The nurse hadn’t called me after a few days, so eventually I rang them back (and left a message, as they never actually seem to answer their phones – always with patients). After a couple of hours (not many, comparatively – normally they call back in the afternoon, but this time it was about 9 am), an unfamiliar nurse returned the call (it isn’t important that she was unfamiliar – I am just setting the scene… She had an American/Canadian accent too, if that adds to the atmosphere).
The doctor has reviewed my notes, and decided that I am going to go on a clomiphene cycle next time. Clomiphene is an oral drug that acts by blocking estrogen signals to the brain (from the ovaries), making the brain think it needs to release extra follicle-stimulating hormone and luteinising hormone, which leads to a strong signal to the ovaries indicating that it is very important that they grow some eggs right now, thank you. They start you on 50 mg/day for five days early in the cycle (they told me it would be days 3-7, but it depends on the doctor/circumstances); if this doesn’t work (i.e. cause ovulation), they can increase the dosage to a maximum of 100 mg/day in the next cycle.
The most common adverse events include hot flushes, mood swings and irritability (especially at the higher dosage). It is apparently a similar feeling to going through menopause (clomiphene decreases estrogen levels in the brain, like during menopause). Also common-ish are tender breasts, pelvic pressure/pain, and nausea. There is also a very minor risk of (usually) reversible visual disruption.
Success rate is about 70-80 % for causing ovulation and, within that, about 40 % for conception, meaning an overall chance of about 30 % for conception. Which is cool. As it boosts ovulation, there is a risk that it will cause more than one egg to develop – increasing the risk of twins from 1 % (of all completed pregnancies) without clomiphene to 10 % with, and the risk of triplets or higher to about 1 %. Of the twins, the ratio of identical to fraternal is 1:5, demonstrating that they are mostly caused by extra eggs.
So, anyway: the plan is to proceed as normal with regard to calling Fertility Associates the first full-bleed day of my next cycle, but to take clomiphene on days 3-7, and then they will start the blood tests a day earlier (day 9), and I will also get at least one transvaginal ultrasound (probably day 12, she said) to ensure that I am ovulating.
Which means waiting for my next period. Which, going by previous experience with missed periods, is going to be a while, annoyingly. Before my cycles miraculously became regular a few years ago, and before the pill (which I was on for years before that, and credit with regulating my periods, but it could have just been LIFE that did that), my cycles were extra long and extra unpredictable. they ranged from 40-somthing to 60-something days. I am currently on day 24, so it looks like a long wait. HOWEVER, I have read that sometimes you can menstruate without ovulation, so it could just be a few days. But my money is on 50-ish. Meaning at least a month away, meaning more delay, meaning I am getting OLDER and MORE BARREN.
Silver lining: I didn’t have to pay for this anovalatory cycle. PLUS I get to save another chunk of money, which will be good.
The nurse said she would send me a prescription for the clomiphene in the mail, so hopefully it will arrive on a fine day (my letterbox leaks).
Oh, and I looked at the Fertility Associates costs sheet to see if there was a more detailed cost (beyond the $0-500 range), and saw that a monitored clomiphene cycle (which I assume is what I am having, with the ultrasound and everything) will be $350 for the monitoring and $20-50 for the medication. Another source (I think it was National Women’s Hospital) said $50 for the medication, so this seems fairly standard, although $350 seems steep for the rest. BUT maybe it will fall under the IUI cycle cost, as the only real addition is the ultrasound, and that $350 could be only for couples who are still getting a baby by having sex, but need the extra push of clomiphene. I guess I will see when they bill me..