SuperO protocol (clomid + FSH) at SG - when did you trigger?

[Anonymous]

I am expecting to start my first medicated/IUI cycle tomorrow.

I know the protocol is to trigger when follicles are around 18mm and that I will be going in on day 11 for monitoring. The nurse told me they generally end up triggering around day 12 because most women are ready to trigger by then.

I am wondering if others who have done this protocol have triggered around day 12.

The reason I ask is that I'm a slightly late ovulator (usually around day 18, never earlier than day 16) so I'm wondering if I will really be ready to trigger around day 12. I guess it's impossible to predict since I've never taken these meds before, but I'm trying to count out the days on my calendar and get at least a rough idea of what to plan for in terms of timing (I know I have to stay flexible).

[Anonymous]

I have done two IUI cycles. On the first, I triggered around day 11 or 12. On the second, I was ready to trigger on day 11 but the cycle was cancelled. My normal cycle is 26-29 days and I generally ovulate on day 14. When you're using medications I think your body doesn't really have a "normal" cycle (it is just doing what the meds tell it to do), so your cycle probably won't be like your normal/unmedicated cycles. Also, I think they want you to trigger before your body ovulates on its own so they can time the IUI to the time when you should ovulate. Good luck!

[Anonymous]

Thanks!
Do you mind sharing why your second cycle was cancelled?

[Anonymous]

As PP said, they are controlling your cycle using the meds so it won't follow its normal course or timing. I'm not sure about the PP's situation, but my doctor said they will cancel a cycle if you wind up with too many follicles/eggs because of the multiples risk.

[Anonymous]

This is 13:53. My second IUI was cancelled because I produced too many mature follicles. I think I had six that were pretty big (18 mm or larger) and my estrogen level (which tells them whether your eggs are mature) was high. So they cancelled due to the heightened risk of multiples. I didn't know this until recently, but the recent sextuplet births (Jon & Kate and the couple in Arizona who also have a TV show) were from IUIs. Hopefully you'll have better luck!

[Anonymous]

That's what I thought you were going to say.

Is there a strict cutoff at SG where they will automatically cancel you? I think the nurse said they want 3 or fewer and may cancel if they see 4 or more? I'm 39 and am told my risk of multiples is lower due to age, but of course I wouldn't want to take a gamble with 6 mature follicles.

I've been vacillating between worrying I won't respond to the drugs at all and worrying I'll respond too well and be cancelled. I do ovulate on my own, though, so I think I ought to get at least one mature follie.

[Anonymous]

This is 13:53. I had three mature eggs/follicles on my first cycle and six on the second cycle, which was cancelled. I don't know if there's a strict cut off or not. We moved to IVF after the second attempt at IUI because we were not ideal candidates for IUI in the first place but wanted to give it a shot and because with IVF, the more eggs, the better, so we didn't have to worry about over-responding again (though you do have to worry about OHSS). Best of luck.

[Anonymous]

Thanks for responding again. I really hope IVF worked for you!

I am starting clomid tonight (100mg). I had 17 follicles at my day 3 u/s this morning. Hopefully we'll have just 3 nice big ones by next week!

I'll try to check back in after I go for monitoring next Wed. Thanks again!

[Anonymous]

Hi Ladies...what dose of Clomid and FHS were you on when doing your IUIs? I'm at SG and about to start 50mg clomid and 75IU of follistim...I'm worried I won't get a good response with such low doses.

[Anonymous]

I am the OP. I am also at SG (Fair Oaks).

I am *supposed to* be doing 100mg clomid and 150 iu Gonal-F.

I say "supposed to" b/c if you see my thread below about converting to IUI to TI, it looks like SG is not going to let me start my cycle today because they screwed up something with my husband's bloodwork.

So I am not very happy with SG at the moment.

[Anonymous]

Trust your gut. The most important thing is the size of the follicles. Once they hit around 17, then you should be able to trigger. I was also a late ovulator and they told me to trigger on the earlier side - follicles were only 14 and it didn't work. The next time, they wanted me to trigger and I asked to go one more day. I also did a back-to back IUI meaning I went in one day for the insemination and then again the next day. It worked!

Also, 17 follicles seems like a lot. I only had about 8-9 at a time. If I had more than 3 that were growing at the same rate, the medication was adjusted, but I have had to cancel 3 cycles due to too many mature follicles. Since this is your first time, they need to see how yourespond so they can readjust for the next time. The first time I was on a low protocol and I produced way too many. The next time the dosages were lowered and it worked much better for me. Not sure what your husband's bloodwork has to do with this. Will they still let you come in for monitoring while they fix your husbands bloodwork issue? Even if you don't go through the medicated cycle, at least you will know how the follicles are progressing so youcan plan for TI on your own.

[Anonymous]

Anonymous wrote:Hi Ladies...what dose of Clomid and FHS were you on when doing your IUIs? I'm at SG and about to start 50mg clomid and 75IU of follistim...I'm worried I won't get a good response with such low doses.

I started at the same dosage, but only 50mg clomid and I still produced too many follicles. I was told to stop the follistim after day 3 to "save" the cycle but I had too many mature ones and needed to cancel. Better to start low and increase than the other way around. Plus, they can attempt to adjust the dose mid-treatment like they did for me.

[Anonymous]

12:36, thank you. 17 sounded like a lot to me too, but SG seemed to think it was good for day 3. I had 15 at my baseline u/s last month (that was a natural cycle). And like you said, the important thing is how many of them are mature.

The issue with my husband's b/w is explained in another thread I posted, but in a nutshell, SG will not start an IUI cycle unless they have infectious disease b/w from husband/partner (or donor). My husband's GP faxed over his b/w from his annual physical and I called SG to make sure it contained what they needed. I called SG again yesterday and said "the GP's office is not sure they have what you need, can you check right now while I'm on the phone and make sure you have all the necessary test results for DH?" Answer - "yes, you're good to go."

Today, day 3, SG discovers that the GP did not run those labs & calls me mid-morning to say do not take the clomid because they will not start the cycle without DH's results.

But back to the main point, I have never taken any fertility meds before so I have no idea how I will respond or how many follicles will mature. I don't have trouble ovulating, but my dr. must have had some reason for wanting me to start out at 100mg. I go back for u/s at day 11 so I guess I will see how many/how big they are then.

I think I will be crushed if I have to cancel for too many follicles. I don't know how you all have handled it.

[Anonymous]

I am so sorry - you really should not have to deal with their flat-out mistake on top of all of the stress you're already experiencing. I have not had anything like that happen, but we have had problems with the insurance people at SGF and I do feel like there are people there who will listen to you and help fix problems. Having a cycle cancelled is crushing, but like everything else with IF, you just have to pick yourself up and keep going.

[Anonymous]

OP. They are letting me start without DHs bloodwork. They know it was drawn today, so it will be back before the IUI but the results may not be in for 2-3 days, in which case it's too late to start the clomid. So my Dr agreed to let me start today!

I'm very glad it's worked out! Thanks for the support!