Clomid or Follistim
I have been communicating with you regarding my follicles & E2 levels, thank you for all the help so far. Brief update, I had 3 cycles of Clomid (50mg,100mg,50mg) of which I overstimulated on 100mg with a high E2 level and my cycle was cancelled. Then the 50mg Clomid cycle I had 3 decent follicles and still high E2 levels + IUI = chemical pregnancy. I usually ovulate on my own and was pregnant naturally in Jan 2011, but unfortunately lost my boy at 25 weeks due to a cord accident. My RE gave me a choice today, I can do a 75mg Clomid + IUI cycle or he can start me on a 75 iu Follistim from CD7 which is tomorrow.
My fear is my high E2 levels and the cycle getting cancelled. Doctor, I have 2 questions, can you please help me: 1)Given my history can you please give me your suggestion whether I should do 75mg Clomid or start with Follistim. 2)Does Follistim have a higher success rate?
I can't guide you towards one therapy vs. the other, as that constitutes "rendering an opinion and dictating treatment upon you", and that's illegal since I've not seen you here as a patient. You are certainly welcome to come here for a consultation (and treatment), if you want....
I CAN give you a broad generalization, though -- injectable fertility drugs typically have a higher success rate than clomiphene alone.
I hope this helps!
Dr. Roseff in Florida
Thank you doctor for the reply. My ultrasound today showed no lead follicles and few small ones which the nurse did not count. Can you please give me a brief idea, for a Follistim IUI cycle what effect does it have if started on CD7 as compared to CD 3?
Normally, a woman starts to produce many follicles (eggs) during her period, but 99% of the time they all die (through a process called atresia) and ONE goes on to ovulate.
In women who ovulate normally by themselves without medicines, the "dominant" follicle (the one that ovulates) is typically "chosen" by cycle day 6, and the others start dying. If we start a fertility drug in a normal-ovulating woman on day 7, AFTER the dominant follicle is selected, then it generally pushes that dominant follicle along and does not induce the other follicles (those that are dying) to grow. This is why drugs like Clomid are started no later than cycle day 5, and injectables are usually started no later than cycle day 3 or so.
Hope this helps,
Dr. Roseff in Florida
Thank you so much for the detailed explanation. So if I understood correctly, for me who ovulates normally the FSH injections will only help the dominant follicle and I will not have multiple follicles. So my E2 level will not typically be very high this cycle and also less chance of multiple gestation. Today my E2 level came back at 54, should it be wise for me to not start the injections this cycle and start earlier next cycle for better result?
If someone has regular menstrual cycles, her "dominant follicle" is selected by cycle day 6 most of the time. So, starting injectable fertility drugs at that time should simply push that follicle along and not stimulate significant growth of additional follicles.
As the follicle produces E2, adding injectable fertility drugs at any point in the cycle can cause the E2 to go higher than it normally would on a natural (unmedicated) cycle.
The earlier one starts injectables the greater number of follicles (and the higher the E2) we typically see occur.
Hope this makes sense,
Thank you Doctor, your explanations are so detail, I love to read them and they definitely make sense. I really appreciate your time and the response.
Today after 2 days of 75IU Follistim, the ultrasound showed 1 follicle at 9.8mm and 3 of them at 6mm. My E2 level came back at 168, so I was advised to lower the dosage to 37.5IU Follistim. Do you think the E2 level is OK with the follicle size & number. I hope the dosage is good for the follicles to grow.