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Thread: Need Advice

  1. #1
    Join Date
    Jan 2011

    Default Need Advice

    I recently had another failed round with clomid. I was taking 100 mg clomid and .5 mg dexamethasone. The u/s showed no follicles but showed that I had a thick lining. My RE said it was clear I produced estrogen due to my lining but seemed surprised not to be able to find a follicle. I now have to make a decision on whether to move up to 150 mg clomid or try Femara. I'm not sure which would be best and would like your opinion on how to proceed. I was given provera to start my cycle, but I need to make a decision on which route I want to take. I'm not too familiar with Femara so I'm not sure which would be best for us. All my tests came back showing everything was good except for elevated testerosterone, which is why he put me on the dexamethasone. I really want to make the best decison as we want to be aggressive at making this happen. I mentioned that we would even be willing to start injectables but my Dr. didn't want to try that yet. I would greatly appreciate any thoughts you may have.

  2. #2
    Join Date
    Oct 2008


    It is unfortunately common to not respond to clomid with PCOS. You will always have a low levelof estrogen circulating in your system that will stimulate the lining to develop. If you only have an ultrasound in the midpart of the month, and the lining is always thick without evidence of follicle growth, there may be a polyp present, which is common in women with irregular menses. An estradiol level to check for estrogen production is also helpful if your physician is confused as to whether follicle growth is occurring or not.

    But moving to a higher dose of clomid, as you have already been on that medication may be all that it takes. Some studies have shown Femara, which is similar to clomid in how it is used and its side effects, may be helpful for women who don't respond to clomid. Usually, I like to increase dosing first before switching meds, but there is no "best" answer.

    Adding an insulin sensitizer to the clomid or femara (such as metformin) may allow ovulation to occur if these medications are not effective alone. There is no test to tell whether you will respond to the combination or not--insulin levels do not help predict your response to the medication.

    So continued attempts with simple medication is recommended before moving to injectable medications. The injections WILL work, it is just hard to keep the response minimal, and the risk of twins or triplets is high with many eggs that develop.

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