Berkeley Parents Network: Advice about Fertility

Berkeley Parents Network

Advice about Fertility

Berkeley Parents Network > Advice > Parenting, Families, & the Community > Advice about Fertility

Ob Gyn is pushing Clomid for irregular periods

March 2007

Hi, I am a bit puzzled by my OB/GYN's response to a problem. I am trying to get pregnant, but it's difficult because of my irregular periods. When I went to see my OB/GYN, I wasn't even given an exam, he simply wrote me a prescription for clomid to stimulate ovulation. Not that I have anything against clomid, but is it really necessary to immediately resort to medication?! I'd really like to try something more natural first, and would be grateful for any suggestions. Recommendations for more holistic OB/GYN's in the Walnut Creek area who take PacifiCare (the Alta Bates medical group) would be appreciated as well. Thanks! anon.

If you have irregular periods, any sort of exam by your ob-gyn isn't going to reveal anything. Even a vaginal ultrasound won't really reveal much UNLESS you go in for a bunch of them after you actually have a period, then your doctor follows the growth of any follicles to see if you are actually ovulating. Anyway - You have irregular periods, you're trying to get pregnant, and the common first step to even the playing field for you with other fertile women is to give you Clomid. It doesn't always work though - I have irregular periods and very long cycles, and Clomid taken 3 or 4 times only gave me a shorter cycle once. Irregular periods are often an indicator of PCOS, so do some research of your own on that, and talk to your ob-gyn about that. As for non-Western medicine you can look into: Maybe try acupuncture. There have been testimonials from BPN users that acupuncture regulated their menstrual cycles. But it's not cheap and you'll be doing it a long time. Don't freak out about the Clomid though. It's better to start trying with that now rather than to wait to use it a year, then realize two years down the road as you near 40 that you actually have fertility problems - like I did. -Clomid is not the anti-Christ

Hey, Clomid-is-not-the-anti-Christ here again: One thing your doctor CAN do is make you get a bunch of blood tests to see if all sorts of hormones and other baby-making essentials you never knew you had are in proper balance. Like if you once had an eating disorder, that can permanently affect your thyroid and can affect your ability to get pregnant. All this will be revealed in blood tests. These tests are usually done around the time you resort to Clomid, or after you take Clomid and it doesn't work for you, or if you end up going to a reproductive endocrinologist. There's also a 3-day Clomid test to test your fertility that you can ask your doctor about. At any rate - it's not a small deal that your periods are irregular. You need to make them regular to ensure you have 12 chances a year to get pregnant rather than 9 or whatever it is for you. -CINTAC

You're very wise to question your OB/GYN's treatment. If you've been trying to conceive for a while, it's important to get some diagnostic testing done so you at least will know if a natural, holistic approach stands a chance. Don't waste any more time with your current OB/GYN. Like you, I had an irregular cycle. I wasted over a year being treated by a doc who took the same approach as yours. He never ordered a single diagnostic -- just prescribed Clomid and OTC ovulation predicting kits, then Clomid plus intrauterine insemination. I'd been following a temperature cycle routine. (I was far too busy at work to research alternatives and too trusting that the doc I saw was competent because his partner had a good reputation. Plus I had a GP who had her 1st child at 40 and told me there was no rush, just be relaxed about it all!) I left that practice with a lot of anger and frustration and headed straight for a fertility specialist, Dr. Chetokowski. I had to wait 6 months for the first appointment, but he was superb -- very ethical, straightforward -- and had a great staff. One of the first diagnostics showed I had a lot of uterine polyps, the likely cause of my irregular cycle, which were surgically removed. We also learned we had male factor issues. No amount of Clomid or intrauterine insemination would have worked for our situation. My hormone levels were fine, but by that time I was 39. My eggs were getting old even though I felt 10 years younger. ICSI was the solution for us. It was expensive, but we've a lovely daughter now. I wish you much luck, AS

Some OBs will push Clomid because that's all they have experience for. I personally wouldn't go with Clomid first, because there are a number of tests that are easy to start with. I personally had started with Hank Streitfeld as an OB/GYN, and he called himself a fertility specialist, but all he really did was offer Clomid. He was NOT a fertility specialist, just an ob who tends to prescribe Clomid for ''fertility problems''. You probably want an appointment with a REAL fertility specialist. There are some fertility/irregular bleeding problems that can be fixed easily (and some lack of pregnancy can be related to semen problems). Clomid is a powerful drug, and probably one of the reasons we've got more twins around. Just remember that it messes with your cycle andyour chances of having twins increases (and twin pregnancies are more risky). Call up a real fertility specialist (an RE or someone who only specializes in fertility issues), and at the very least, get their list of standard tests that they start with, and ask your ob/gyn about them. In fact, if I were you, I'd probably get a new OB/GYN. Also, you can spend a little time on the web, with sites like resolve.org, that may lead you to some of the info that you'll need to start. Just don't get too wound up about it-it's worrisome. (Many OB/GYN's are frightently uninformed about some of these fertility issues.) Also keep in mind that most docs won't recommend you to a fertility specialist until you've had 3 miscarriages or have been unsuccessful for a year (the 3 miscarriages rule is in my opinion, needlessly cruel, having been down that route). Plus, once you get the recommendation, it will probalby be 6-12 weeks before you can get an appt, so you might want to get the tests that you can now.

Using an ObGyn vs. Reproductive Endocrinologist

August 1998

Re infertility docs: I'd recommend you save yourself time and stress by seeking the expertise of a Reproductive Endocrinologist for infertility treatment (We have friends who have used UCSF, Chetkowski and Willman). You can obtain R.E. referrals from the organization Resolve, along with support and loads of information. If you haven't already done some extensive reading about infertility, you might want to obtain a book such as "Dr. Marr's Infertility Book" (I purchased at Stacey's Books in S.F.) which outlines causes, diagnostic procedures and treatments, costs, etc. There's definately different medical protocols out there and it's helpful to be knowledgeable about your options so you can fully participate in your care. We wish you much luck!

We used OMNI group which is in the building on the corner of Regent St...4th floor I think. Darcy Ketchum was our doctor, now moved, but we did see all of the doctors at one time or another. We actually used them once we were already pregnant...for the pre pregnancy testing, etc., I went to Dr. Margaret Cuthbert (now retired and writing her second novel.) We also saw Dr. Chetkowski, but maybe that is a step beyond where you are now. Can you ask to have appts with just one doctor...whichever one you feel most comfortable with? Seems like not so much to ask. Good luck.



I have not used the doctors you mentioned but have gone through
lots of treatments.
Round 1:  Used my gynecologist, Dr. Gore of SF.  He was not a specialist
          and how he treated me was inexcusable.  PLEASE continue to use 
          specialists.
Round 2:  Used Dr Kiltz, a partner of Dr. Chetkowski, in Berkeley.
          He and everybody in the group were wonderful.  However it
          wasn't a good test since I got pregnant the first round of
          Pergonal treatments.  Kiltz has since moved to New York.
Round 3:  One year after my son was born we went back to Chetkowski.
          I had run ins with one nurse, told Chetkowski about it, and 
          never had to deal with her again.  4-5 tries of Pergonal later
          we left that practice.  Chetkoski told me I couldn't have 
          childre and should give up but never gave me test results to 
          back that up.
Round 4:  Went to Dr. Eldon Schriock at UCSF.  He looked at my records, show
          showed me the test results that strongly suggest I couldn't have 
          children.  He suggested a psychologist to talk with (Dr. Ellie
          Schwartzmann of Oakland,  what a wonderfully helpful woman)
          We have tried a variety of treatments with him since then
          Although they haven't been successful, on the whole everybody
          has been nice and supportive.  One comment about Schriock,
          he has his nurses talking with you.  You have to force them to 
          have him call you and then it takes a couple of days.

Both of the practices have their pros and cons as do all of them The only suggestion I can make is that you make sure you are extremely comfortable with the practice, doctors nurses and receptionists alike. These treatments are unbelievably stressful and you need a lot of support.

If you need more information, try Resolve, the national fertility support group. They have a San Francisco office.

When is it time to consider IVF?

January 2003

My husband and I have been trying for our second child for almost 2 years. After a miscarriage, we sought out a RE (reproductive endocrinologist) in San Francisco, Pacific Fertility Center. We have done 3 rounds of IUIs with injectible medications and they all failed. Our diagnosis is mild ovulatory dysfunction and borderline male factor. Help! Did you have success at other fertility clinics? When did you know you have to advance to IVF and was that the answer for you? Did you have insurance coverage? If yes, who? If no, how much was it and how did you afford it? Did you use alternative methods, ie acupuncture, vitamins/supplements, diet, exercise, etc. We don't have infertility coverage and would like to avoid IVF if possible. The procedure and the medications are so expensive. Any suggestions. Thank you for your help.

It seems to me that you need a Reproductive Endocrinologist that you can really work with. A good RE will answer questions about how likely you are to succeed with differing fertility techniques. (You should be comfortable enough with them that you value their advice over, say a mailing list ;-) I talked to several, and found one I liked.

I loved my RE, Dr. Susan Willman, who's in Orinda (925) 254-0444. I did try IUI's, but ended up with IVF, and now have two children. The decision to go from IUI to IVF depends on many factors, your diagnosis, but also your age, and what's important to you. The Center for Disease Control publishes the rates of IVF success by clinic, by the way. See http://www.cdc.gov/nccdphp/drh/ART00/index.htm

We paid for the IVF ourselves. None of the insurance offered us covered IVF. However, the insurance did cover many of the blood test before and medication (progesterone) after I got pregnant. If you're already using injectibles, you're already paying some of the costs of IVF. IVF Parent

I believe that it is important to pursue IVF as soon as it is feasible for you, since age factor is one thing that is always looming during infertility. You might want to have a second child, and you need the lead time.

We were lucky in that we had insurance to cover all of our attempts. My husband was employed by a company based in Massachusetts. When Dukakis was governor he mandated infertility insurance and we owe him a great debt of gratitude. There are a few other states that this is also the case for. He also worked for a California company that got infertility insurance and offered us a $25,000 cap, which paid for 2 tries.

I would join an online group called Fortility. They are incredibly knowledgeable about fertility issues and it is a great support group. You can reach them through surrogacy.org

Also, try looking into other clinics such as UCSF, Chetkowski, or other East Bay alternatives. Go for the doctor/practice that you like the best. It helps when your stress level goes up.

Dr. Wu in San Francisco is also amazing for fertility issues via acupuncture.

2 time IVF winner, 6 attempts anon

I'm sorry about your miscarriage. I too when through a number of miscarriages and many IUIs and drugs. Before you take the big (and expensive) step up to IVF I would recommend you try acupuncture and herbs. You may have already but you didn't mention it. There's a specialist in SF called Angela Wu who deals with fertility issues who has had tremendous successes. She'll get you to change your diet, take herbs and she's expensive but it worked for me and I now have a son. It won't hurt you and it can only do good.

Her phone number is (415)752-0170 and she has a website at: http://www.wushealingcenter.com/ Good luck! A very satisfied client

You don't mention your or your partner's ages, but they should be considered a factor when deciding your next options. In my case, my husband and I had been trying for more than five years, and we were both in our late 30s when we began fertility treatments.

My doctor's belief was that anything more than one year of trying without success constituted infertility. I believe the fertility clinic we had an IVF at used three years of trying as a baseline.

All our treatments were covered under Blue Cross PPO. But keep in mind that even the same carriers offer different coverage, depending on what the employer pays for. My husband's employer paid for very good benefits and covered fertility up to a set amount (I don't recall the amount); it didn't matter which type of medical fertility treatment was used. I don't know whether that included acupuncture and other alternative therapy.

My own OB/Gyn took us through six cycles of artificial insemination before he referred us to a fertility clinic in Palo Alto: Fertility Physicians of Northern California (http://www.fpnc.com/). It also has an office in San Jose. We live in the South Bay. The senior doctor there, G. David Adamson, is a pioneer in the fertility field.

Neither my doctor nor the clinic could find anything wrong with either of us, which in terms of pure statistics meant the odds were lower than other couples that we would conceive. That's because you can address a known cause of infertility. For instance, if the male partner has a low sperm count, ''cleaning'' or ''spinning'' the sperm combined with directly fertilizing the egg does wonders. Similarly, if a woman is not producing eggs, she can use donor eggs.

At the fertility clinic, we were offered the option of one cycle of artificial insemination with stronger fertility drugs (that I would inject myself) to increase my egg production or going right into in vitro. The difference was several thousand dollars in price. At this point I was 38, and it seems 37 is the magical cut-off point at which doctors tsk-tsk at you and say your odds of conceiving have plummeted. We figured that although IVF was more expensive, it would be even more costly to do another round of insemination FOLLOWED by IVF if the insemination didn't take.

So we opted for IVF. I'm happy to report that we were successful, and our son just turned 3. The funny thing is because no one could ever find anything wrong with either one of us, my doctor kept asking me about birth control, and I kept saying we were holding out hopes of having one more child. But by this time, we had exhausted our fertility coverage, and we were down to one income. So we just tried the old-fashioned way.

To put a coda on this, we're expecting our second child in March, and we did this one completely on our own. I believe a lack of stress from my being away from the working world may have a played a role. (On the other hand, I do have a toddler at home.) But go figure. Anonymous

I also went to Pacific Fertility Center in SF. We also did 3 medicated IUI's with them, and finally moved on to IVF. I think they are very conservative in that they suggest several IUI's before IVF--this is a testament to their honesty. If after several IUI's you haven't succeeded, then I think the choice is really yours (as it was ours) as to whether you want to make the financial and emotional investments that IVF requires. I have a 2 month old son thanks to IVF and the doctors at PFC. The most important thing is to trust your doctor and their advice--I was very pleased with everyone there and obviously, thrilled with the outcome.

One last comment--do consider seriously the payment options (''Plans'') they offer. We felt conflicted about our choice immediately after making it (basically one is ''insurance'', one is a one time shot, and one is a refund plan). We opted for the one time shot, but really felt as though we were gambling--not a nice feeling when you're dealing with something as unpredictable as conception... My two cents: Give it lots of thought so that you feel comfortable with your decision. Good luck to you! nina

Accupuncture & Chinese herbs regulated & shortened my cycle for the first time in my life, & I wasn't necessarily a ''believer''. Treatments can also be very soothing & relaxing. These can be expensive, but you might call Chinese medicine schools or Quan Yin in SF. Also, the idea that adoption leads to increased rates of conception due relaxing about having a baby & ''letting go'' may actually be better (or also) explained by changing hormones. I had started to miss periods for the few months before my (soon to be adopted) baby daughter moved in w/ me, but they quickly returned & became regulated, and I had clear signs of ovulaton. Research has shown hormonal changes in non-birth parents in reaction to babies. Is there a baby in your life you could bond with? (I'm sure the parents would be thrilled to have your help!).

Having said all this, you may want a 2nd opinion, especially depending on your FSH level, so as not to ''waste'' any more time-been there. I recommend Susan Wilman (RE) in Orinda.

I got a happy (different) ending, but dealing w/fertility can be so challenging. Good luck to you. Vicki

We did three IUI cycles before moving on to IVF. Unless there are identifiable reasons why the IUI's weren't working that could be addressed during future IUI's (like not enough follicles), it seems that IUI is not working for you. There is so much more control during an IVF cycle - they can really up your stim meds because there isn't the multiples risk (or as much of a risk) as with IUI. If you respond well, you may get enough embryos for more than one cycle, so the money you are putting into the stim meds goes further than with IUI. We got pregnant after our 2nd IVF. Have you talked thru IVF with your current RE team? THey should be able to help you understnad how IVF may improve your odds over IUI. Good luck!!! anon

I was in a similar situation and am so grateful I moved on to IVF. We were getting nickled and dimed doing IUI's, not to mention still spending a fortune on meds. (we did 1 clomid IUI, and 3 medicated). We did a shared risk IVF program through Dr. Susan Wilman in Orinda and got lucky the second time. We're still paying down the home equity loan, but its worth it.

If you want some onging support from very cool informed women, I recommend going to http://www.inciid.org/interinfertility.html There are two forums that could be useful: Infertilty waiting room and the IVF waiting room (see left column). These ladies saved my sanity. anon

You did not say your age, which is VERY important...2 years of trying at age 40 indicates you should run not walk to more advanced care. It sounds like you have tried the strategies pre IVF. IVF will cost about $10,000 for drugs, egg retrieval, and 1st round embryo transfer. If you have alot of good embryos, then 2nd and 3rd rounds should involve only the costs of frozen storage and embryo transfer (probably $1000). After all the failures with clomid, IUI, etc., I was happy to finally get to IVF, where I felt I had a better chance of success. We did get pregnant on the 1st round and went through UCSF (the docs have all moved on together to a new practice -don't know the name - the docs are Schriock, Givens, and Ryan). Again, if you are older, you should not waste any more time on unproven or less effective therapies. Anon

I tried for 3 years to have a baby, but was opposed to using fertility drugs. My sister in law recommended ''Eight Weeks to Optimum Health'' by Dr. Andrew Weil, as she had several miscarriages, did his program, and was able to carry her baby to term. I did this program and did also get pregnant and had a baby boy. I also had minor endometrial surgery which may have been the fix (hard to know as the doctor said that there wasn't much endometrius). I never had to try IVF, although I have two friends who did for their first child, and ended up having second children without planning them! Good luck! anon

It took me 4 years of medical intervention to get pregnant. I have Polycystic Ovary Syndrome. I spent about two years having a surgery and then using clomid and seeing bad doctors who weren't really paying attention. The second two years I was with a fantastic fertitlity specialist at Kaiser San Francisco, Dr. Seth Feigenbaum. I don't know how many cycles of Repronex injections we did but it took about two years so it was a lot. It was entirely free with my Kaiser coverage. Kaiser doesn't cover IVF so we were at the end of the line when Dr. Feigenbaum got a little more aggressive with my treatment and we have a beautiful 11 month old son now! Good luck! Danielle

The opinions and statements expressed on this website are those of parents who subscribe to the Berkeley Parents Network. Please see Disclaimer & Usage for information about using content on this website.