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Polycystic Ovary Syndrome (PCOS) Moderated by Shaun Williams, MD

Dr. Williams answers your questions about PCOS and fertility.
Dr. Williams is an active supporter INCIID Programs.

Dr. Williams is a board certified Reproductive Endocrinologist who has authored numerous articles, abstracts, and research papers. Dr. Williams has extensive experience in assisted reproductive technologies with a particular clinical interest in polycystic ovarian syndrome. Dr. Williams will answer your questions and share his expertise.
Be sure to click here to visit, print and read the PCOS FAQ (Frequently Asked Questions).

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  #1  
Old 01-02-2009, 11:55 PM
amber_w65 amber_w65 is offline
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Default Clomid Question

I am 29 years old and was recently diagnosed with PCOS by my OBGYN. Insulin levels (fasting and non) are fine, fsh and lh levels were off, testosterone was high in the 100's I think) but not what he considers extreme, I have gained weight over the last year and a half and have excess black hair on my face, stomach and breasts. I feel that this diagnosis is correct and am thankful for my doctors persistence and listening to my concerns. I was ovulating on my own-just not very well I am getting ready to begin my 4th month of Clomid/Dexamethazone treatment. I was started on 50 mg, progesterone levels the first couple of months were fine and this past month he was not happy with them at all and has upped me to 100 mg. I have been pregnant before-first month off birth control-but miscarried at 8 weeks in July of 2007. My OBGYN was also honest with me from the beginning and told me that he would only treat me as far as he felt comfortable. I got a call the other day and he wants to meet with me in 3 weeks to discuss what has been done so far, so my feeling is that he is going to refer me to a RE, which is fine with me as I feel that I need a little more help and monitoring than he can give me. Now after that novel comes my question-is it true that Clomid can only be used for 6 months and that it has a higher miscarriage rate? I am scared that I have "wasted" 4 months of the 6 and am worried that whatever protocol I follow next will consist of Clomid. My husband checked out fine, and we are ready to do whatever we can to have a child I just worry that I have wasted time and I am terrified of miscarrying again. Thank you in advance for making it through all this .
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  #2  
Old 01-03-2009, 10:23 AM
DrWilliams DrWilliams is offline
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Default Clomid use

Amber,

No, it is not true that clomiphene can only be used for 6 months. The length of use depends on the reason clomid is being used, and the entire treatment cycle in which clomid is used. Clomid is usually used for 2 reasons: 1) to induce ovulation in women who are not ovulating or may be ovulating ineffectively (such as with PCOS), and 2) to increase the number of eggs that are being released in women who are ovulating regularly (called superovulation, which is used in women with unexplained infertility or as part of a treatment cycle in which more eggs are desired).

Statistically, (and we have to just look at statistics and evidence to help us guide our therapy), there are increasing pregnancy rates for women who do not ovulate up to 6 months of clomid use, in which clomid is actually stimulating ovulation. This means, that if clomid is actually stimulating egg growth and you are ovulating, then we can give a women up to 6 months worth of good pregnancy rates before considering moving to another treatment option. That is where the "six month" confusion arises. Now if clomid does not induce ovulation, and a woman needs to advance to a higher dose, well then that higher dose may be effective for up to six months if it is able to induce ovulation. Statistically, any treatment that can induce ovulation in a women that is not ovulating can be effective for up to 6 months. Pregnancies can still happen after that, but we like to move to other forms of treament that can increase the likelihood of success at that point.

For superovulation for unexplained infertility, most pregnancies happen within 3 or 4 attempts, so we like to advance methods after that "course of treatment", again based on statistics. Sometimes couples move to clomid plus an insemination for 3-4 tries, or gonadotropins with or without an insemination for 3-4 tries, etc. So I expect that if you see an RE, a course of treatment will be started that will insure ovulation for a good period of time, not necessarily 6 months. But you still can use clomid for many more months even though you have been on that medication.

There has been concern about the use of clomid for longer than 12 months, with some studies indicating a possible increase in the risk of ovarian malignancies, but other studies do not show the same type of increases. However, it is always best to consider other treatment options if clomid has not been effective prior to 12 months of use.

Hope this helps.
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