In my last post I mentioned my barely 3 day period, how my acupuncturist believes a light period suggests a thin uterine lining and blood deficiency and how my RE says these qualities are within normal range. The possibility of a thin lining makes me anxious about my IUI + clomid cycle coming up, so I called the nurse coordinator to express my concerns.
She explained their protocol for first time IUI cycles for a patient with unexplained infertility:
Empiric therapy: treatment before diagnosis. level one for unexplained infertility: IUI + clomid. We are unexplained until a diagnosis can be made during treatment, if treatment fails, or (if my lining is too thin like my acupuncturist suspects) if they discover my lining is too thin via ultrasound--during treatment. The other part of empiric therapy: even if my lining is too thin now, we would still proceed with IUI protocol and monitoring and add progesterone mid cycle. If that doesn't work then adjustments would be made.
My other option for IUI (before injectibles) is to take Fem.ara instead of clomid, which doesn't have the same side effects such as scant cervical fluid or thin lining. She said this was my choice so I decided to do some research.
Why does this have to be my choice! I get anxious about taking drugs and this decision is especially difficult. I don't have any research studies to cite or reference here but this is what I found when I peeked at some online literature about Fe.mara:
I visited Femara's website to check out the Fe.mara Car.es Program that offers a prescription discount to users. I left as soon as I read that Fema.ra should only be used by post-menopausal women. I read elsewhere that Fe.mara is not approved by the FDA for use in the treatment of infertility. Further, Dr. Liccardi from the Infertility Blog writes in a post that he does not use Fe.mara.
When I talked to the nurse coordinator at my clinic, she described a study that found higher incidence of birth defects in babies conceived with the help of Fe.mara, but quickly followed that the study was later refuted and subsequent studies did not find the same data. She also explained that Fe.mara is flushed from the body very quickly. Still, Dr. Liccardi does not prescribe it as a precaution.
I am sure many of you have already come to this decision, maybe you were just prescribed Fe.mara, or chose it over clomid. Please do share your experiences, thoughts, info you've gathered, your RE's opinions, and all your additional wealth of knowledge about infertility drugs. I would really love to hear what you think.
8 comments:
When I was starting off on this 3rd dIUI journey, I asked my doctor about switching to Fe.mara. He was okay with eventually switch to Fe.mara but wanted to do a few more Cl.omid cycles first. Cl.omid can cause the scant cervical fluid, but maybe you can ask to follow up your Cl.omid days with estrogen supplements. I noticed an increase in mucous using the estrogen & it improves your lining... just an idea.
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I personally have not tried fe.mera but I work with lots of pregnant woman and the ones that have worked through clinics to achieve pregnancy typically start with cl.omid then move to Fe.mara if needed. I think your acupuncturist may be on to something though, is your actupuncturist a chinese medicine doctor or a naturopath? If so she may be able to add teas or topical progesterone to help things along?! I'm not sure if this would be contraindicated during a medicated cycle, but there is no harm in asking. this would help with the mucus and the lining.
OH AND, sounds like we will be doing IUI at the same timeish!
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I've had experience with both. My experiences with clo.mid weren't typical but were pretty bad and I won't take it again. I took it once unmonitored (because I was traveling during O time), O'd somewhat late for me and then, after AF showed up, had my next cycle canceled because of multiple >4 cm cysts on both ovaries. I took it the cycle after the canceled one with plans for an IUI -- I quickly developed 4 large follicles and lots of small ones but my uterine lining was only about 4 mm. We canceled the IUI, triggered and then I had an extended LP (3 days longer than normal) that seems to have come from the three or four 6 cm cysts they found at the beginning of the next cycle (which was canceled again). So, essentially, for me, clo.mid was a giant devil! It also gave me bad migraines, INCREDIBLE pain around O (I thought I had a bladder infection), hot flashes, horrible mood swings, etc. I'm not sure why I responded so badly. The doctor said we could either continue with clo.mid and add estrogen or move to fem.ara.
For Fem.ara -- what I've read and heard from my doctor is that it is only contraindicated for birth defects if taken while pregnant -- which you wouldn't be if you're taking it pre-O. Fem.ara gave me two or three decent sized follies each time and didn't thin my lining (although one cycle I did have to use estrogen patches when things were moving a little slower). No cysts at the beginning of subsequent cycles, either. And, very few side effects. I didn't get pregnant with it (my short-lived BFP came on a non-medicated cycle after a Fem.ara cycle), but my RE was pleased with my response.
Personally, I had such a bad response to Clo.mid that I will never take it again and would choose Fem.ara. I was nervous about taking it off-label as well. But my doctor had confidence in it.
I did use the Fem.ara Cares program to get 30 pills of Fem.ara free. (Be careful how your doctor prescribes it, though, if you do it. Mine made it three refills of 10 pills which made only the first 10 free.) Also, since Fem.ara isn't technically an infertility treatment, my insurance actually paid for it. Clo.mid is cheap, though, so it wasn't an issue when they didn't pay for it.
I did three rounds of clomid and was pulled from it once I had a cycle with lining of like 2. I also had a giant cyst after my first round of clomid. I then switched to femara. I didn't have a very in depth conversation with the RE on the side effects. I did read online about the possibility of a link to birth effects but that study is widely reputed to have had major errors, wasn't controlled, etc. I've been told the risk is if a woman handles or ingests it after already being pregnant.
As far as my reaction on each, I had heat flashes with each and gained weight on femara. I did three rounds and it didn't work for me, but my lining was nice and fluffy the whole time and I had a much better reaction follie wise.
I loath clomid and would never take it again. Femara is a bit scarier (and way more expensive; my insurance company would only pay for it if I had breast cancer) because it's used off-label as an infertility drug, but if I had a choice I'd go with that one.
One more thing, I was told the only reason they go with clomid first is because it's got a much longer record of success and more studies to back it up, but that really they're the nearly identical, with the exception that femara doesn't have a risk of a thin lining.
Wishing you the best. Happy ICLW!
Thanks for your comments and feedback. It sounds like most of you have switched to femara after negative reactions or lack of success with clomid. I should say that we tried one clomid cycle after my HSG even though I ovulate regularly and it did move my late ovulation up to cd14 and I didn't have any side effects other than emotional (crying at everything). If my lining ends up being thin after all (like my acupuncturist suspects) on the mid cycle ultrasound with clomid I think I will feel more comfortable trying femara then.
Tishi, my acupuncturist is licensed in acupuncture and TCM. I'm not sure yet what herbs I will be taking, if any while on clomid. And, I'm so happy to hear you are going ahead with the IUI! It has been hard for me to let go of my determination to conceive naturally. I'm glad to know someone will be cycling close to the same time as me. I'll be sure to follow your cycle!
My RE specifically put me on Femara, to avoid the complications that can be present after using clomid - cysts, thinned lining, compromised CM. He also had me on prometrium to enhance my lining as a precaution.
I got two to three follicles each time I used it - and had great results with my lining. I didn't get pregnant from it, but I think it was because of a yet to be diagnosed issue. I have a new RE now... =)
I have to say I'm a little surprised that your RE is giving you a choice between the two. And I agree with your acupuncturist thinks your lining may be thin right now. I would definitely discuss the prometrium or estrogen options with your doctor.
I'm interested to hear what you end up doing. Good luck!
Have never been on either drug - we jumped right to injectible drugs. But it sounds like you got some good info. This is so exciting to be moving to the next step!
I did take clomid for my clomid challenge test but it was not a monitored cycle so I don't know what it did to my lining. I might of had one hot flash or two, and my ovaries felt like grapefruits, but otherwise no adverse reactions.
I did do research on femara and my doctor(s) that I asked about it wouldnt prescribe it do to lack of research on it. I did read that the birth defects were caused from taking it while pregnant which would never happen with any of us for obvious reasons.
I think trying clomid first can't hurt and if needed perhaps try femera.
I am so excited we are cycling together, it makes the journey so much easier to have someone to obesses with :)
xoxoxoxoxox
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