Wednesday, October 20, 2010

Patient Runs Risk Of High Multiples With 7 Mature Follicles In IUI Cycle

I am on my 7th IUI cycle (a miscarriage on the 4th attempt). This month I have 7 follicles mature and ready to go. I am 36 years old. We would gladly welcome twins or even triplets.

What is the risk of higher order? A. From the U.S.A.


Hello A. from the U.S.,

I would not continue the cycle with 7 ovulatory sized follicles (>15 mms) because of the risk of a super-multiple gestation (>2). I cannot give you a statistical risk as that number does not exist, but I would expect the risk to be high. Keep in mind that even twins are a high risk pregnancy and should not be taken lightly! I had an IVF patient this week who was pregnant with twins that just lost both at 23 weeks due to premature labor and delivery. It is heartbreaking. That is why we try not to have twins and definitely, try not to have triplets.

I will allow up to 5 mature follicles at 36 years old, but no more than that. Some RE's will not allow more than 3. I don't think you should take that chance.

You did not say if you are seeing an Ob/Gyn or an RE. I would like to comment on the fact that this is your 7th IUI (intra uterine insemination) cycle...I would hope that you have had a thorough infertility evaluation. One very simple reason that many women fail their IUI's is that their tubes are blocked. I can't tell you how many patients I have seen that have done multiple cycles of Clomid and IUI's who end up having this problem. If you have had a complete workup and you still fail, at 36 y.o. I would only have had you try 4 to 5 IUI cycles. At this point I would be counseling you regarding a more advanced fertility procedure, IVF (in vitro fertilization). Time is not on your side after the age of 35 as fertility begins to decline rapidly.

See my blog post: "Tips On How To Increase Your Fertility" for more information.

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.

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