I'm 41 years old and have had one successful pregnancy (my daughter is now five). My periods have been every 20-24 days for the past six months. My husband and I have been trying to conceive for 10 months with no success. My OB/GYN ran a blood test to check FSH, and that came back normal. My specialist is very clear that there are no other tests to conduct at this time until after I take Clomid. Shouldn't I have an HSG first to make sure the uterus is normal and the tubes are open? I'm not happy about putting synthetic hormones into my body. I am already experiencing frequent urination, tiredness and blurring of vision. Any suggestions?

J.H.

I recommend that when patients have vision problems while taking clomiphene, they discontinue treatment and come in for a consultation to explore other options. However, at age 41, you have few effective fertility options. Much depends on your ovarian reserve. A simple day 3 FSH test may not be sufficient to evaluate this. The clomiphene challenge test is a more specific and informative test.

I do not believe that the use of clomiphene alone or in combination with intrauterine insemination will likely improve your odds of conception. If the clomiphene challenge test shows sufficient ovarian reserve, and an HSG shows your tubes are normal, you may consider the use of injectable medications and insemination. The cumulative success rate after four or five treatment cycles would be about 15 percent. Following four or five cycles of in vitro fertilization, you can expect a cumulative live birth rate of 25 percent.