Trouble TTC

IUI Timing, Follicle Rupture, LUF...an interesting NIH article

I was surprised at some of the findings and references in this study. It made me rethink my worries about this cycle's IUI timing (3pm day after first OPK+, with an already very ruptured follicle), and I thought it may be something to think about especially for those with unexplained IF.
  • O can occur in a wide range of time after trigger shot - and the egg is not actually fertilizable until about 6 hours after O.
  • In IUI, sperm do not wait happily in the cervix for 40-80 hours as they do with TI, but instead enter a hostile environment (peritoneal cavity past end of fallopian tubes) about 20 minutes after insemination.
  • 10% of fertile women (and up to 25% of women with unexplained IF using Clomid) experience LUF - luteinized or triggered follicles do not release the egg - which may be a cause of IUI failure.
  • When follicle rupture was already seen on ultrasound at time of IUI , the success rate was over 23%, but when there was no follicle rupture seen yet at time of IUI, success rate was less than 9%. (I know not everyone has an ultrasound at time of IUI, but our office does this so this is really interesting to me). Also note - these success rates do not include cycles for women with endometriosis or total motile sperm <5 million.
  • Almost 1/3 of the time, a smaller mature follicles ruptures before a dominant follicle, but IUI timed to the rupturing of a non-dominant follicle has a smaller chance of success (not that we can get hourly vag cam sessions to time IUIs so carefully!).
January 3T Siggy Challenge - New Year's Resolutions
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Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
MFI (low everything) | Endo Stage 1 & Stenotic Cervix (treated) | PCO
Married - July 2008 | Started TTC - Jan 2009RE Visit #1 - Mar 2014 
IUI #1 ICI #1 - June | IUI #1.1 Laparoscopy - Aug
IUIs #1.2, 2, 3 - Sept, Oct, Nov (Letrozole) - BFNs 
IUI #4 - Dec (Bravelle) | IUI #5 - Dec/Jan (Bravelle) - 5 follies + TI - BFNs
IUI #5.1 - Jan (Bravelle) Cancelled 
Planning to start IVF in March!
***All Welcome***

Re: IUI Timing, Follicle Rupture, LUF...an interesting NIH article

  • @angelina2404 I think (perhaps the article link can explain it better) that it should take up to 20 minutes for sperm to reach the end of the fallopian tube, but once there they will be exposed to the environment of the peritoneal cavity where they will be attacked by the body's immune system. So no word on exactly how long they can live there - but it's not a nice hideout for them like the cervix is, I suppose.

    Sorry you're worried about the timing now, Lol! I was thinking, perhaps that's why it can take a few tries, because the timing is always a bit different? 
    January 3T Siggy Challenge - New Year's Resolutions
    image
    imageimage

    Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
    MFI (low everything) | Endo Stage 1 & Stenotic Cervix (treated) | PCO
    Married - July 2008 | Started TTC - Jan 2009RE Visit #1 - Mar 2014 
    IUI #1 ICI #1 - June | IUI #1.1 Laparoscopy - Aug
    IUIs #1.2, 2, 3 - Sept, Oct, Nov (Letrozole) - BFNs 
    IUI #4 - Dec (Bravelle) | IUI #5 - Dec/Jan (Bravelle) - 5 follies + TI - BFNs
    IUI #5.1 - Jan (Bravelle) Cancelled 
    Planning to start IVF in March!
    ***All Welcome***
  • Thanks for posting. Very interesting. @bunnyberry Quesssssshhhhh. When they are talking about the follicle rupture at time of u/s do they mean like the follicle has since released the egg and has disappeared or do they mean like your can actually see where it's ruptured? The reason I ask is because when I had my iui on wed my 23mm follie from Monday was gone already. And I triggered Monday night!
    Me: 26 (IC/PCOS-2000mg of Metformin daily)

    June 2014- HSG=clear

    DH: 27 (SA results were great minus the slightly low morphology)
    Started dating DH in 2002 at 14 years old
    Married on 03.01.2014
    Officially TTC since April 2014 
    January 2013- Surprise BFP, m/c at 6 weeks, D&C 2 Weeks later
    April 2014- First RE appointment
    July 2014- IUI#1-Canx due to scar tissue and polyps. TI with the help of Ovidrel. BFN

    August 2014- Hysteroscopy to remove scar tissue and polyp

    September 2014- IUI #1.1-100mg Clomid, Ovideral, 11.5 million swimmers=BFP

    EDD-6/3/15- Our sweet baby Ryan was born on 1/6/15 and is in the arms of an Angel

    Dx with IC on 1/6/15



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  • @carsaidyes Good question - I assumed that seeing it in the midst of rupturing counted too? But not sure.
    January 3T Siggy Challenge - New Year's Resolutions
    image
    imageimage

    Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
    MFI (low everything) | Endo Stage 1 & Stenotic Cervix (treated) | PCO
    Married - July 2008 | Started TTC - Jan 2009RE Visit #1 - Mar 2014 
    IUI #1 ICI #1 - June | IUI #1.1 Laparoscopy - Aug
    IUIs #1.2, 2, 3 - Sept, Oct, Nov (Letrozole) - BFNs 
    IUI #4 - Dec (Bravelle) | IUI #5 - Dec/Jan (Bravelle) - 5 follies + TI - BFNs
    IUI #5.1 - Jan (Bravelle) Cancelled 
    Planning to start IVF in March!
    ***All Welcome***
  • @rainbowbridge14 I interpreted that part as meaning that part of the time, one or more mature-size follies, but not the dominant follie, ruptures first - I didn't think it was talking about the smaller ones below mature size.

    I hope your new doses work perfectly! :)
    January 3T Siggy Challenge - New Year's Resolutions
    image
    imageimage

    Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
    MFI (low everything) | Endo Stage 1 & Stenotic Cervix (treated) | PCO
    Married - July 2008 | Started TTC - Jan 2009RE Visit #1 - Mar 2014 
    IUI #1 ICI #1 - June | IUI #1.1 Laparoscopy - Aug
    IUIs #1.2, 2, 3 - Sept, Oct, Nov (Letrozole) - BFNs 
    IUI #4 - Dec (Bravelle) | IUI #5 - Dec/Jan (Bravelle) - 5 follies + TI - BFNs
    IUI #5.1 - Jan (Bravelle) Cancelled 
    Planning to start IVF in March!
    ***All Welcome***
  • @angelina2404 Lol, I wondered too where they found the subjects for that hourly vag cam study! I guess we IFers will do whatever it takes.
    January 3T Siggy Challenge - New Year's Resolutions
    image
    imageimage

    Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
    MFI (low everything) | Endo Stage 1 & Stenotic Cervix (treated) | PCO
    Married - July 2008 | Started TTC - Jan 2009RE Visit #1 - Mar 2014 
    IUI #1 ICI #1 - June | IUI #1.1 Laparoscopy - Aug
    IUIs #1.2, 2, 3 - Sept, Oct, Nov (Letrozole) - BFNs 
    IUI #4 - Dec (Bravelle) | IUI #5 - Dec/Jan (Bravelle) - 5 follies + TI - BFNs
    IUI #5.1 - Jan (Bravelle) Cancelled 
    Planning to start IVF in March!
    ***All Welcome***
  • Thanks for sharing this! Very interesting read! Now I definitely want my next IUI to be 36 hrs after trigger instead of 24!
    Me: 37 DH: 37, married since Sept. 2013. "actively" TTC for a total of 13 months (after 7 months of TTC, took a 1 1/2 year hiatus due to work scheduling and wedding planning. Started up again after our wedding in Sept.) First evaluation by an RE November 2013

    HSG-normal
    OH-tiny polyp found, but RE assured me she doesn't think it's contributing to infertility and doesn't recommend me to remove it because it's so small.
    DH's SA-normal
    Hormones all within normal levels
    Ovarian Reserve-RE says "is great" she's not concerned about my egg quantity (which I was until I saw her and results came back good!) 

    04/2012 50mg Clomid=BFN (prescribed by OBGYN, not monitored)
    06/2012 50mg Clomid=BFN (prescribed by OBGYN, not monitored)
    11/2013 100mg Clomid, with HCG trigger=BFN (prescribed by RE, monitored with US (2 dominant follicles) and baseline bloodwork done)
    01/2014 100mg Clomid, with HCG trigger-(prescribed by RE, monitored with US-1 dominant follicle)=BFN
    06/2014 7.5mg Letrozole, HCG trigger (prescribed by RE, monitored with US-2 dominant follicles), IUI #1 on 7/3/14=BFN
    07/2014 7.5mg Letrozole, benched for IUI#2 this cycle, because I ovulated on my own before my follicular US. Progesterone suppositories=BFN Diagnosed with PCOS this month too. Testosterone levels high at 76. =( 
    08/2014 7.5mg Letrozole, HCG trigger with 19mm follicle. IUI#2 on 8/31 cancelled last minute due to family emergency. 
    09/2014 Taking a 3 month break starting this month. If not pregnant in 3 months, will start up again with medicated cycles and IUIs. Had all my labs and AFC re-evaluated this month also. RE says nothing much has changed since my eval last November, okay for me to take a little break. =) 




  • Interesting! Thanks for sharing.

    as a side note: my phone autocorrected "interesting" to "inbreeding"
    I'm glad I caught that. It would have been an odd/awkward/funny comment to this post :))

    4 Losses (2003, 2008, Apr 2012, & Oct 2012)
    All RPL and IF testing with multiple REs = normal

    5 IUIs = BFN

    All AL are welcome
    Image and video hosting by TinyPic

  • @rachaeleigh That would have been so funny! I would have been thinking, um....? :)
    January 3T Siggy Challenge - New Year's Resolutions
    image
    imageimage

    Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
    MFI (low everything) | Endo Stage 1 & Stenotic Cervix (treated) | PCO
    Married - July 2008 | Started TTC - Jan 2009RE Visit #1 - Mar 2014 
    IUI #1 ICI #1 - June | IUI #1.1 Laparoscopy - Aug
    IUIs #1.2, 2, 3 - Sept, Oct, Nov (Letrozole) - BFNs 
    IUI #4 - Dec (Bravelle) | IUI #5 - Dec/Jan (Bravelle) - 5 follies + TI - BFNs
    IUI #5.1 - Jan (Bravelle) Cancelled 
    Planning to start IVF in March!
    ***All Welcome***
  • Thank you for posting this! This is great info. We should add this to the newbie blog.
    Love 2010 | Marriage 2011 | TTC #1 since 2012
    PCOS | Anovulatory | Metformin + Letrozole
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