In the previous post I reviewed the most common infertility protocol for women with PCOS. Clomid or Femara and monitoring throughout the cycle, and timed intercourse.

As you already know, things aren’t usually “easy” for us. Its quite rare that a medication/treatment works perfectly the first time, that’s just something we’ve come to accept I guess….

So, if the basic protocol does not work (at the highest doses); if you do not produce mature (or enough) follicles, if your body does not release those follicles, then additional medication may be added to the “plan”. Most doctors do not want to use Clomid (or Femara) alone for over 4-5 cycles, they would like to see a pregnancy before that time. If you have not conceived, or aren’t responding as they’d like, they will most likely add injections to the mix.

The most commonly used injectable is called Gonal-F. It is used to stimulate development of the follicle. Gonal-F will be used until the doctor sees/finds adequate follicle development (by checking estradiol levels and monitoring by ultrasound) Most women respond within 5 to 7 days, some may need longer. These injections are most often used after you have finished the Clomid because it alone did not produce mature follicles (for example, Clomid may have created follicles sized at 10, and 12 – not nearly mature enough for ovulation). The Gonal-F will basically start where the Clomid stopped and help mature the follicles.

Once you have at least 1 mature follicle (mature is considered 18-20mm in size — again, confirmed by ultrasound) the doctor will most likely prescribe an HCG trigger shot. This shot is given (either by you, your husband, or a health provider). The purpose of this shot is to “finish up” the follicles; it matures the follicles that are nearly mature, and it helps them release for fertilization.

The easiest way for me to describe this is bread… yes, its odd, but follow me here….

The Clomid makes the bread; gets it going. The Gonal-F (or other injectable) bakes the bread completely, and the HCG finishes the baking process and removes it from the oven.

If a doctor prescribes the above injections, he will most likely do an IUI. A doctor doesn’t want to put you through this regime and then leave it up to timed intercourse. Adding an IUI increases your chances of pregnancy even more because you bypass the possibility of hostile CM and/or a hostile inner environment.

Next post….

A detailed review of an IUI procedure….what is it? What is done during an IUI?