Posted by on March 06, 19100 at 21:22:39:
In Reply to: Re: Med. Dose posted by Ellen Bender on March 06, 19100 at 11:37:34:
Thank you Ellen! I am combining Clomid and metformin. It has not been successful so far. I am being monitored properly with ultrasound but so far nothing's changed. I would love to know more about the low and slow method. Also if you can recommend any good book regarding this. Please e-mail me at above address when you have a chance. Thanks, Donna
: Donna: Let me preface my response by saying that I am not a doctor, but here is what I know about clomid. Clomid causes somewhere between 70 and 80% of women with PCOS to ovulate. There is a group of women with PCOS -- @25% is the number I think -- who are "clomid resistant." Obese women with PCOS tend to be clomid resistant. That said, I think it is reasonable to do 3 or 4 cycles of clomid to see if it works because the benefits of clomid are that it is relatively inexpensive and easy to take and it has a relatively low (5%) chance of twins compared to the injectibles. 150 mg is a high dose but certainly within acceptable practice. Is your doctor monitoring you through blood tests and ultrasound to see what's going on during your cycles? In terms of the next step, there are two basic options. First, you can go the injectible route and though it is significantly more expensive and carries with it a higher risk of multiple births and hyperstimulation, I can attest to the fact that at a good program with very careful monitoring, it can work. I became pregnant for the first time, after 5 1/2 years of infertility, after a cycle of low dose (1 ampule a day) of pergonal. If you do decide to go that route, make sure that your doctor is familiar with the low dose protocols ("low and slow"). The other possibility is to consider combining clomid with metformin, one of the insulin sensitizing agents. Although metformin has not been FDA approved for PCOS, there was a study published in the New England Journal of Medicine showing that for clomid resitant women, the combination of metformin and clomid resulted in an ovulation rate of 89%. Talk to your doctor about this. And please join us for our first PCOS chat on line on March 21st. It will be moderated by Richard Grazi of Brooklyn IVF. Good luck, Ellen