QuestionThank you for taking the time to answer my questions! I have written before.
I am 30 years of age with secondary infertility. My husband and I have been
trying for 21 months. Our infertility is unexplained. We conceived my first
child in the first month of trying, he is 3 1/2 now. This is my 4th month being
on Clomid (50mg). This will be my second month having IUI. I went for an
ultrasound yesterday and my RE said that I had one follicle that was 26mm on
my left ovary. He had me take the HCG trigger shot last night at 9:00 p.m.
and wants to do the IUI tomorrow morning at 9:00 a.m.
Won't I ovulate before then with a 26mm follicle yesterday? That seems
somewhat large to wait 2 days. Yesterday, I had mild discomfort on my left
side, which I don't have today. I'm worried that I've already ovulated and will
be wasting my time/money to do the IUI tomorrow?
Also, my doctor doesn't want to increase my Clomid dosage, but I've had only
one dominant follicle 3/4 months (last month I had 2). Is the Clomid
increasing my chances at all, with one follicle? I ovulated on my own before
the Clomid.
Thank you!
AnswerHello Kirsten,
You have some very good questions and issues to work out. I agree that there is a high probability that you will spontaneously ovulate a 26 mm follicle, despite the timing of the HCG injection, and therefore the IUI will be ill-timed. Ovulation is not that predictable by any method. In that case, you are correct in thinking that the IUI would be useless. Instead, you should have intercourse today and tomorrow.
The goal with IUI, and the significant factor that increases the pregnancy chances, is the ovulation of 2-3 follicles per month. That will slightly increase your chances of a twin (12%), but it is worth the increased pregnancy rate of 20-24% (you chances naturally would be 16%). Therefore, if you are not ovulating at least two follicles per cycle, then (1) you are not being stimulated hard enough and (2) the IUI's are not giving you the maximum benefit. I would recommend increasing the Clomid to 100 or 150 mg per day.
I think that if you are in disagreement with your RE, then you might want to find another one before you waste more money.
Sincerely,
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.
