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When Clomid Fails

Next Steps to Have a Baby

Clomid, also known as Serophene or clomiphene citrate (the generic name) is the most commonly prescribed fertility medication. Clomid is often used to help women ovulate who are not ovulating naturally or ovulate irregularly and want to get pregnant. It’s often part of treatment for women with PCOS, and may be used in women under 35 who have unexplained fertility. But what if you’ve used Clomid, and you’re not getting pregnant? In general, about three quarters of the women who were not ovulating regularly will ovulate with Clomid. However, about half the women who ovulate with Clomid do not get pregnant. Why does this happen? What other treatments are available to help you get pregnant? Just because Clomid didn’t work for you, this doesn’t mean you can’t have a baby! It does mean this is the right time to see a reproductive endocrinologist and find out your options.

Advanced Maternal Age

If a woman is less than 38 years old, treatment with Clomid may be effective. The American Society for Reproductive Medicine (ASRM) recommends that Clomid be used for no more than six months because over time it can have a negative effect on a woman’s cervical mucus which will make it harder to get pregnant. Most women who are going to get pregnant on Clomid will do so within three cycles. If you are older, you may want to move on to a fertility specialist quickly and consider other treatment, because your fertility clock is ticking. Clomid is not recommended for women 40 or older and has not been shown to be effective at that age.

Male Factor

Maybe it’s not you, it’s him—male factor infertility accounts for 30 percent of infertility cases. If your partner has not been tested for male factor issues, you both need to see a reproductive endocrinologist and find out what’s up. A semen analysis will help your doctor determine what’s causing any fertility problems from his side, and what can be done about them.

What You Learn from a Fertility Workup

When you and your partner get a fertility workup, you will each have a physical exam and certain tests to look for signs of what’s causing your fertility problems. For men, semen analysis is the basic test. This analysis measures sperm quality, quantity, and motility (ability to swim and move). For women, tests are used to determine if you are ovulating, if your fallopian tubes are normal, and if your uterus is receptive to embryos trying to implant. Your fertility specialist will use these results to develop a treatment plan tailored specially for your specific needs.

Male Factor, Age and Treatment Options

If a woman is under 38 and her male partner has fertility problems like lower quantity of sperm, her fertility specialist may recommend trying a few cycles of Clomid and IUI, with close monitoring by ultrasound. This is usually not done if the woman is older or if both partners are feeling some urgency about getting pregnant. There is also some risk of high multiple pregnancy with use of Clomid. Some specialists will prescribe Menopur, a hormone which stimulates egg production, along with hCG, which helps the egg mature and release from the ovary, instead of Clomid. If the male partner has fertility problems and/or the female partner is 38 or older, your reproductive endocrinologist may recommend IVF treatment. In an IVF cycle, the woman’s ovaries are stimulated to produce multiple eggs, which are fertilized in the laboratory. Fertilized eggs which grow into embryos may then be implanted in her uterus or frozen for future use. IVF with ICSI, intracytoplasmic sperm injection, fertilizes the egg in the lab with a single sperm, so sperm quantity is no longer a concern.

The Next Step

If Clomid has failed you, the next step is for you and your partner to see a reproductive endocrinologist and learn more about what’s causing your fertility problems. Are you ready to take the next step?

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