Before you can blink...
...I'm on to Clomid Round Two. Today I spoke with Dr. Quixotic's nurse-practitioner, Nurse Patient (heh). We were on the phone for nearly fifteen minutes, during which time she went over everything at least twice and was careful to answer all my questions (hence the name). She's putting me on 100mg of Clomid, starting tonight. No uterus reset required, since I had a "recent bleed" (as she put it). I'm not thrilled at the prospect of another midweek meltdown so soon, but it's better than taking the stuff during Passover, surrounded by our extended families, which was the alternative.
Nurse Patient also told me to stop the metformin for now, as it appears that my particular brand of PCOS does not respond to it and she'd rather take it easy on my liver until we can do more testing. My fasting insulin last summer (with no metformin at all) was only a 6, which does not indicate insulin resistance. Since June I've been building up to my current dose of 2000 mg per day, and Nurse Patient (in consultation with another doctor, since Dr. Quixotic is out today as well) doesn't think it makes sense to continue now, when there's no indication that it's helping and there's a slight risk it could be causing liver damage. How ironic that I just called in my metformin refill this morning, and have recently been exchanging emails with another PCOS-er about the possible benefits of metformin therapy!
I go back in for monitoring on Thursday of next week, about six days after my last Clomid dose for this round. Along with the usual ultrasound and bloodwork, they'll be checking my fasting insulin level and making a follow-up decision on the metformin. Other instructions from Nurse Patient: ditch the OPKs, forget charting, and have sex at least twice a week. I think I can handle that.
Labels: Clomid Monster
posted by Robber Barren at 12:58 PM
comments (7)
I'm sorry to hear take one with Clomid didn't work out. I hope take two works better.
wow! my head is spinning. i've never heard of doing this. but VERY happy to hear you don't have to sit around stewing!
seph - I'd read about it in passing here and there, but didn't think many doctors did it either. The reasoning seems to be that if the lining is (probably) healthy/young enough to receive a wee embryo, then why waste time ending the cycle and beginning a new one? I suppose there's a chance that my lining is not as receptive and healthy as it would be a little earlier in the cycle, but here's how things could play out:
1 - I don't ovulate at all on 100 mg. Since I won't be able to drug up again for a few weeks, we probably end the cycle with Provera. In the meantime, we've learned that 100 mg doesn't make me ovulate, and learn this nearly a month earlier than if I'd had to reset this time.
2 - I ovulate on 100 mg Clomid and get pregnant (and stay that way for approximately 38 weeks). Score!
3 - I ovulate on 100 mg Clomid, but don't get pregnant. We have learned, at least, that 100 mg is (probably) an appropriate dose for me, and that it's (probably) worth giving it another chance or two. We gain this information earlier than if I'd had to reset for this cycle. We probably do not learn whether the lack of pregnancy is due to a poor lining, or sucky cervical mucus, or just plain bad luck, but we still have more information by mid-April than we would have had if we had to do a cycle reset first.
#3 is the worst scenario, and the only really bad thing about it is that we would have maybe-possibly "wasted" a Clomid cycle. But, really, I think the benefits of getting information earlier outweigh the chance that I may ovulate and conceive, but cannot sustain the pregnancy solely because my lining was "old."
(Just, um, don't remind me of that if I do end up conceiving this cycle, and then I miscarry. I will be right pissed.)
You gotta love a medical *order* to have sex! ;) Sorry about the first take, but I'm glad you don't have to wait. I'm praying for option #2 for you!!
I'm so sorry that 50 mg Clomid didn't work for you, but am really happy to hear that your dr is all for putting you right onto 100. Hopefully it will work and get you ovulating!
I also hope that the not being on Met works for you. When I wasn't on Met, I barely responded to Clomid (I had 3 Clomid cycles when TTC#1: 50, didn't work; 100, worked but no pregnancy; 100, didn't work). But I know that different people respond in different ways, even with PCOS.
I'm so sorry that round 1 with Clomid was a bust. I'm glad to hear that the doc's moving you up to 100mg. Even with my crappy ovaries, I was able to ovulate on 100mg, so I'll keep my fingers crossed for you!
I'm reading this late so you are probably already off the metformin.
The medical literature has shown that women with PCOS who don't ovulate on clomid or metformin alone are VERY significantly more likely to ovulate on the combination, even in the absence of any signs of insulin resistance so it seems unusual to me that your NP/doc would take you off the metformin this early in the game unless you had blood work suggesting liver damage from the metformin. It also appears that egg quality is better for women with PCOS when they ovulate with metformin+clomid rather than clomid alone. Miscarriage rates are significantly lower when the two are combined.
It may be worth enquiring about metformin again.
-A Biologist with PCOS
Speak up!
<< Home