OPK's- u/s monitoring and IUI's (timing ovulation)

My question to you ladies is:  When you are having u/s monitoring and IUI's how many days after your LH surge is detected do you see follicles developing in the u/s?   I'm asking because I just checked my calendar for the previous 3 months and discovered I most likely am ovulating 5 days after my LH surge.  I came to this conclusion because after counting backwards 14 days from each cycle, the day I should have ovulated was about 3 days later than I've had each IUI.  Each IUI was scheduled 24 hrs after the LH surge.   Since DS only lives about 12 hours this has me very concerne for the next cycle.  I'll be calling my dr. Monday to see what he thinks.  But, wanted to know your experiences.  (I'm not having u/s monitoring or trigger shots - just Clomid, OPK's and IUI with ds.)  Any suggestions?

[Heather5]

When I was having my three cycles of IUIs in the beginning of the year, I would have an ultrasound on day 10, and by that point she could already see the follicles and point out the one that would most likely be the dominant one. I would then usually get my LH surge on day 13, and when coming in for the IUI, they would confirm that the dominant follicle was still there (that I hadn't ovulated yet). I would then have a second IUI and ultrasound the following day, and by that time, the egg had been released.

You know what, though, my luteal phase is usually 13-15 days, and some women have even longer luteal phases, so the counting 14 days back from the first day of your new cycle can be misleading. I think they say that at the latest, you'll ovulate 48 hours after the LH surge, so maybe you just have a longer luteal phase instead.

:-)

[Heather5]

Also, if you're not already, maybe you could start charting your temperatures. That way it would be easier to see when you might have ovulated and how long your luteal phase is (since you're not doing u/s monitoring). Just a thought...

[HeathJo]

When I was on Clomid they did an u/s on day 12, and usually the follicles were there and the dominant one identified. Both months I needed an extra 3 days for the follicles to get to a mature size, making that cd15. I know you don't do trigger shots, but they would give me a trigger shot on cd15 and the one IUI I had was 36 hours later.

It seems silly to me that your doctor does not monitor you with an u/s, and also that he uses a 24-hour window. 36 Hours seems to be the standard, trigger or not, but I could be wrong. Still, no u/s??? How in the heck are you supposed to have it timed correctly if they aren't even looking?

I know your situation, and I think you deserve better treatment. XXOOO Heather Jo

[bizbiz]

I would ask for an u/s 24 hours after LH surge (right before they do the IUI), and if the follicle doesnt look like its going to rupture anytime soon, then another u/s again in 24 hours and so on until they think its about to burst, and THEN do the IUI. I detected my LH surge in the morning and went in for an u/s 2 hours later and she said that I was definantly surging because the follicle was all jaggered around the edges. I then had my IUI done the following day at 3pm. Needless to say it was not successfull, and I think this was because I ovulated the day I was surging (not long after she saw the jaggered follicle).

My RE did tell me that you get AF 14 days after ovulation give or take a day, so if you are counting back 14 days and it is still a few days after they did the IUI then you might be right about missing it. My RE still gave me the trigger shot even after I surged naturally and when I asked why he said that even though as a general rule of thumb women surge anywhere between 12 - 36 hours after they get their surges, some do take a few more days, and in your case this might be true.

I dont want to sound horrible but if I were you I would start asking for u/s's - otherwise without knowing exactly what is going on they are wasting your time and money.

Good luck!!

[Tanker Chic]

Everything that i've read says ovulation should occur 24 to 48 hours after lh surge.  Counting backward from the start of your next cycle is a good tool but you have to look at everything else also.  Like is there a thermal shift at that time, if you are using opk when is your lh being detected.  Things like that. I also find opk very confusing and very unreliable tho.  That is why I really don't understand why your dr doesn't want to use hcg trigger shot.  It takes the guess work out of the timing the IUI.  I hate to be negative but if you are paying for it, he should do everything he can to get it right and hcg trigger it the best way.  

With hcg trigger they monitor your follicle size. Once they get to a certain size you do the shot and ovulate approx 36 hours later.  No guessing.  Easy peasy.

I honestly don't think you are ovualting 5 days after your LH surge. I just don't think that is possible.  Maybe your luteal phase is short or you are getting false positive opks.  

According to your bbt temping, how many days is your luteal phase?  Ovulation should occur the day before your temp goes up.  

[Helen72]

Ovulation takes place within 48 hours of LH surge. Your follies should be mature before the surge.  Are you doing BBT this cycle?  BBT should show when O is over.  When do your temps go up after positive OPK?  
Also note that clomid extends LP so counting 14 days backwards on clomid is not a good predictor.

[Lexima]

Hi. Here is how it works at my clinic.  I start going for monitoring 5 days after I start the meds.  By then there is still not much to see.  Maybe a max of 10mm and multiple under 10mm.  I keep going there every other day.  Usually by CD11 Follicles mature to 18-20mm at that time they tell me to stop the meds and do a trigger shot.  I skip a day and go for IUI on CD13.   If I ovulate on my own (like last month), then I go for IUI the next morning right after LH surge was detected.

Good Luck

[LJ307]

Thank you so much everyone for the information. It  really is helping me to put all the pieces together when I learn from your experiences.  Yes, it seems very odd to me that this guy is so againt u/s monitoring.  I will defintely press him more over the phone tomorrow to see how willing he is to do it,if for no other reason than for my piece of mind.  On the other hand, he is the specialist whose had ions of experience with this beyond mine.  So, I want to trust his expertise.  But, I trust YOUR expertise as well!!  It is funny to me that he does do u/s monitoring with injectables, every couple of days, just not with Clomid.  That's a route I would like to take, but it all comes down to $$.   Ok.  Thank you again for sharing your stories.   I'll be phoning the doc. tomorrow.

[Helen72]

If you are not doing trigger, u/s monitoring will be a waste of your money.  It's informative, I guess, and I am always curious what's going on in there but since you just wait for the natural LH surge u/s does not improve your chances.  Simply, it may reveal what chances you may have each cycle by monitoring the # of mature follicles.  Unless you are ready to cancel your IUI because you don't have enough follies, u/s in your case will not be very useful.  
Asking for a trigger is a different story....