Q&A: After no success with Clomid IUI, is IVF my only option for pregnancy?

Ask A Doctor Question: 

I am an overweight,non-smoking 27y/o female that's been trying to get pregnant for 4 years.I was seeing an infertility specialist for 2 of those 4.My tests have included post-coital tests, endometrial biopsy, HSG, laporoscopy(which showed 3 "spots" of endometriosis), and all of the "usual" hormone levels. All of the following were normal except for the lap.My husband had an semen analysis done and all was normal. I took Clomid at least 6-8 months without success. With the Clomid we did discover I was ovulating so my doctor suggested IUI.We followed through and then discovered that my cervical mucus, as well as my husband's semenal fluid, is thick. So, the doctor then suggested I take Robitussin for ten days during my "expected" ovulation.  Needless to say, we thought IUI was the answer but we were wrong.I am still ovulating without the Clomid(testing by home tests occasionally). My cycles are still "monthly", but vary from 28-45 days . I realize that IVF may be the next step but my insurance does not cover this procedure and I can't afford it right now. Do you have any suggestions? 

- Michelle


Wendy J Schillings, MD, FACOG -

The objective with using Clomid and IUI is to produce more and better quality eggs and then to have sperm placed near the eggs at the correct time with the IUI.  Clomid alone and Clomid IUI are good first steps in accomplishing this and pregnancy rates are improved over a couple’s natural conception rate without treatment but they are not very high. Typically, if a treatment hasn’t worked after 6 tries the success tends to decrease further each cycle.   IVF has significantly higher pregnancy rates than Clomid and IUI.  There is a middle step of using gonadotropin medications by injection to produce higher quantity and quality eggs than the Clomid and gives  higher pregnancy rates but still  lower than IVF.  Using these medications will also give you a higher risk of multiples including triplets or more and hyperstimulation compared to the Clomid. You also mentioned that your laparoscopy was abnormal and that you were overweight which also may be a <>factors affecting  your success.  This should be discussed with your Doctor to discuss all the pros and cons of each treatment for your particular situation.  If you do not feel comfortable having this discussion with your current physician, I would recommend that you obtain a second opinion.

--Wendy J Schillings, MD, FACOG
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