Rapid Follicle growth with Femara yet no LH surge

I am on my second cycle of clomid and noticed one common thing in both of my cycles. I see trhat my follicles grow very rapidly with Femara. My lead follicle was 32 mm on CD14 in the last cycle, so my RE asked me to come in early in the next. So in my second cycle I went in on CD12 and found my follicle was 28 mm, that's when they gave me trigger shot this time. My question is that am I not supposed to get a LH surge when the follicle grows like 18-22mm and then I should be ovulating. Why at both times I did not get a surge at that size and why did I not ovulate.

[HeathJo]

I remember your post about your gigantic follie last month! You are on Femara now, right? You said Clomid first, then Femara, but I think I remember you are on Femara.

Anyway, a trigger shot is called such because it "triggers" ovulation. Thus, your doctor is inducing ovulation before your body actually does it naturally. With fertility issues, many women (including me) do not ovulate normally on their own all of the time, so that may be why you did not last cycle. Have you been diagnosed with PCOS? If not, it could just be that the fertility meds alone just stimulate the ovaries but do not cause them to release the follicles. This is why you need the trigger shot. Are you doing IUI?

[candie429]

As far as an LH surge goes, if you get one, does that absoutely guarantee that an egg will be released?  That's pretty much my doctor's belief, but I see so many of you getting the trigger shot that it's confusing.

[jzyj]

my RE told me with meds, they don't normally use OPK to monitor O. they use u/s and trigger shot. once they see the leading follicles reach 18~20, give the trigger shot and come in 36 hrs later for IUI. I wasted 5 previous IUI because my NP was using OPK and trigger shots to determine timing for IUI and I was shock to find out from my RE that this is not the standard practice for IUI with meds. good luck!

[vergovana]

hi,it seems for me that your ovaries r responding good to medice but the problem is in release of ovum,sometimes ovum mature&reach good size but don't get out it's follicle,that's why u have to take trigger shot,ithink it is v.essential specially in your case&right it takes about 36 to 42 hours to release egg so u have to regulate bd in that time&sorry for your wasted 5iui hoping this time ends in a baby.

[G_S]

HeathJo: Yes you are right...I have been on Femara in both of these cycles. Clomid was a typo, dont know what I was thinking (maybe reading a post on clomid before I wrote this). But I have been on Clomid for 6 cycles before I started Femara (which I have taken in the last 2 cycles). I know for sure my follis really stretched hard to reach 18 mm by CD17 with Clomid. So Femara seems to be working better for me. I have been diagnosed of mild PCOS. And yes I have had IUI in both of my Femara cycles.
Thanks for the info. I see what you are saying. Even if the follis grow to the optimal size it dont mean ovary will release the folli because the required hormone is not there. I was under the impression that follis themselves produce the required hormone and when the grow to 18 mm this hormone is enough for ovulation to occur.

Candie: In my first Femara cycle I got a nartual Lh surge and ovulated on my own. The did not give me a trigger shot because my folli was 32mm...too big to be given a trigger shot according to them.

jzyj: Thanks for sharing your experience. My RE is using US to monitor my folli grown. They also ask me to do OPK until the day of my US just in case I get an early surge, in which case I should be going for an US immidiately

vergovana: Thanks for your thoughts. I am hoping hard this is this cycle is the one, but again my folli was 28mm when they gave me a trigger shot. So hoping it would work out fine.

I know 18-22mm is the optimal size of folli for a trigger shot. But does anyone know what is the max GOOD size folli??

[vergovana]

the max.good follicle size is about 22-24,iknow that for an ovum to b released from its follicle its size have to exceed 20 but don't worry 28 isn't that big size to say egg is spoiled or we r late in trigger shot as human body isn't a machine with district sizes &results,i had 1 before 26&took trigger&by u\s found it released &endometrium was good indicating that it was active,hope good for u &don't worry.

[G_S]

Thank you for your inspiration. I was starting to think maybe I get too late to get the trigger shot. I will know for sure about the ovulation with my progesterone testing day after tomorrow