QuestionHello- I am doing a med/iui this month my periods are exactly q26 days- last period oct 26 took femara x5days then follistem 200 sq since nov 1- on friday started cramping ovulation test positive tried to call dr no return call u/s scheduled nov 8th tomorrow not bloated anymore feels like ovulation already occured (done this before) my iui is scheduled for wed nov 10th - isn't that to late now- I am upset for the follistem cost $700.00 and I feel it was wasted should I go for u/s in am to check?
AnswerHello Anne from the U.S.,
I am worried that you might be correct. That is not how I or most infertility specialists do IUI. We know that when a natural cycle is being used, then we have to monitor closely so that we don't miss ovulation. Otherwise, the timing is incorrect and the IUI won't work. In general, here is how I do IUI's:
CD#2,3,4 or 5 Baseline ultrasound to rule out ovarian cysts so that the fertility medications can be started.
CD#3-7 or 5-9 Clomid or Femara are used to induce ovulation or superovulation.
CD#8-12 or 10-12 Injectables are taken if needed due to a lack of adequate response from Clomid or Femara (I don't use them in everybody because of the expense#.
CD#9 or 10 Begin ultrasound to evaluate for ovarian response, how many follicles are growing and to time when ovulation might occur.
CD#10-13 Follow with sequential ultrasounds as needed based on the size of follicles, to determine when the HCG trigger is needed. Basically this is done when the follicle is 18-22 mms.
CD#13,14,15 If the lead follice is 18-22 mms, then HCG is given to trigger ovulation #I use Ovidrel).
After HCG I do the first IUI at approximately 24 hrs and then again at 48 hrs so that I can have fresh sperm in the tube as close to ovulation as possible.
In your case since you tested positive with an OPK on Friday, then that indicates that ovulation will occur within then next 24-52 hrs. An IUI on Wednesday would be way too late. Based on your doctor's method, I'm not sure you are in the right place for your fertility treatments. Any fertility specialist would know that you have to do in on the weekends to do IUI's if needed. Does your doc to IVF?
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
