QuestionQuick background-I am 31 with unexplained fertility. I had twins girls in 2004 with follustim/pergonol/ganarelix/HCG trigger/IUI. Successful first time. Now TTC for a year but just started with RE again, 1st IUI with Gonal-f low doses/ ganarelix/HCG trigger; 2nd cycle IUI with Gonal-f/ganarelix/ovidrel/IUI. Good response per RE.
This cycle I did 9 days of 112.5 gonal-f triggered day 10. E2 was in the 500's. RE said I had 4 good follicles 17-19mm with one lead being 22mm, and produce many small about 12 between the size of 10-15mm. I trigger and then have IUI @ 24 hrs and 36 hrs. I know I probably should not be so frustrated, but it is hard not to be when it happened the first time round 5 years ago.
Does it sound like to you everything is being done right?
Is my age already a big factor?
Should I ask for my dose to be increased or go back to Follustim?
Sorry for the lengthiness. Thanks!
AnswerHello Michelle from the U.S.,
It sounds like everything is being done appropriately. I would NOT increase the dose because that would significantly increase your risks of a super-multiple (>2). In fact, at your age, I do not trigger if I have more than three ovulatory-sized follicles (>16 mms). Also, I too use the two IUI method. I think it is better than the 1 IUI method, so bravo to your doc.
Five years ago, you were in your peak fertile years and so your chances of pregnancy were much better. It has decreased a bit now but now by a great amount. Your chances are 20-24% per cycle. It can take the average person up to 4 IUI attempts to become pregnant. You were very lucky the first time. That is not typical.
There is no difference between Follistim or Gonal-f except for cost and the Follistim pen is easier to use.
You don't mention if you are using progesterone supplementation after the IUI. If not, I might suggest it. Talk to your doc. You can use Crinone, Prochieve, Endometrin or Prometrium. Also, I add aspirin 81 mg per day to all my patients. You begin with the beginning of the cycle and continue until you are 10 weeks pregnant.
Sincrely,
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 and twitter with me at @montereybayivf.
