Clomid & IUI vs. Injectables and Intercourse

[Anonymous]

Hi All,

I just got back from the RE. Based on my test results he said I have a luteal phase defect. I still need to get an HSG and the RE need the results of the 2-3 day hormone blood test. I had the same blood test with my OB last month and my numbers were FSH 4.7 and LH 3.3 and thyroid was 2.4. They didn't give the estrogen levels so the RE needed to repeat the test. Assuming the HSG is clear, and I think it will be. I had one last May and it was clear.

The doctor said he was going to give us options and possibly recommend one over the other. Does anyone know which one has a greater success rate? Is one preferable over the other? Is one more difficult on your body than the other?

Thanks.

[Anonymous]

I did Clomid with IUI and it's not too difficult, although you do still have a decent amount of monitoring each month (at least 2 monitoring appts plus the IUI itself). I didn't have a bad reaction to the Clomid, but some women do have hot flashes. Will you have to take progesterone after the IUI? I've heard those shots can be painful. I think injectibles have a higher rate of multiples if you are worried about that. Also, I'm curious how you were diagnosed with luteal phase disorder since I've always wondered if I have that but REs seem to dismiss that possibility. My luteal phase is 10 days.

[Anonymous]

OP here. I believe he was able to diagnose the luteal phase defect by endometrial biopsy and coordinating it with my cycle. For me my EB said that I was 23 days into my cycle, which was correct, but that is based on a 28 day cycle. I started my period at day 26. I ovulated on day 17 of my cycle so my luteal phase was only 9 days this month.

[Anonymous]

Did he say why he wanted to do IUI with clomid but not injectables? Is is because of insurance coverage? Usually, if you're younger and don't have egg problems clomid is the first choice to try; using just injectables is usually reserved for women in their 40s or those with egg problems; a combination of clomid with perhaps 1 day of injectables is used for in-between cases.

In any event, most studies show that doing an IUI, as opposed to timed intercourse, does not increase pregnancy rates (or does marginally, like by 1-2%). But in your situation, perhaps the monitoring that comes with doing an IUI would help ensure that they address the luteal phase issue?

[Anonymous]

OP here. I am 40 but it looks like I have a good ovarian reserve. He'll know for sure when he gets the numbers along with the estrogen. I was measured in April 2008 and FSH 6.1, LH3.5 and TSH 2.3; Jan 2009 FSH 4.7, LH 3.5 TSH 2.4. These were taken by my OB and they didn't give the estrogen. I just had the blood draw this morning.

After the HSG the doctor wants to schedule an appointment with my husband and I. I was just curious if people knew of better success rates with one over the other or in different situations.

[Anonymous]

OP Here. I forgot to answer. The reason he wanted to do Clomid with IUI is that clomid dries up cervical mucus and injectibles don't.

[Anonymous]

Yes, Clomid really requires IUI, since it can cause mucus issues, and also lining issues, particularly if used for consecutive months. Clomid/IUI is easier on the body than injectibles. I've done both. I guess if your stats look ok, you could try Clomid/IUI, but since you're 40, I would recommend you just go right to injectibles and intercourse. You're unlikely to have an issue with multiples and the success rates are higher.

[Anonymous]

I have done injectibles as part of both IUI and then IVF. I have also done a Clomid IUI. From my own experience (and I really think every woman reacts differently -some notice nothing, some women seem to suffer from every side effect under the sun), I noticed nothing on Clomid, the first IUI cycle on Bravelle (an injectible), I was just sleepy all the time. The next cycle on the same medication, same dose, I noticed nothing at all.

If he is giving you the option of injectibles with intercourse, this might be preferable to the Clomid IUI for a couple of reasons. 1) Clomid does often cause problems with thinning lining (as well as cervical mucous), which is one more little wrinkle in ttc. 2) Cost: I would also recommend finding out exactly what your insurance covers. Mine would cover the cost of the drugs (whether it was clomid or an injectible), and would cover monitoring for injectibles with intercouse, but not anything with an IUI (monitoring or the procedure itself). As a PP said, in certain cases (male factor infertility being an exception), the IUI might not raise the success rate enough to make you want to spend the money.

If progesterone is prescribed for you, and the IM shots hurt too much, you can ask your doctor about prometrium suppositories. I used those after an IVF cycle. The injectible shots, themselves, aren't a big deal -you typically use a short insulin needle.

In terms of your LPD (I had the same problem), fertility drugs often help improve the issue, esp. fertility drugs used in conjunction with an hcg trigger shot.

Whatever course you decide upon, good luck.

[Anonymous]

OP, I don't have any stats for you and anecdotal evidence is only worth so much, but ... I did five cycles of clomid (4 with IUI) and did not get pregnant. Next we tried injectibles (follistim) with timed intercourse and got pregnant the first time.