Secondary Infertility


Dear Midwife,
I am 30 yrs old as is my husband of almost 10 yrs. We have a beautiful, healthy 8 yr old son who was not a planned pregnancy :) We have been trying to conceive since he was one yr old with no success-not even a miscarriage.

We have run the list of testing: his sperm count is fine; my HSG showed no blockage; my laproscopy showed NO endometriosis or other abnormalities. I completed 3 rounds of clomid(on days 3-7) while having ovulatory ultrasounds, with timed intercourse and finally an IUI with HGH injection performed at physicians office. I am very responsive to clomid, producing 5 large quality follicles at the time I had the IUI. All of this between 4-6 yrs ago.

My GYN was not that aggressive/we had to insist on these treatments against his advice that "we were still young and it would happen all in good timing." We had decided to just give up(heartbroken).

We moved to a new town recently and it was time for my yearly exam so I scheduled with a new GYN. She said my previous workup was very thorough and like my previous doc said I was "perfectly healthy." However she prescribed a combo of 500 mg of metformin with clomid on days 5-9 (with at-home ovulation test kits) which I've heard other former "infertile" women swear by.

Is this some new "miracle" treatment? Why the new popularity of this combo? Does anything come to mind that we may be missing to cause this "secondary infertility" in me?


If you have insulin resistance and/or polycystic ovarian syndrome and/or are overweight, this combo can just possibly do the trick. Let's hope so!!!

-- Cynthia, CNM. PhD.

Cynthia Flynn

Cynthia Flynn, CNM. PhD, is the General Director of the Family Health and Birth Center which provides prenatal, birth, postnatal, gynecological and primary health care to underserved women and their families in Washington, D.C. Recently Cynthia served as Associate Professor of Nursing at Seattle University. There she not only taught, but remained in full scope clinical midwifery practice at Valley Medical Center where she cared for pregnant and birthing women, and practices well-woman gynecology, family planning, and treatment of sexually transmitted diseases.

Cynthia founded Columbia Women's Clinic and Birth Center, where she took care of pregnant women and infants up to two weeks of age and attended both birth center and hospital births. Before Cynthia earned her CNM, she worked as a registered nurse in labor and delivery and postpartum and is a certified Doula and Doula trainer.