IUI

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crockdc

IUI

Post by crockdc »

Good evening Dr,

I would love your opinion on our situation. We will be starting our fourth round of IUI next cycle.

My husband's sperm analysis was 5% morphology Kruger Scale, 70% motility grade 2+, and a very above average count.

The first IUI I took Clomid 50mg days 3-8, had a 17mm 16mm and 14mm follicle on day 12 ultrasound and an 11mm lining, then took the Ovidrel shot the morning of day 14 and had the IUI 26 hours later on day 15.

Second IUI same regime, day 12 only had one follicle 16mm, 5mm lining, and took Ovidrel shot day 13 at night. Had IUI 36 hours later on day 15. They checked my progesterone a week later and it was 11.6. During that cycle I started taking herbal supplements which I stopped after a few weeks since it probably ruined that cycle.

Third IUI I switched to 5mg Femara days 3-8. Day 12 had a 20mm and 17mm follicle with a 9mm lining. I triggered immediately with Ovidrel and had IUI 29 hours later. A week later my progesterone was 24.

My HSG showed two open tubes. My blood hormones were all within range on day 27 of my cycle prior to all of these IUI's. My cycle was mostly regular around 30-31 days prior to starting these IUI's. I also had multiple LEEP procedures in the military about 10 years ago. I've never been pregnant or tried to conceive until last year. I was on oral birth control for about 15 years and got off about a year and half ago. In your opinion, is there a decent chance to conceive if we try a few more IUI's with the Femara and Ovidrel or should we move on to injectibles even though I'm responding well per the ultrasound? I'm worried that since I normally have a longer cycle that maybe the follicles are growing very fast and the eggs aren't yet mature and we are triggering them too early even though they are around 20mm at trigger. Is this a possibility? Also, is it possible the Ovidrel might not be maturing the eggs properly compared to other trigger shots (ie Pregnyl)? I'm 33 years old, 120lbs at 5'3" if that helps. We don't want to wait until the follicles get too large or I ovulate on my own because that will be hard to time properly. Any suggestions or advice we would be so grateful for. Thank you in advance.
Dr. Wisot
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Re: IUI

Post by Dr. Wisot »

I think the issue may be that you are triggering too early. Dr. Yee in our group did studies on that issue many years ago and found the Clomid follicles are mature at sizes above 22. In fact he likes them even larger. Your low progesterone level may have been for that reason and then when triggered at 20 it was normal.

We prefer Pregnyl to Ovidrel but it's not much of an issue unless someone is obese.

There is nothing wrong with having your own LH surge to time the IUI as follicle collapse can be documented on ultrasound.

There is nothing you write that would make your unlikely to have a good chance of succeeding with Clomid or Femara if your follicles are allowed to get to an ideal size or triggered with your LH surge.

Realize though that there will be differing opinions on what size to trigger. But as I always say, "Each to his/her own stupid opinion." That includes me. 8-)

Arthur L. Wisot, M. D.
crockdc

Re: IUI

Post by crockdc »

We appreciate your time and opinion. What you said makes sense and we will try to stretch the wait a little longer to allow the follicles time to grow a little larger.
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