Q: My gynecologist has prescribed Clomid and I’ve been on it for 6 months, but still am not pregnant. At what point should I stop and move to something else?
A: This may be time to start a diagnostic work-up with a fertility specialist to assess if there are any specific issues impacting your ability to conceive. A typical work-up includes an evaluation of your uterus, tubes, and ovaries. Your doctor may recommend a hysterosalpingogram to ensure your tubes are open and that the uterus is normal in shape. Additionally, ovarian reserve screening (which involves a simple blood test for FSH and AMH levels) will confirm that your ovaries are acting like the number of birthdays you have celebrated. If your ovaries are acting older than expected it may be important to move forward with more advanced treatment sooner. Finally, it is important to evaluate your partner with a semen analysis, as this could help enhance treatment specific options. If any test result is positive your doctor may recommend additional testing or treatment specific for that finding.
Now let’s say you have completed the diagnostic work-up and no specific problems have been identified-what could be the cause? Often times, the cause may be egg quality. The tests we perform give us information about egg quantity, not quality. If egg quality is a factor it is possible that genetic rearrangements in the embryo are preventing you from becoming pregnant.
My recommendation for treatment would be to consider using injectable medications to allow more eggs to grow and give you a better chance at pregnancy. In this situation I would also consider doing an intrauterine insemination to enhance the opportunity for pregnancy. However, depending on the results of your diagnostic work-up it is possible your doctor could recommend IVF as the next best step.
The most important part of this is to stay positive. Make sure to treat yourself well because a healthy mom equals a healthy baby!
Answered by Dr. Marie Werner of RMA-NJImage credit: Liza Lagman Sperl