QuestionHello. I am on my third cycle of IUI with Clomid 150mg CD 3-7 and Ovidrel trigger shot. Due to an injury and failed vasectomy reversal, my husband and I have resorted to using donor sperm for the procedure. I am 30 years old, and I have fairly regular 28-30 day cycles. I had an initial day 21 progesterone level of 9.6 prior to starting Clomid. I went for an ultrasound on CD13 of this cycle to check how well the Clomid worked. I had no dominant follicles on the right, and had 2 dominant on the left. They measured 18 and 16 I believe. My endometrial lining was 8.9. My RE told me to trigger at 8pm on Thursday, with an IUI at 2pm on Friday (CD15), as they are not open weekends for IUI. They told me that thawed sperm can live 12-24 hours after insemination. Well, doing my math, Ovidrel should make me ovulate around noon on Saturday according to my RE's paperwork (approx 40hrs). If my IUI was Friday at 2pm, wouldn't ovulation be at the very end of the sperm's lifespan of 24 hours, if not already too late? Also, she confused me when I went in for my IUI. She said that my cervical mucus was thick, and that was a great sign as far as timing....I thought cervical mucus was supposed to be thin and stretchy leading up to ovulation? Is that likely a side effect of the Clomid, or can the timing be that far off? A I said, this is my third cycle in a row, and I am curious as to whether I should stay with my current plan or move on to injectibles with IUI. My RE said there was an approx. an 85% success rate at her office with IUI after 8 cycles. I just don't want to waste any more time if this treatment plan is unlikely to work.
AnswerHello Jessica from the U.S.,
You are second guessing your doctor, which is a sign that you don't completely trust her. I am afraid that I can't comment on your doctor's protocols as there are lots of variations and none are the exact or correct method. For example, I do a two IUI protocol, whereas your doctor is only doing one. With the one IUI protocol,the IUI is timed to be at approximately 36 hrs The reason I don't do the one IUI protocol is because it is known that the sperm have to precede ovulation. If not, the cycle will not work. It is NOT know how long the sperm will live in the tube, but will live up to 24 hours in culture media. My evaluation of your cycle would be the same as yours. There is some question about timing in this case.
With IUI, timing is the key because it is not doing anything else to help the cycle (except recruit more eggs to ovulate each time). The process that the body has to go through to become pregnant is basically all natural. For this reason, just like it would take a normal woman 8-12 months to get pregnant trying naturally, it can take several attempts with IUI. In general, we do not recommend more than 4 IUI attempts, because the statistical chances decline, but if your doctor has documented a different statistic in her hands then you have to go with that. Since you respond to Clomid, I don't think you necessarily have to go to injectables.
In terms of the cervical mucous, you are correct in your description of what the mucous should look like at the peak estradiol levels, just prior to ovulation, but it does not matter because the sperm are being placed up into the uterus and tubes so the mucous is not a necessary part of getting pregnant with IUI. It is only important in getting pregnant naturally so that the sperm can get into the uterus.
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
