Clomid is often the first treatment given to couples with infertility. What if you tried
Clomid and you still didn't conceive? What are other treatment options after Clomid?
First and most importantly, I hope that your doctor has completed some basic infertility tests
on you and your partner. If she didn’t, then that is definitely your next step. At a minimum, the
female partner should have a hysterosalpingogram to ensure that the uterus is normal and that the
fallopian tubes are open. She should have an ultrasound to look for abnormalities and in
ovaries and uterus and blood tests to check for ovulation, ovarian reserve, thyroid function,
evidence for infections and inflammation and for Vitamin D deficiency. Male partners should
have a semen evaluation. If abnormalities are found on your testing there may be additional
testing that is needed and there may be other treatments that may be appropriate for your case.
If both of your fallopian tubes were blocked, then there was no chance that
the Clomid was going to work. It is reasonable to continue more Clomid cycles after opening
the tubes. If you found that your partner had no sperm on his semen analysis, again
there was no chance that the Clomid could have worked. Further treatments
would be based on whether sperm can be found or produced in your partner.
Let’s say you have had testing and everything looked normal or the problems that you have
found have been corrected. How many times is it reasonable to continue taking Clomid?
I cover that in this episode. If you and your doctor have made the decision to move
on from Clomid, what are some other treatment options you can consider?
One option is to switch from Clomid to a different fertility medication. There are
a group of medications called gonadotropins which are administered by daily injections. Like Clomid,
these medications are designed to induce ovulation or in people who already ovulated,
to get multiple eggs to develop. Like Clomid, couples can attempt pregnancy with intercourse
or intrauterine insemination, IUI, or both. Generally speaking, injections will
result in a higher percentage of couples getting pregnant each month. That’s good. Unfortunately,
the risk for multiple pregnancy is higher. That’s bad. Multiple pregnancies are higher
risk pregnancies with more poor outcomes for both mom and baby.
Another option after Clomid failure is to perform more extensive diagnostic testing. For example,
there are two types of problems that could be lowering your chances for pregnancy that
may not have shown up on the basic testing I discussed earlier. Endometriosis and scar
tissue. Endometriosis is when the tissue which normally grows inside of the uterus
instead grows outside. It can occasionally be diagnosed on ultrasound if it produces a type
of cyst in your ovaries known as endometriomas. Scar tissue is abnormal tissue which develops in
the abdomen or pelvis. Scar tissue can cause infertility if it makes it more difficult for
the egg to get into the fallopian tube at the time of ovulation. The only way to currently
diagnose endometriosis or scar tissue with certainty is to look inside the abdomen with a
surgical procedure. The most common procedure is called laparoscopy. In addition to being
able to diagnose these problems, laparoscopy also enables the doctor to try to remove them.
Last but not least, a third option after Clomid failure is IVF. The pregnancy rates
with IVF are typically higher than with any other treatment. IVF also works well even if
you have endometriosis or scar tissue. So if you are worried that you may have those
problems but aren't really excited about having a laparoscopy, IVF gives you a way to become
pregnant without having to do surgery. IVF also works well even when your partner may have very
poor sperm or when your fallopian tubes are blocked. Other advantages of IVF are
the ability to test embryos for abnormalities and reduce the risk for multiple pregnancy.
Our Infertility TV Bottom Line is that there are a number of treatment
options that are available if Clomid didn’t work for you. Each option has
pros and cons. The next step is not going to be the same for everybody.