IUI with 5 good follicles... chance of twins?

[Anonymous]

We've been TTC for #2 for about a year and are getting ready to do our first IUI. I did a round of clomid and follistim and went for monitoring today. My RE told me that I have 5 really good looking follicles and we should trigger tonight for an IUI on Sunday! But the RE acted like 5 was more than he expected (he would have been happy with 3-4) and launched into a discussion about the risk of multiples. I'm really excited about doing this, but also a bit nervous... My RE said that IF we were to get pregnant (20% chance with this procedure which is good but of course that means an 80% chance of no pregnancy at all) we would then have a 20% chance of twins given the way my follicles look... But he reminded me that this is a big IF and he encouraged me to move forward with the cycle. That's 20% of 20% which really comes down to a 4% chance of twins which doesn't seem that high to me.

We are fortunate to already have a 3 yo DD. DH and I had discussed that if we were to conceive twins, we'd be OK with it and would find a way to manage (but it's not what we're going for and it terrifies us just a tad). But the way I look at it, there's always the chance that we could conceive twins with or without IUI, right? There are no guarantees about anything in life. But the fact that the chances increase with the combination of drugs/IUI makes us a bit nervous.

So.... long story short, here's my question: DH's initial sperm analysis showed only 1% morphology. So wouldn't that bring down the likelihood that we would conceive twins with IUI? I forgot to ask that question to the RE and I honestly don't know if he was taking that into consideration when he quote those stats this morning.

What do people know about the risk of twins (or multiples) with IUI when low morphology is an issue?

[Anonymous]

I am SHOCKED your doctor is agreeing to do an IUI with 5 good follies. Especially because you have already had a successful pregnancy. I would be concerned about more than twins. I don't know how the 1% morphology affects this, and perhaps this is why your doctor is comfortable going forward. Ultimately, you should absolutely have this conversation with your doctor prior to IUI.

[Anonymous]

I am at SGF and my RE cancelled an IUI when I had six good follicles. Our issue is low motility (25% or less) so I'm not sure about low morphology. It was crushing but definitely the right thing for us. Keep in mind that the sextuplets on TV (Jon & Kate and others) got pregnant via IUI, not IVF. I think that the chances of getting pregnant from IUI are pretty slim no matter what, but before you do one with that many follicles I would think long and hard about whether you are willing to do a selective reduction. Best of luck to you!

[Anonymous]

Couldn't proceeding with 5 good follicles have to do with her age? How old are you, OP?

[Anonymous]

I'm not shocked, depending on OP's age and diagnosis. Given my age and number of failed cycles, I would not hesitate to go through with the IUI, especially with that morphology number (which will reduce the chances).

[Anonymous]

But this is OP's first IUI, so proceeding seems pretty risky/aggressive esp. givent aht she has been pregnant before. OP, I'd call your RE and talk about the multiples risk a bit futher. And I agree with the previous PPs who said that the risk of twins is not really your problem -- it's the risk of triplets or worse.

[Anonymous]

OP here. Thanks for your comments. Although, now I'm feeling worried! I'm going to be 36 shortly, so not too old. My RE asked if we would be comfortable with selective reduction in the case of high multiples and I said that we would... his reply was that in "that case" he feels comfortable with moving forward with IUI and recommended we not cancel. He said he would not recommend moving forward if we had ethical reservations about this topic.

DH and I would definitely be OK making the decision of selective reduction if we were faced with it... but it's not a situation I want to have to be in! But if we don't go through with this treatment, what's the point of all this? Would we go a less aggressive route (i.e. IUI with less stimulating drugs) which would lower our chances of getting pregnant at all? I'm feeling very confused.

Some additional information: We were originally diagnosed with low ovarian reserve and low morphology. I wonder if I really have low ovarian reserve though? Also, DH has been taking vitamins and quit drinking for the past couple of months since we got that diagnosis, to try to remedy the morphology issue.

I'm trying to reach my nurse (and RE) at SG so I can discuss before the weekend!

[Anonymous]

OP here again. What if we cancelled the IUI and tried intercourse this cycle instead? Would we still run the same risk based on my 5 follies? If we cancel the IUI should we also plan on abstaining by the same logic?

[Anonymous]

someone posted here a little while ago who had her cycle cancelled due to over-response and she was told to abstain (fi I am remembering correctly). But she may not have had male factor issues, not sure if that changes anything. In any event, this should make you feel good about your overall chances of getting pregnant (since you respond well to the drugs, which is half the battle).

[Anonymous]

I am the 15:09 poster. I was told to abstain for a week after our cycle was cancelled. Even though you don't trigger, I think you'll still ovulate all of those eggs. I have always known that I would be willing to do a selective reduction (and I still would) but someone posted a link on this forum to an NYT article about it recently and it really made me realize how difficult it would be to do.

[Anonymous]

PP, thanks for sharing your insight. Did you go ahead with another cycle and did you alter your protocol to a less agressive one?

[Anonymous]

Hi- I'm the poster who had a cancelled IUI cycle mentioned by a PP. In my case, I had 8 follicles that looked good. My husband does have MF issues (5% morphology and motility), but we successfully concieved our first child on the first IUI with similar numbers and 2 follicles. In my case, my doc decided to cancel because of the risk of high order multiples and also because I am highly prone to OHSS ((I had it through my first trimester of my first pregnancy- really not fun!). So, I would say talk to the nurse, but there are so many individual factors that go into a decision like this. Good luck! My IUI is tomorrow- this time I have 2 follicles (we did a very low and slow protocol this time).

[Anonymous]

I went to SG and had 9 follicles, 7 were good, and my cycle was not cancelled. I got a BFN

[Anonymous]

15:09 here again. We moved to IVF after our cancelled IUI, which would have been our second IUI (first one failed). We just got pregnant on our second IVF and are hoping for the best. Good luck to you.

[Anonymous]

16:38, I think we're twins. I could've sworn 15:38 was talking about ME!

My cycle was also cancelled for over-response. I had 5 good follicles and some smaller ones that had a chance of making it by the time of the trigger. I am also at SG, and my dr said absolutely no way. I had my monitoring appt at another office, and as I was leaving the ultrasound room, one of the dr who was there called me into his office to tell me I had too many and was cancelled. So he seemed to have made that call without talking to my regular dr since it was within about 5 minutes of finishing the u/s. Then my regular dr called me later that day to reiterate the importance of abstaining. She wanted to put me on BCPs and although I said no, the nurse called me later asking me which pharmacy they could call my pill prescription in to and to remind me again to use another form of birth control if I didn't want the pills!

I did not trigger, but they told me I would ovulate all the mature follicles.

They did not give me a choice whether to give it a try, talk about selective reduction, etc. There was no possibility of proceeding with the IUI and they were pretty forceful in telling me to abstain. And I am older than the OP (39), so I am confused. I though SG really stuck with their protocols and that you would get uniformity of recommendations from any doctor there, but apparently not.