Thursday, February 18, 2010

PCOS & Insulin Resistance Syndrome Trying IUI for the Fourth Time


Hi, I am 37yrs old soon to be 38. I have PCOS and Insulin Resistance Syndrome. I did three cycles of IUI (intra uterine inseminations) with 150mg of clomid. When it came time for the IUI I received the first one then was given the Ovidrel (HCG) shot then had the second IUI the next day. No success at all.

For my fourth cycle, my RE put me on Bravelle 150 for 4 days then 225 for two days. I was told to take the ovidrel shot the evening before the IUI. I am wondering if my RE is having me take the triggers too late? Everything I read says 24-36 hours later. I asked my nurse during the clomid cycles why get the trigger after the first IUI and not before? She said to make sure I have definitely O'd (ovulated) for the second insemination. I am using Donor sperm.

Thank you. N. from U.S.A.

Hello N. from the U.S.,

I am greatly dismayed by the treatment regimen you have received! Is the doctor you are seeing really an RE? Does he/she do IVF? The usual protocol for IUI is to follow the follicular development by ultrasound, just as is done in an IVF cycle, and when the lead follicle reaches 18 mm to 22 mms, the HCG (human chorionic gonadotropin) trigger is given, stimulating the release of the egg, or ovulation. The IUI is then done at approximately 36 hours (if only 1 IUI per cycle protocol) or at 24 and 48 hrs (if 2 IUI per cycle protocol). Neither cycles that you have gone through makes much sense to me, and may be a waste of your time and money (I know how expensive donor sperm is).

My other question is at your age, one or two IUI's might be advised but not more than three. Is it something that you insisted on? Certainly there is a chance of pregnancy with IUI at your age, I have had patients that were successful up to the age of 41, but the chances are only about 5% per cycle, whereas, with IVF you have a 60% chance of pregnancy per month.

I would recommend that you give that option some thought.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

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