Need to decide about going throught with IUI tomorrow. HELP! WWYD?

[Anonymous]

OK, here is the situation (and history).

* DS born 2003 on first try,
* had uterine polyp surgery October 2005 (hysteroscopy, D&C)
* secondary infertility treatment (clomid) w/IUIx3 with DD born 2007 as a result of IUI #3.
* Another uterine polyp surgery June 2008, have been on no BC since.Tried for a year on our own without success.
* went to RE fall 2009, had to have uterine fibroid surgery (myomectomy) Nov. 2009. As a result of that surgery my left tube is closed.
* RE thought I would get preggo, but no...did a few cycles with femara/timed intercourse, then femara w/IUI x3 (husbands #'s are off the chart good), then was told no more oral meds, because it was thinning my lining too much.
* This past month received some free injectables through the compassionate care program and just did my first cycle ever of injectables. I have done gonal-f dose of 112.5 daily this past week and they have been monitoring closely. Well, I have so many follicles they can't even count them! They think there is 4-5 on each side that will release with the trigger. I triggered last night and have the IUI scheduled for tomorrow morning.

So....the issue is that I could potentially have 10 eggs released for the IUI! Yikes! My RE, who is typically conservative said that since I am 35, have had so many unsuccessful cycles (2 yrs 4 months trying with three IUIs already), three uterine surgeries (there is scar tissue) and a left tube blocked, they they absolutely recommend I go ahead with the IUI. It sounds right on paper, but just wondering what you all think. I really don't want multiples, but really want a third child. This would definitely be out last. : )

[Anonymous]

Sorry, OP here. My estrogen levels were great, originally in the 500's and then the 1000's, taken two days apart. Also uterine lining was on the thin side. I think it was barely 7.

[Anonymous]

i would go for it. i had 8 follicles for one IUI and miraculously (in my opinion!) didn't get pregnant that cycle. i don't say that to discourage you, but to say that you should be agressive. (i did get pregnant the following month while "taking a break." go figure.)

[Anonymous]

I'm an IVF veteran - not IUI - so I don't know all the ins/outs of IUIs so can't offer perfect advice. But wanted to say that at least with IVF what was really important was your Estrogen level - as you already mentioned - but also the SIZE of all those follicles. For instance - when I was doing IVF - they wanted at least 3 follicles over "18" (not sure of the exact measurement but that was the number the RE always threw around). And they didn't want the follicles over the low 20s as far as size because then they were usuall "too mature."

So in my personal case - I knew that any follicle at 18 or a bit higher would like result in a mature egg (still doesn't mean it will fertilize, etc.) but that was our goal for maturity. If the follicle was a 14-17 - it without fail would be immature for me. I don't think this is usually the norm - I think sometimes people can get mature eggs out of ones that are 16.

But just as important is the ratio of follicle size: number of follicles: estrogen level. I found out it's not always an exact science (went through IVF 9 times to conceive our 3 kids). But I thought generally a mature follicle should be out 100-200 estrogen. So a lot of times REs don't want your estrogen much over 2,000 for IVF. Unfortunately again in my personal case - we had to let my estrogen get really high to get a good number of mature eggs (I mean like over 5,000) which is usually not a good idea because you run into possibly getting OHSS.

I don't mean to add more confusion to an already tough decision. I guess what I'm trying to say is that if it were me - I would have a very honest discussion with the RE before doing the IUI about what was the size of the follicles - how many were at that size - and what was your estrogen level. I am assuming that they don't think that 4-5 mature eggs would release on each side. I thought normally with IUIs people tried to have 2 (or at most 3) mature looking follicles. I can't imagine a RE recommending to do an IUI if you could have 10 mature eggs released. It doesn't sound safe or healthy. I have heard of people converting to IVF if they have that many mature follicles.

Another factor would be (and don't mean to start crazy wars) is what your stand is on selective reduction in case you did get prego with multiples. Not necessarily referring to twins or triplets but I mean many multiples if you're looking at that many eggs.You and your DH need to be on the same page.

While it's hard to make a rational decision while you're on all the meds - esp. when you've been through so much already - try to take a step back and have a solid conversation with your doctor. You don't want to end up getting in a worst predicament if mulitple, muliple eggs fertilize.

Good luck.

[Anonymous]

I would say that if you absolutely CAN NOT have multiples, do not go. You asked what I'd do, and what I'd do is soul search about whether or not my family could deal with a multiple birth and all that entails. If not, I would not go forward.

I agree with the PP who said to pin your RE down and talk very frankly about the possibility.

[Anonymous]

I agree w/the poster who asked about the size of the follicles. If you have multiple 5 (+) mature follicles, then I'd seriously question having an IUI with that many potential follies that would release.

I'm an IVF/Infertility veteran, but even that many follicles makes me take pause.

Who is your RE?

[Anonymous]

I'm the parent of a deceased twin. The worst with multiples is awful. And the risks to the babies are much much higher than with singletons.

[Anonymous]

OP--I am actually in N.C. but was combing the internet for resources and found your board. Hope you don't mind me crashing!

They verbally told me all the measurements, the RE and I actually went over them twice. They had been monitoring me daily and I know Friday morning there were several on both sides that were 14-15. I did another dose of gonal-f that night and Saturday morning, they said I was "ready". I know I heard the numbers 17 and 18 several times, but again, there were so many dang follicles (not mature ones necessarily, but all you could see on the US were those black circles!) and they measured so many. I know she said "up to 4 or 5" would be mature on each side and be released. But my thought is with the left tube closed (yes, I know they can transfer over) that takes a lot of those out of play immediately.

This I forgot to share. I requested another HSG two months ago to make sure the fibroids and/or polyps had not returned. Well, on HSG, my uterine cavity looked actually pretty good. My left tube was closed as we knew but my RIGHT TUBE WAS NOT OPEN EITHER. The RE was convinced it was a spasm, since there is no biological/physiological reason for the tube to be closed. You could see the dye "start" to go but it would sort of squeeze back out whenever he relieved the pressure on the syringe. The left on the other hand was just a wall, no squeezing up or out of the entrance of the tube. So yes, it may be a spasm, but what if it wasn't? (RE said we would have to do surgery to really find out)

We could handle twins, but honestly, not triplets, but would never reduce the pregnancy either. If God allowed triplets then we would be blessed and it would be hard. I did find a study online regarding this exact scenario (all healthy women with no closed tubes) and there were no instances of triplets in all women 35 and over. It was a large sample size, but yes, I realize that it is just a study, but I found comfort in it. It also stated that cancelling the IUI reduced singleton pregnancy rates by 50% in ages 35 and over (yes, I am just 35).

So the plan is to go ahead with it. I have not been trying for almost 2 1/2 years to not go for it. Like I said, the cards are stacked against me in so many ways. I have had many "perfect" cycles before with up to 4 eggs (once, the rest were 1-3) with no success. My RE has mentioned IVF several times to me, but honestly DH and I didn't want to go "that far" (whatever that meant to us!) and the $$ was certainly an issue. I figured we have two kids, and really want a third but wanted to keep it somewhat "natural". That makes me laugh now since I have 8-10 follies that could release.

Anyway, thanks for letting me crash your party! I did live in Fairfax during elem./middle school. but am in N.C. now. Would love any more input and I will be back to let you know what happens. Honestly, if I got pregnant I would be shocked. I think I am mentally convinced that my uterus/reproductive system has just had it!

[Anonymous]

I'd also think very hard hard about what you'd do if you got pregnant with higher order multiples. If it were me though, I'd probably skip the IUI and wait another month to cycle with less stims.

[Anonymous]

May be too late - but why didn't they convert you to an IVF?

[Anonymous]

From OP-- Man! You guys are making me nervous! Really, you would skip it, even given all the barriers I have??? I really felt a sense of peace today about it. I just feel like this may be our shot to get pregnant. I also trust my RE. I have been with them for a year and they are one of the top in N.C. As I stated before, we didn't want to go onto IVF because honestly we felt like we didn't want to go "that far" to have a third. A first, yes. Anyway. I appreciate the thoughts no matter how they make me feel. It is just good to talk about it. I may talk to my RE again tomorrow before my IUI, but I think we will go ahead. Heck, with my history, I still think it would be a miracle to get pregnant with one!

[Anonymous]

I would cancel.

Put aside whether or not it's your only cycle with these free meds or whatever. The bottom line is that you could have 10 mature follicles & you are not that old. What if you end up with quads? To me, there's no way that's worth the risk. Even twins are high-risk & not a desirable outcome for most REs in most cases.

I cancelled a cycle with fewer follicles than you have & I was almost 40 at the time. I know it is heartbreaking to cancel a cycle at this point. But my RE would not do it even if I had wanted to go ahead, & I have to wonder about an RE that would perform IUI with so many mature follicles. Even with a blocked tube, you know the functional tube can reach over to pick up the eggs from the opposite ovary.

[Anonymous]

I would trust your RE and do it (and have in similar situations, with resulting singleton pregnancies)

[Anonymous]

I would talk to your RE again about the risks if multiples and that you are not open to selective reduction.

Personally in that scenario I would cancel.

[Anonymous]

With one tube blocked, the odds of multiples declines enormously. But most importantly, trust your instincts. if doing it gives you inner peace, then that is most likely the right answer. That is what I would do as well.