QuestionI am 38 yrs old. I have had a miscarriage (blighted ovum). I have a hypothyroid condition that tests normal every time (what is normal). I just recently decided to try clomid to help out just in case. Ovulation days were 16 & 17 but the ultrasound showed on day 17 the largest follicles were 14 mm.
I still inseminated day 16 & 17. I am confused about what all this means in relation to achieving a pregnancy. Is it still worth a shot to have inseminated? Is there hope. I ovulate pretty consistently between days 14 & 17. I have normal periods. Do I still release an egg even though my follicle was 14 mm? I know age plays a role in this but I was able to achieve pregnancy on third IUI last year. I'm currently my own worst enemy right now.
AnswerHello Lisa from the U.S.(Texas),
Since you were able to get pregnant last year, it shows that your body can go through the 9 steps that it takes to get pregnant, and that is a good sign. Therefore, the only major obstacle you have is the "age factor." What this means is that the egg quality deteriorates with increasing age, making it more difficult to achieve pregnancy. This translates into either taking a longer time to be successful or not getting pregnant without assistance. To give you an example, a woman under the age of 30 year old has an 85% chance of pregnancy per year, or 18-20% per month. At 38 years old, you have a 10-12% chance of pregnancy per year or 2-3% per month. With IUI, that increases to 5-7% per try. It doesn't increase much because IUI is basically a natural treatment and relies completely on your body to do all the steps to achieve the pregnancy, as well as, hopefully getting a good egg. Using fertility medications the goal is to increase the number of eggs that you ovulate in the hope that you will have a good egg in the group. Without fertility medications (superovulation), IUI is not helping your chances at all.
In terms of IUI, the goal, as mentioned, is to get you to ovulate more than one egg per month (which is what you naturally will do). By doing this, you increase the likelihood of having a good egg in the group. A study in IVF patients at the age of 37 found that only 20% of the embryos formed were good embryos. At 38 yo, that number will probably be less. So, you want more eggs. I usually try for 3-5 eggs to ovulate in an IUI cycle in 38 year olds. We have to limit to 5 eggs because we can't control how many good embryos get into the uterus. In addition, we know that the follicle is ready to ovulate when it reaches a minimum of 18 mms, but preferably 20 mms. It does not ovulate at 14 mms. One of the keys to IUI is timing. The sperm has to be there at the time of ovulation. If it is early or late, then then cycle fails. For that reason ultrasound is usually used to time the ovulation and when to do the IUI. I have to be frank and say that I don't have a lot of confidence in the care you are receiving because your doctor does not seem to know this.
Because of your age, I would advise that (1) you see an infertility subspecialist (defined as a doctor that can do IVF, not just IUI's) and (2) that you strongly consider going to IVF as the treatment. With IVF, you will have a 50-60% chance of pregnancy per cycle because less is left to chance. In addition, with IVF, we can try to obtain 10-15 eggs per cycle. In order to be successful with anything in life, you have to choose the right path, or make the right choices.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
