QuestionQUESTION: Hi! I am writing from Athens, Ga and I recently underwent my third IUI
cycle. This is the first one for which we used clomid, u/s, and hcg trigger.
I had a 22mm follicle on day 10, and my doctor scheduled the trigger for
the following day at 9am, with the IUI 24h later. I had read that the IUI
should be 24h after the trigger and when I explained this to my doctor,
she agreed but in the process of rescheduling for later, I told her that my
temp had been mildly elevated that morning and that I had a positive OPK
6h after the Hcg shot. She told me that the OPK should not have been
positive that soon after the shot and that I must have ovulated on my own.
So we did an ultrasound and the technician was confused because she
saw fluid indicating ovulation and endometrial changes (even I could see
them!) but the dominant follicle was still there. My doctor said that since
the follicle hadn't grown since the day before, the oocyte had likely
ovulated even though you could still see the follicle on the ultrasound. Is
this possible? I ask because my ovulation pains (which I usually have for
about 4 days prior to ovulation) continued for another 12h after the IUI
and I had a low temp easing later on and I'm worried that we missed the
ovulation with the IUI at least 12h before it. Also, I read that the opk will
detect a false positive because it recognizes the hcg. Would this have
happened as early as 6h after the shot? Thanks very much for your help!
ANSWER: Hello Kristen from the U.S.,
I can see why you are so confused. Too much wrong information is being propagated.
First, an OPK will turn positive if HCG trigger is given. This is because the OPK looks for the LH surge which the HCG mimics. You cannot use an OPK concurrent with an HCG trigger.
Second, the Ultrasonographer was WRONG and that is why you should not trust the information given out by technicians who have less knowledge that your doctor. The finding of culdesac fluid or the intact follicle, neither confirms ovulation or the lack of ovulation. In fact, based on the timing of the ultrasound, I would presume that ovulation had not occurred yet.
Third, your information from the internet or your source regarding the timing of IUI is also wrong. It cannot be known exactly when ovulation actually occurs. All we can know is that it will occur between 24-52 hrs. Most ovulate around 32-36 hours so that the convention for doing IUI is 34-36 hours after HCG if your doctor is using the one IUI technique. 24 hours would be way too long, but in your case, you doctor waited 12+ hours after the follicle was the appropriate size, which moved the IUI time back. Even without the HCG, the LH could still surge on its own before the HCG is given.
I cannot tell you if you missed the IUI or not, but a very interesting study done about 5 years ago showed that the sperm needs to be in place before ovulation occurred. If not, pregnancy did not occur. That is the problem, in my mind, with the one IUI technique. The margin of error, ie missing the ovulation, is bigger than the two IUI technique, done at 24 hrs and 48 hrs from HCG trigger. Another problem you are facing, is that if you see the wrong Physician to do specialized treatments, you will also be led in the wrong direction ie given the wrong information such as you have been given in your clinic.
Good Luck,
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
---------- FOLLOW-UP ----------
QUESTION: Thank you so much for clearing up my confusion. Would you happen to
know what journal, volume, etc. the study you mentioned about the need
for the sperm to be waiting for the egg was in? I am a scientist with
access to journal articles and would like to read up on this as well as
bring the article to my next doctor appointment. Thank you!
AnswerHello Again,
It was quite a while ago, but I think the article was either in the journal "Fertility and Sterility" or "Human Reproduction".
Good Luck,
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
