Posted by Ellen Bender on May 03, 19100 at 11:15:46:
In Reply to: next step posted by Lesly on May 02, 19100 at 11:00:08:
I'm not a doctor and you may want to repost your question asking for a doctor to respond. The good news is that you have conceived three times on clomid (counting your miscarriage) and you are young. However, 200 mg is a lot of clomid. You didn't mention weight. Clomid can be less effective with women who are overweight. In terms of the next step after your break from treatment, some doctors might want to try clomid again since you have had success with it in the past either alone or with glucophage (though some doctors are reluctant to prescribe glucophage to non-insulin resistant women with PCOS.) Other doctors might suggest that you try a cycle of low dose gonadotropins (like follistim or fertinex or pergonal). As you know, those drugs are more expensive than clomid and you need to be monitored much more carefully than with clomid because there is a much higher risk of multiples and hyperstimulation. However, if you follow a low dose protocol (one or two amps a day), the risk of multiples and hyperstimulation is much lower. They are also given in injectible form, either intramuscularly (in the case of pergonal) or subcutaneously (in the case of follistim). Pergonal is combination of FSH and LH and follistim is purified FSH. In theory, follistim might be better for women with PCOS because our LH is already elevated but practice and research studies have not borne this theory out. My doctor has even said that sometimes he finds that women with PCOS are too sensitive to the purified FSH. I got pregnant on pergonal. The downside of pergonal vs. follistim is that with pergonal, you need someone else to give you the shots. With either medication, you will find yourself at your RE's office a lot more than with clomid for morning blood tests and ultrasound. Hope this answers your question. Ellen