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Over 35: Is Clomid Right for You?
December 21, 2012
For a woman over 35 diagnosed with infertility, it is troublesome to think that you are not only racing against your biological clock, but your efforts to conceive a child are now further muddled by your diagnosis. It is only natural to hope for success with minimal intervention.
For those just starting out on the fertility journey, Clomid may be a good first line treatment, but at what point should pursue more advanced fertility treatments? Most doctors agree that after 3 or 4 unsuccessful cycles, a 35-year-old woman should “break up” with Clomid. For those over 37 or with significant fertility conditions like Diminished Ovarian Reserve or tubal infertility, other interventions may be the best starting option.
Is Clomid Right for You?
While fertility doctors agree that repeating a particular treatment for extended periods of time will not increase a patient’s odds for success, they have differing opinions on the best interventions for older patients.
Lori Arnold, M.D., of California Center for Reproductive Medicine, acknowledges that IVF can be an invasive procedure. “Clomid and IUI can be a first line treatment. Patients under 35 have about 30-40% chance of getting pregnant within 3 cycles. Over 40, a patient might try 1 or 2 Clomid cycles, though they will have low Clomid efficacy to start.” Dr. Arnold suggests patients between the ages of 35 and 40 work closely with their doctor to determine the best treatment for them. There is some gray area there regarding likelihood to conceive with Clomid.
Current research shows that Clomid has the greatest efficacy in women whose sole fertility condition is infrequent or absent ovulation, or unexplained infertility. Katherine McKnight, M.D., of Houston IVF says: “We know that age has somewhat of a negative impact on Clomid working. It can diminish the uterine lining and can cause her to ovulate abnormal eggs. At 35, one half of a woman’s eggs are abnormal. At 40, ninety percent of her eggs are abnormal.” Advanced maternal age, history of failed cycles, and more complicated fertility concerns are indicators to consider the next treatment sooner than later.
But apprehension to pursue advanced treatments is completely justified- even over the age of 35. Infertility treatment does not have to be black and white and there is plenty of room to explore other options while still feeling good about your treatment protocol.
John Zhang, M.D., Ph.D., HCLD, of New Hope Fertility Center in New York may not believe that continual cycles of Clomid is the way to go, but he does believe in less medicated interventions --even in an IVF cycle. “For many years, we wanted to make lots of eggs [in an IVF cycle]. The question for fertility doctors was ‘can you make a baby with IVF?’ Now everyone is very good at IVF so it is about getting a patient pregnant with less medicine”, he says. Dr. Zhang states Pregenetic Diagnosis, while expensive, is the best way to get an older patient pregnant with less intervention.
What Are the Options for Fertility Treatment Over 35?
A woman over the age of 35 who has not found success within 2 or 3 cycles of Clomid may see greater success with other combinations of treatment. Injectable gonadotropins (fertility drugs) and IUI, Mini-IVF, Traditional IVF, and Embryo Banking are some of the current options.
After multiple failed IVF cycles, repeated poor response at time of egg retrieval, or poor quality of developing embryos, a woman’s fertility doctor may encourage the use of donor eggs. Some fertility clinics will require donor eggs after the age of 42.
There are a variety of treatments available at varying degrees of medical intervention. The most important factor for a woman over 35 to consider is that time is of the essence. If a particular treatment is not working for you, it is time to consider other options.