Question:
Hello Dr. Ramirez,
I am a 30 y.o who is TTC with donor sperm. I have not been diagnosed with any infertility issues at this time. My HSG test was normal. I did the first IUI with clomid, the second and third IUIs with 150 units Gonal and 5 units Lupron for 12 days each producing 6 follicles. Each follicle was greater than 15mm. I triggered with ovidel the night before insemination. My estradiol two days prior to the IUI were 2500 and 1500 respectively.
I am curious if there is something medically that could be done differently to increase the odds of conceiving. Also is it possible that I am not genetically compatible with the donor sperm? I am frustrated with not having any answers.
Please help. K. from Upstate NY
Answer:
Hello K. from New York,
I don't think that "genetic incompatibility" is an issue. It does not exist. I am very, very worried about your gonal-f stimulation cycles, however. The estradiol levels of 2500 and 1500 are IVF levels, and that is where we are stimulating very strongly to get a maximum number of eggs. For an IUI cycle that is way too much stimulation. The goal with IUI is to have 3 ovulatory sized follicles (>16 mms) at the time of trigger and the minimum size needs to be 18 mms for ovulation to occur. Also, if you are only having one IUI done, it should be timed to be 33-36 hours from trigger. I prefer the two IUI technique at 24 and 48 hrs, which gets the fresh sperm into the tubes closer to ovulation.
Keep in mind that IUI is a natural process and just replacing trying with intercourse. Because of this, it has a maximum pregnancy rate of 24% per cycle, and can take up to 4 cycles to achieve pregnancy. In this case, you just need to keep trying. However, I am a little worried about the protocol that you are using. Are you seeing a fertility specialist for this? With IUI, we generally do not use Lupron suppression, but that is okay to use. It's just an extra drug and shot that you don't generally need.
I would not have given up on Clomid so quickly. It works well and is much, much less expensive than Gonal-f. The only reason I would go to Gonal or Follistim is if you did not respond to max dose Clomid (250 mg).
I hope this answers your questions. Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
I've never heard of Lupron during an IUI protocol.
ReplyDeleteI wish the lady loads of luck and blessings.