QuestionI menstruate regularly and ovulate on my own. I had a surprise pregnancy (we
weren't timing/trying to get pregnant) towards the end of my 37th year but
had a missed miscarriage on the cusp of the second trimester due to Turner
syndrome. I am 39 and just started actively trying again. I began seeing an RE
and I just finished my third IUI. My doc prescribed 100 mg of clomid from
days 2-6...He monitored me with utrasounds and I seemed to respond well to
the clomid having many follicles and eventually had 2 dominant follicles
measuring 19 and 21 on day 13 of my cycle. That very same day (13) he
administered an Ovidrel trigger shot. Approximately 24 hours later (day 14)he
performed an IUI. He then wrote me a script for progesterone suppositories
200mg. My instructions from the doctors assistant was to start the
suppositories the same night of my insemination. My question to you is
this...if I started the prog suppositories before I actually ovulated would it
stop ovulation from happening..I'm getting conflicting information. I am
reading that progesterone started too early (even a day before 0) could halt
ovulation. If this is the case why would i be instructed to start them
immediately. Supposedly Ovidrel triggers ovulation 24 - 40 hours later. I'm
just worried that I was misguided and told to begin the progesterone too
early. Also, following the IUI, if I had sex soon after progesterone vaginal
suppository would the progesterone impede the sperms movement - would
the sperm be viable once it came into contact with the progesterone? Any
clarity on this matter would be greatly appreciated. I don't want to get false
information by perusing bulletin boards of well meaning but ill advised
people. It is unproductive and leads to a lot of emotional distress as you can
well imagine. I appreciate andy expertise you have to offer on the matter.
Thank you.
AnswerHello,
I do think that starting the progesterone on the day of the IUI is a little premature. It is unlikely that it will impede ovulation, because the trigger was given the previous day and the process has already started, but it could cause the endometrial lining to be out of sync with implantation. I generally do not have my patients start the progesterone until the day after ovulation, and I do two IUI's (24 hrs and 48 hrs) because we don't know exactly when ovulation will occur and I want there to be fresh sperm present at the time of ovulation. My recommendation to you would be to hold off on the progesterone until two days after your IUI. Delaying won't get in the way of pregnancy because HCG provides the same hormonal coverage for a couple of days.
My only concern is why you are doing IUI? Do you know that the chances of pregnancy are only about 3-5% per cycle in your age group? This is not to say that you can't get pregnant, and I certainly have had pregnancies as old as 41 years old with IUI, but the chances are not good and your biological clock is ticking very loudly. In general, the recommendation by ASRM (the fertility society) and other RE specialists would be to go directly to IVF after the age of 37 years old. I know it is more expensive and more invasive, but the chances of pregnancy are far superior (40-50% per cycle). At 40 years old, the chances for pregnancy with IVF drop to 27%. So, time is not on your side. Just food for thought.
I hope this answers your questions.
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.
