unexplained infertility: advice on protocol

[Anonymous]

TTC #2 for 14 months. bloodwork and hsg all came back normal. put on clomid days 3-7 this cycle. going in on fri for ultrasound to see how i respond to clomid. dh giving sample tomorrow but we have one dc already and he has a dc from 14 years ago, so i suspect things will come back normal from that test as does the re.

re suggest going straight to iui this first cycle with hcg shot. i was leaning towards clomid and timed BD, but he says statistically clomid has not shown to do anything for those with unexplained fertility. so, is it a waste of this cycle and taking the clomid to try BD one more time and then do iui next cycle or should we bite the bullet and just do the iui?

i am really torn here. also, if i go fri for the ultrasound and they tell me to do the hcg shot that day or sat when would they do the iui? how long does an iui take and do people go to work afterwards? any suggestions for more information or specific web sites on iui is greatly appreciated. i have also heard of a back to back iui and want to investigate that as well.

if anyone has advice, suggestions or been here and has stories to relay i would really appreciate it!

[Anonymous]

For me it would depend on a couple of things. 1. Is the cost of an IUI an issue for you? 2. How many follicles do you have? and 3. Are you comfortable with multiples if you have more than one follicle?

Personally, if I am going to go to the effort of taking medication, and cost was not an issue, I would go ahead with the IUI. What do you have to lose? I did not do well with Clomid, so the fewer times I had to take it the better. Also, it can have lasting effects if taken long term.

Regarding the timing, typically you ovulate 36 hours after a trigger, so they would want to do your IUI close to that time. Some people do back to back IUI (as in two IUIs in the same cycle). My doctors does not think it makes a difference, but I had a friend that only got pregnant when she did two IUIs.

Good Luck!

[Anonymous]

First, I am not a fan of clomid in older (AMA) women (based on personal experience and what the research says), so my response would depend on your age. If you are older, I would seriously consider injectibles rather than clomid. More expensive but better success rates.

But second, if you are taking clomid, there IS a benefit to IUI over timed intercourse, because clomid tends to dry up your cervical mucous, and IUI bypasses the cervix and puts the sperm directly into your uterus, so it eliminates that problem. That's why so many REs use the clomid/IUI protocol and it works better than clomid/TI.

So if it were me, and I were going to the trouble of taking clomid and going in for monitoring, I would just go for the IUI as well. It takes about 5 minutes, and there is no "recovery" time after you leave the office. It's not unlike a pap smear. A little bit of spotting is possible, but that's about it.

PP is correct that the majority of women will ovulate 36 hours post-trigger, pretty reliably. So you would trigger at night, then not the next morning but the following one, you'd go for the IUI. You have to drop off the sample about an hour or two before the IUI (either you or DH can drop it off), they will prepare it, and then you go for your IUI. If you triggered Fri night, IUI would be Sunday morning.

As far as the comment about multiples & number of follicles, again, age is again a crucial factor. If you are younger and you see multiple follicles, your odds of a multiple pregnancy are a lot higher than if you are older. If you're AMA, even with multiple follicles, the chances are not as nearly high b/c odds are that all of those follicles do not contain healthy, normal eggs.

[Anonymous]

OP here. The last two comments are really helpful to me. I am 33. I have been going back and forth because it is all happening so fast, but at the same time I was thinking well if I already took the clomid maybe I should just do the IUI. I will see how many follicles I have on Friday and talk to the re further. Thank you so much for the advice/info.

[Anonymous]

I was diagnosed with unexplained infertility at age 32 and was prescribed clomid. My RE's plan was to try 3 cycles of clomid and time intercourse and see where we are. We ended up getting pregnant on the 4th cycle, our "last ditch." I was never a candidate for IUI, produce too many follicles.

Going directly to IUI sounds pretty aggressive, but I guess if you don't want to waste time, it makes sense. Clomid with timed intercourse doesn't have that high a success rate. My only advice is make sure you are clear on the likelihood of multiples since this is your first cycle on clomid and everyone responds differently.

Good luck!

[Anonymous]

Thanks PP. OP here-When I went in for the ultrasound I had 2 28mm follicles and they had me trigger that night. DH and I did the BD the night I triggered. THe next morning I got a positive OPK, but I had to go out of town and there was not time to BD again with my DS running around. However, I got a positive OPK again this morning and we did BD this afternoon when I returned. Hoping for the best and congrats on your success!