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332747 tn?1198120117

follicles and IUI

I keep reading that you all are able to see how many follicles you have before your IUI.   I'm single and 42, ttc for the first time.  I'm using donor semen and IUIs.   I've had two so far.  The first IUI wasn't successful and I just had the second IUI on 11/13.    I've asked my dr. for a blood test, or ultra sound to determine if I'm trully ovulating before I schedule my IUIs.  However, the doc. just states doing a 21 day post ovulation progesterone test is sufficent to know if I'm ovulating.  However, my concern is, my age - the cost of IUI's and donor sperm and the 21 day post-ovulation blood work only tells me past tense.   Because of my age and the cost of IUI's I'm frustrated with my doc.  Is it typical for docs. to perform a sonogram/ultrsound or blood work to determine ovulation and number of follicles?
8 Responses
189192 tn?1261341628
I would change dr ASAP. If you are paying for IUI and donor sperm you need to have the best chances possible.  Tyipcal protocal includes (cd depends on typical cycle for that person so it may vary)

Cd 10 u/s to verify development of maturing follicle(s). After the initial cycle, depending on the dr this one may be skipped on follwing cyles.
Cd 12 u/s to verify size/maturity of follicle(s)
If follicle(s) is mature on cd12 you do an HCG trigger shot that evening to ensure you ovulate in the next 36 to 48 hours.
Cd 14 do IUI approximately 36 hours after hcg trigger shot

In addition to this, some people will take follicle stimulating meds (like clomid) to develop addtional follicles.  I've done it both ways and have gotten positive pregnancy test with and without extra follicle.  Unfortunately the first time didn't work out.  
Sounds like your dr is leaving way to much to chance.  I would change before I wasted another $$.  Best of luck to you!!
296340 tn?1336164001
I agree with Tanker Chic.  change Dr asap.  this is my routine for monthly cycle

Cycle 3 - 7 - I took Clomid 50mg -- some ppls take 100mg
Cycle 8 - 12 - I took Estradiol 200mg {cycle 10 I have appt to do sonogram to see how big is the follicles and if it's mature}

Cycle 12 - I went to see Dr. again for another sonogram to see if follicles ready to rupture.  If follicle size about 20+mm, Dr will give me trigger shot (novarel) usually on cycle 12 or 13 then on cycle 14-15  I come back for IUI or if you want to do naturally you start doing it during that time.

After all that, I wait for 2 weeks to come back for HCG test.  

That how the routine should go.  If you feel this dr do not do the job, change to another one.  don't have to stick with him/her.  

good luck
186627 tn?1257877774
I agree.Are you seeing an OBGYN?Maybe you should switch to a RE.
Good luck!
332747 tn?1198120117
Yes, I'm seeing an OB/GYN fertility specialist!   I went to my first visit last month asking about all the things you've mentioned.  He stated that my 21 day progesterone test levels were adequate for showing I'm ovulating and so anything else was unnesessary.   When I mentioned to him my concern regarding my age and the cost of donor sperm and IUI, he just said "Well, as long as you're ovulating your age really doesn't have any bearing! The cost of your procedure doesn't really have a bearing on how to treat infertility"  He does have me on 50mg Clomid.  I asked if we could up it to 100mg after the first IUI wasn't successful.  He said it wasn't necessary.  He wanted me to keep ttc for 6 months before raising it.  Hmm....me thinks he may be may be idiot.  (-:
He is a very young dr, maybe inexperienced, I don't know.  Wow, I have to wait 2 weeks now to see if this IUI was successful.  Hopefully it was and all is well.  But, if not - I'm requesting a new doc. for sure.  

I"m so grateful for all the info. you've given me!  Thanks for replying!!  Best of luck to you in TTC as well!!!  
189192 tn?1261341628
Without u/s and HCG trigger shot, you probably are ovulating on your own but it is like trying to hit a moving target.  If you are paying for IUI and ds, he needs to hit the bulls eye!!  

You might try seeing a RE (Reproductive Endocrinologist) instead of an OB/GYN.  good luck to you!!!
332747 tn?1198120117
Thank you so much.  You're right about it being like trying to hit a moving target.  Especially since frozen sperm has a very short life span 12 - 24 hrs versus up to 5 days fresh offers.  Plus with a partner you logically have lots of chances to try, but with the IUI & ds it's a one shot deal.    I'm not gonna fret about it this month, nothing more I can do but wait it out now.  I hope it's a good sign that I have no side effects from Clomid this month.  Had lots of cramping, stomach aches, mood swings, back aches, and fatigue last month.  

How long have you been ttc and/or are you pregnant?
Avatar universal
I did 3 months at 50mg Clomid, then my doctor bumped me to 100mg for 6 months, but she said, after that, if that hasn't worked, move on to a Reproductive specialist (RE).   No sense wasting time when all my and my husband's tests came out fine.  RE tested by ovarian age and all came out fine.  The RE didn't waste time and went right to IUI.  
Avatar universal
This is also an older post but I will comment. I have been TTC to three yrs, I am almost 41, two miscarriages, mild endo, history of ovarian cysts, and this past year I have not gotten hardly  any positive OPK's and in my opinion, I am not ovulating though I get cycles every month and two different GYNS told me I am ovulating, but I doubt this. I do not think the day 21 actually confirms if youve ovulated, and if you're being medically monitored, your RE should be looking at your follicles midcycle and if you're doing a trigger shot, you SHOULD ovulate with the help of an RE- the problem is older eggs make it very hard to conceive. I got pregnant from two IUIs using injections but I miscarried, and I knew I ovulated because I had some large follicles around CD 15, triggered, and got the IUI done. I have not been monitored for a while but I am back to going to the RE because nothing has happened the last few cycles and I am trying naturally with a male partner. I am on a low dose of injections and 50 mg Chlomid (which I hate and can barely tolerate) but I have no insurance coverage for any fertility stuff so we're going to see how I do and my next ultrasound is Monday. I feel cramping but I am curious if I have more than one follicle as I am older, elevated FSH, but I tend to be a decent responder to meds. Also, my last fertility DR tested my E2 levels right before the IUI- it gives them an idea of how mature your eggs in the follicles are- they should be atleast 200, and the higher, the better. I had an e2 of over 600 when I conceived both times. In my opinion, with your age and the costs of IUIs, I feel for you- it is frustrating and I would switch doctors. You need one that is aggressive and I can say both of my docs have been. So you should be taking injectables at this point, getting ultrasounds to look at follicles, and an e2 test before the IUI. I dont actually know if there is a blood test to see if you actually ovulated, they just look at hormones to see what your progesterone level is and that is only an indication. Good luck and I wonder if you've had any BFP's??
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