Moving in the wrong direction??
1 Replies
mmcgilli - October 18

Hi Dr. Jacobs, I am wondering if you could provide me any advice or insight into my situation. I am 27, also an MD (pediatrician), with apparent PCOS (no lab values suggesting this, but U/S certainly looks this way) who is coming off of an intense year of ART.
My main question/source of confusion comes from the fact that my infertility seemed to worsen or become more resistant with every step that we took this past year - to illustrate, I started with Clomid and ovulated with the lowest dose, then stopped responding, moved to Tamoxifen and same situation, then injectables and same thing - first time around responded great to low doses and then became more resistant every month after that - we also tried IVF and didn't stimulate all that well with fairly large doses of Menopur and Bravelle, only retrieving 6 follicles - only 2 of which were were able to be transferred. Our last step was to do an IUI cycle to use up my injectables left over from IVF and failed to stimulate AT ALL. So I feel like every step we take with ART almost seems to take us backward as things progressively get more difficult and less responsive. I am confused as to how I went from responding to Clomid to not responding at all to fairly high doses of injectables.
We are taking a break right now to reevaluate what we want to do. So I am wondering is this common? Does it say anything about what our next step should be? Any advice or insight that you could give would be very appreciated.


B. Jacobs, M. D. - October 20

I am sorry, but I really do not have an adequate explanation for your story. Certainly with Clomid, there is a continual increase in residual drug with countinued use. Clomid blocks the estrogen receptor and can do more harm than good. I do not know why you failed to respond to gonadotropins. As young as you are, you should have had a brisk response, unless you have poor ovarian reserve, and are a Turner mosaic. I have treated one in the past.
Good luck.



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