Sunday, December 13, 2009
Trouble With 2nd IUI & Using Clomid
Hi, I'm on Clomid for my 2nd IUI (intra uterine insemination), as the first one didn't work out. The first cycle I went for the sonar on cd13 and had the IUI on cd15. The doc would've preferred to do it a day or so later but we couldn't because of lab related things. So this cycle I'm going on cd14. I would like the doc to give me the trigger to do on the eve of cd15 and do the IUI 36 hours later.
I'm worried though, I do ovulate on my own. Is it possible for my body to get the LH surge before I trigger or do I need the trigger to ovulate because I'm on Clomid? I'm taking 100mg a day. Will cd15 be too late? We're dependant on the lab for processing the sperm, so the doc cannot do the IUI on cd16 (a weekend).
Clomid does not inhibit your body's natural ovulatory processes, therefore, you can indeed mount an LH surge and ovulate spontaneously before the IUI, if the doctor does not use anything to inhibit ovulation. Drugs to inhibit ovulation are GnRH antagonists, such as Cetrotide, or GnRH agonists, such as Lupron. Most do not use these with IUI cycles. I'm concerned because 36 hours after trigger may be way too late.
There was a nice study done three years ago that showed that if the sperm was not present prior to ovulation, then pregnancy did not follow. Therefore, for docs doing only one insemination per cycle (there is another option of doing two), they usually will plan it for 32-33 hours after the trigger. I prefer doing two, at 24 and 48 hours in order to have fresh sperm closer to the time of ovulation. Unfortunately, the studies comparing these two methods have not shown any significant advantage between them but I believe that is because there are too many variables with IUI. As it is, pregnancy rates are a maximum of 24% per cycle.
Your doc should not be dependent on a lab to do IUI's. He needs to make other arrangements, such as processing the sperm himself in his office.
I hope this answers your questions.
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program