IUI #1: The Clomid Experience

I was 38 when I first heard about reproductive endocrinologists and how they could help me. After nearly a decade of unsuccessful attempts to conceive, I was relieved to learn that I no longer had to resort to regular OB/GYN doctors, whose experiments with birth control pills never did make me fertile. I was also surprised to find out that both OB/GYN doctors and reproductive endocrinologists like to start a patient’s treatment conservatively—with a pill.

Why Not In Vitro Fertilization (IVF)?

Like most people, I knew the basics of IVF but had not heard of intrauterine insemination (IUI). I had assumed that anyone who fails to achieve pregnancy for years and years but is still not ready to give up would eventually have to do IVF. My reproductive endocrinologist, however, explained to me that there were good reasons why IVF would not be the first line of action he recommended.

Per attempt, IVF is the priciest option, and it takes longest to prepare the body. It is also the hardest on the body both because of the high quantity and dosage of medications that need to be administered and because of the surgical element involved in the procedure. The heightened risk of multiple pregnancy should also not be discounted.

IUI, on the other hand, is much less costly per attempt, does not require so much medication, can be completed in a month, and is very easy to perform. Thus, since we did not have a reason to jump straight to IVF, my reproductive endocrinologist suggested we try IUI first and see how my body responded. If it worked for other couples, maybe it would work for us too.

Clomid: The Ineffective Cost-Effective Approach

Since I ovulated highly irregularly, my doctor recommended a fertility medication (Clomid) and close monitoring of the treatment cycle via transvaginal ultrasound imaging. Ovulation was supposed to occur after five or ten days on this medication, but since we did not yet know the right dosage for me, the doctor started me on one 50 mg tablet a day for five days.

Clomiphene citrate (a generic version of Clomid) turned out to be quite inexpensive—roughly $1.75 retail value per tablet (or less than a dollar with insurance)—so I could have potentially jump-started my ovulation cycle for less than $10! Alas, the 50 mg dosage did little for me. It managed to stimulate one follicle in each ovary, but the follicle size was too small (10 mm in the right, and 6 mm in the left).

My doctor doubled the prescription. After five days of taking 100 mg of clomiphene per day, the results were slightly better. I had one 8 mm follicle and four small ones in the right ovary, and one 10 mm follicle and six small ones in the left ovary. It was time to increase the dosage again.

I was supposed to take 150 mg of clomiphene a day for five days, but in the evening of the third day, I started having vision problems that I had never experienced before. I was seeing layered afterimages of objects and strange shimmering in the peripheral field. A quick Google search revealed that these were symptoms of detached retina, and my boyfriend drove me to the emergency department.

The person who examined my eyes determined that my retinas were intact. He also pointed out that if I did have detached retina, it would likely not happen in both eyes at the same time. So it had to be something else.

Since clomiphene was the only new variable, the physician went online to research its potential side effects. He returned with a confirmation: clomiphene could indeed cause symptoms associated with detached retina, and in some reported cases, the impairment had been irreversible even after immediate discontinuation of the medication.

I was only two days away from completing my IUI protocol, but I did not want to gamble with my vision. I discontinued taking the pills.

My next transvaginal ultrasound showed two stimulated follicles (10 mm and 8 mm) in the right ovary and one (24 mm) in the left. According to my doctor, had I been able to continue taking the clomiphene, we would have had a very good chance for a successful IUI. Now, with only one mature egg, the chances were slim.

We went ahead with the procedure, just because we had nothing to lose, but we didn’t gain anything either. The pregnancy test came out negative.

We decided to try again immediately after I had my period, but we replaced the clomiphene with injectable medications, which were much more expensive but did not carry the same risk of side effects. To read about this attempt, please visit my post “IUI #2: Quasi Success.”