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dmracek - February 27th, 2009 12:27 PM

Dear Dr. Jacobs,

I’m 41 years old, have a beautiful 3 year old daughter, but for the last 2 years we’ve had miscarriage after miscarriage due to chromosomal abnormalities. We recently went through our first unsucessful IVF cycle. The result of the PGD testing was 2 of the 5 embryos tested “normal”.

While we want to do another cycle in the coming months, our RE encouraged us to try to conceive naturally in between cycles. I’ve gotten pregnant 5 times in the last 2 years, so I typically can get pregnant pretty easily (hope that is still true). I’m seriously considering trying again naturally, but as you can imagine I’m very nervous since the last 4 attempts naturally ended in miscarriage which means extra time to deal with the miscarriage before we can try again. Since we potentially had 2 of 5 “normal” embryos after PGD, would it be an option to try to conceive naturally with Clomid or Femara? Perhaps we could get 2 or 3 eggs and have better odds of 1 of them being normal. What are your thoughts of trying this approach?

Kind regards,
Donna

B. Jacobs, M. D. - February 27th, 2009 10:10 PM

Even though statistics only apply to large populations, I must alert you that your potential for a successful pregnancy is statisticly poor after the age of 40. I would not recommend Clomid. Femara will probably be a better drug.
Good luck.

dmracek - February 28th, 2009 10:55 AM

Ok, can you help me understand why you would recommend Femera over Clomid. Also if i take one of these drugs in between IVF cycles would i need to wait longer before starting the next cycle to give my body a rest from the drugs between cycles?

B. Jacobs, M. D. - February 28th, 2009 3:56 PM

Clomid stays in the body far a very long time, whil Femara is cleared in hours. Clomid blocks estrogen effect on the endometrium, increase the risk of having a fillicle which grows but does not release the egg, in addition to making a wreck of cervical mucus. Femara does not do any of those things. Pregnancy rates with Femara seem to be greater than the 15% to 20% pregnancy rate in 6 treatment cycles of Clomid.

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