience?

[Anonymous]

Hi OP! IUI with Clomid and never multiples? I wouldn't rely on it!!! I really wonder how he can say that!
Why don't you just do IUI without fertility drugs? You have regular 28 day cycles and it will slightly increase your chances versus a normal cycle. The other possibility would be natural cycle IVF. It sounds like you do ovulate each month reguarly, so it likely will happen for you with or without ART eventually (unless you think you are really running out of time), you don't have to take the risks of multiples.

[Anonymous]

There was a study a little while ago that randomized women with unexplained IF and those who were randomized to do unmedicated IUI were no more likely to get pregnant than those who just kept trying on their own. When I talked to SG, they said that they have no data to support doing unmedicated IUI vs trying on your own.

[Anonymous]

Clomid will not only help you produce follicles / eggs but it also is helpful in producing better "quality" eggs. You might regularly ovulate based on (+) OPKs but that does not mean that the follicle you ovulate has an egg in it. I would regularly ovulate based on (+) OPKs but then come to find out, they were empty follicles. We found this out when we did IVF and my RE retrieved multiple empty follicles.