I'm 35, TTC#1, trying two years. We just found out I have high prolactin and low AMH with a normal FSH (6). I've been on medication to help the prolactin for 3 weeks. My RE does IUIs only with ovidrel. He recommended we change from femara/TI to femara/ovidrel/IUI or IVF. I don't feel ready for either, but am trying to force myself to do the IUI. I forgot to ask:
1. Does the risk of multiples go up compared to femara/TI? I have googled and can't find anything clear about ovidrel and multiples risk.
2. Does anyone have good data on likelihood of success with IUI?
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I believe the O is to make you ovulate at a specific time, that way they can plan the IUI and the correct time! No guess on when you ovulate, since they Know you will 24-36hrs post shot!
I did O with my IUI-s -
@FaithFertility: Did your IUIs work?
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@AmeliaBedilia:
1. Nope. If anything, the risk of (unexpected) multiples would go down with IUI due to the monitoring you'll get, so you'll know your risk of multiples based on the number or follicles.
2. My RE gave me an 8% chance with Clomid + TI, and 15% chance with Clomid, Ovidrel + IUI. I am 'unexplained' but had hypothyroid, short LP, and DH had borderline low morphology (3% strict). IUI didn't work for us, but neither did IVF (x2) so we may have other undiagnosed issues. -
Yeah I agree that you will know. I do believe femara increases chance of multiples, but nothing like injectables. I typically had 3 follicles on clomid, with one largest and my docs were always confident that I would O only the largest. I did 3 IUIs and none worked. Are all issues on your end? Ours were more my husband I think.
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Monitored cycles are much more controlled and unlikely to result in multiples or higher order multiples. My clomid+Ovidrel+IUI cycle didn't work but the next cycle with clomid+ovidrel and timed intercourse did. I had three mature fillicles with each but with my age (37) and low AMH, it was unlikely they were all good quality. Dr was right and only one took. I'm almost 17 weeks. It's not really a very scary process-- MUCH less invasive than IVF and worth trying!
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So what I understand is that ovidrel makes you more likely to ovulate multiple follicles (if you have them), but the monitoring keeps the risk down (or at least you know)?
@Shutterbug: thanks!
@Mrs Green Grass: thanks. DH has great count and motility, but morphology is 5% (up from 4%). RE doesn't think this is significant. My issues- elevated prolactin (just started cabergoline), TSH 2.7 (just started low dose synthroid), elevated NK cells (just started prednisone after O), and low AMH 0.27 (FSH is 6 on CD3, and rechecked a different cycle CD11 after femara and was 6).
@travellingbee: Thanks- the scary thing is that I recently got so much unexpected bad news. We expected my labs to be normal except possibly an elevated prolactin. The elevated NK and AMH have made me feel depressed and hopeless. RE recommended we monitor me and see how I respond, and that has me super scared. I recently saw a master acupuncturist (I have had multiple acupuncturists praise him in an almost cult-like way), and he did a treatment. Then he casually said, "I think that will work," seemed confident I would be pregnant, said about everyone he works on gets pregnant including a 45 year old recently, and was not concerned by my low AMH.
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@AmeliaBedilia: Good! I went to a great acupuncturist too! I'm certain it helped! I understand about all the bad news but now at least you know what you're dealing with! Now you can move forward and get pregnant!
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@AmeliaBedilia: 2/3 did but ended in CP
that was I believe due to me me having urea plasma, which inflamed the uterus and makes attaching hard for egg!
Once I took antibiotics and baby aspirin I got pregnant that month on our own...go figure! -
@AmeliaBedilia: Praying for you
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@AmeliaBedilia: My RE said that the average number of IUIs to get a pregnancy is three. I did two IUIs and didn't feel like doing a third so I'm moving on to IVF. Good luck to you! Do what makes you feel comfortable. (Or as comfortable as you can be under these sucky circumstances.)
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@AmeliaBedilia: our issue was morph, 4% and I feel like it necessitated IVf w ICSI for us...but hopefully this works for you!
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So, I did a monitored cycle of Gonal F plus Ovidrel plus IUI. Any stimulation will increase your risk of multiples but like others have said, you will be monitored. However, I feel it's important to note that there is an increased risk of multiples with IUI vs IVF because it is not as controlled. So you may have 3-4 follicles and 3 could take, which is what happened to us. We knew it was a risk and hoped it would work out but obviously we were not hoping for triplets. I guess I just wanted to make sure you are aware of all the possibilities of outcomes since most of the responses have been positive experiences.
All that being said, I would still most certainly go ahead with your recommended protocol after two years of TTC on your own. May I kindly ask why you are not ready for this next step? It's really not bad at all and it worked for us on the first attempt.
Also, just to give you some hope, my AMH was at a .3 and my FSH was at a 21, which is practically premenopausal. And it still worked for me.
I hope it works for you too! -
@Trailmix: Thanks. After getting Such unexpected bad news on AMH and NK cells, I am scared it will never happen and am afraid the monitoring will give me more bad news. It seems like I'm going from "IF light" to "IF big problem." I'm nervous about fitting it in around work (office is 20 minutes away from work, first appointments available are 7am, and I have to be at work at 8:00). I expect my regular ovulation day will be on Sunday and that we will miss it. I'm worried they will mix up DHs sample with someone else. Please tell me I am overreacting. Thanks!
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@AmeliaBedilia: It is a lot to take in. My clinic was open on the weekends, is yours not? As for work, I don't know your situation but I had a sit down chat with my boss and explained what was going on and that I might need a bit of flexibility for doctor's appointments, which he was really understanding and supportive of. Your monitoring appointments should be quick (15-20 mins at most) so if you can get in in the very early morning, you would still be able to make it work on time. And they will only be every 2-3 days for approximately 2 weeks. So maybe 2 appoints for 2 weeks will interfere with work, not too terrible in the grand scheme of things. The things like messing up your DH's sample with someone else's are beyond your control and most likely will NOT happen. Modern medicine has a lot of bureaucratic roadblocks in place to make sure things like that don't occur. I actually found the medicated cycle we did to be much more positive than I expected because I was aware of everything that was going on, I had so much more information from the monitoring then I did when we were just winging it on our own. It was easier for me to 'relax' in a way when I knew what was happening in my body than when I had no clue!
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@Trailmix: How long does IUI take? Did you work after?
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@AmeliaBedilia: IUI for me were quick and painless!
DH and I would get there say 8 a.m. for his deposit wait 45 mind for them to wash it, then IUI I go in they show you his sample you sign, lay back, speculum in, cathater in (painless) 5 seconds of injectiom....done!!!
Lay down for 15-20 mins!!! We always just prayed during that time!!!!
You could totally go to work after!
Sometimes I'd feel crampy totally normal!!!! -
@FaithFertility: So about an hour for the whole thing?
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@AmeliaBedilia: The IUI itself only takes a few minutes, and then they'll have you rest on the table for a few minutes afterwards. I went back to work after mine. Your DH will likely have to drop his sample off 90 minutes before your appt, so it can be "washed" and prepared. The sample was always clearly marked with his name and ID info and checked and confirmed with me by like three people before insertion, so I wouldn't worry too much about that if I were you. Good luck!!! ETA I did three IUIs without success before moving on to IVF.
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Yeah, I agree with others that femera (& clomid) increases your chances of multiples and ovidrel just makes you ovulate when your RE feels you are ready. If you are doing monitoring and you see there are more than follicles than you are willing to proceed with, you could ask them to cancel the cycle. For me, I had upto 3 follicles (maybe I had more at some point but the failed cycles made me proceed) and still did not get pregnant during the 6 IUIs I had. So for me, getting pregnant with multiples was a risk I was willing to take. The idea of multiples was not scary to me and my DH so we were prepared for this risk. As you know, we are currently pregnant with twins through IVF and ICSI.
Oh, I would have to check with a RE about this but I believe naturally (without meds) you ovulate on one side each month but if you are using meds to stimulate, you could make follicles on both of your ovaries and then the ovidrel would release all of them. But I think the risk of multiples is primarily caused by the clomid or femera. The ovidrel doesn't create more follicles, it just releases them earlier or at the same time. Like I said, I would ask your RE, my assumptions may be wrong.
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@AmeliaBedilia: give or take
I always went in 45mins-1 hr after wash
IUI takes 5 mins
Lay down 15-20
So I would plan 2hrs -
@bluestriped bee: Yes, your correct it "can " make you release from both sides
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@AmeliaBedilia: As for sperm tracking, I would ask your clinic about the process to ease your mind that they won't mix up samples. My first clinic where the IUIs were done did not have a software or tracking system. My DH dropped off his sample and 1-2 hrs later, I came in. They showed me the syringe with his name on it. When I went to another clinic for my 2nd set of IUIs and IVF, they had a better tracking system where each tube had a bar code. So they could track his sperm through the process and when it came to me, I could follow and be assured it was my DH's sperm.
Oh, one issue that came up was my DH had trouble creating a sample on demand. So we would have to wait til he was ready. (One time, my IUI was pushed to a later time.) There was once or twice, where he was unable to provide a sample and we did not have an IUI that cycle. That is when we decided to start freezing his sperm so we had a back up sample. We preferred fresh but a frozen sample is better than no sample and having to wait another month to try again. It is an added cost. We paid $400 each time we froze a sperm sample. Oh, my DH did not like going to the office to provide a sample. He didn't feel comfortable in the room so he did home collections and drove his sample in. The RE was fine with that because we lived within a hour commute from the office.
My boss knew I was had medical procedures and was fine with me leaving work because she knew I would get my work done eventually. My work is fairly independent so it usually affected just me when I needed to leave the office.
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@FaithFertility: cool! Thanks!
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@FaithFertility: So normally (without fertility meds), do you make follicles in both ovaries or only one? Or is it that you can make follicles in both ovaries but when it comes time to ovulate, your body only releases from one side?
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Crosspost from 6+ months thread:
RE says with our femara/ovidrel/IUI plan, ovidrel additionally 5 days after IUI for implantation support, and continue Cabergoline, synthroid, and prednisone, our chance is 12-15%, instead of the usual 15-20% because of the low AMH. He said if we do IVF, our chance is 40-50% instead of the 50-60% if my AMH was better. He was more positive than I expected and thinks he can get me pregnant. We are doing femara 5mg (his usual starting dose) instead of the 2.5mg I had been doing. Follicle count was 6 on left, 4 on right with a corpus luteum cyst on right. He said he wants to see at least 8 follicles, ideally 15, so this was a little low but better than my AMH would suggest. Any info on follicle counts would be much appreciated. I appreciate all the helpful responses! -
@bluestriped bee: In unmedicated cycles your ovaries generally switch off each month. While I was cycling I only ever ovulated from my left ovary though.
that was I believe due to me me having urea plasma, which inflamed the uterus and makes attaching hard for egg!
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