If you've ever done IUIs please come in (monitoring questions)

mockingjay1

So long story short I am incredibly frustrated with my clinic. The only monitoring I get for my IUI cycles (with femara and trigger) is a CD 12 ultrasound and then ultrasounds to follow up after that (because I'm never ready that early). They don't do any lab work or a CD 3 baseline. I got pregnant after our 3rd IUI but it resulted in a loss. I am now in the TWW of my 3rd IUI post loss (so 6th total) and I'm not hopeful. I had a follicle at 27 and one at 22 (after having to be redosed with femara because I didn't respond to the first dose). My RE obviously waited too long to have me come in. The one time I got pregnant was the one time I had a follie on my R side... this time I was so excited to have one on my R side again, but it was the 27 so likely too big. I've had two normal SHGs and a normal HSG. PCOS is my diagnosis. Here are my questions:

1. What monitoring is done for your IUI cycles as far as lab work and ultrasounds go? 
2. Do/did any of you temp to confirm ovulation? I don't start my progesterone suppositories until after fertility friend confirms ovulation which is consistently 3 days after my trigger shot (and aligns with my CM and cervical position) which leads me to question number 3...
3. Do follicles continue to grow after the trigger shot until you ovulate? If so I feel like mine would always be too big by the time I ovulate.

The nurses in the office tell me contradicting information, and I am so frustrated. I feel like a lot of my concerns get brushed off. My RE is fine, but there is no way in hell I'd do IVF here. I also feel like my RE gets annoyed when I ask him a lot of questions. He believes IUI to be very hands off, but if monitoring me correctly would help guide when to trigger, if I need re-dosed, etc, that would save a ton of money over IVF. After this cycle that I think will be a bust I MIGHT do one more round of IUI while I wait to get a consult for IVF in another state, but I will ask for monitoring my way (which is why I'd really like to know what the norm is). TIA! 

mcgeeva

Hi! Jumping on here. For IUI my clinic always did day 3 bw, then started stims and would come in every other day for ultrasounds and bloodwork until my follies were a 19-20 (which for me was 13-17 days of stims) to then use the trigger shot and do IUI in the next 24-36 hours. I never tempted because with PCOS and the stims the temps won't really be accurate. I trusted my doctors information and daily calls from my nurse to confirm what was going on. Did they use clomid or anything else or just trigger shot? 

tosh24

Hey! I know we've briefly discussed this before, but I just wanted to say that I am sorry you are so frustrated with your clinic. You definitely don't need any added stress during this process.

1. I always had a CD 3 ultrasound (AFC and lining) and blood work (e2, FSH, LH, prog, hcg). On Femara alone, I would go back CD 10 for u/s and b/w and sometimes again CD 12 if needed. Always used a trigger and went in for b2b IUIs the day after trigger (so about 18 hours after trigger) and the day after that (about 36-40 hours after trigger. On injects my first monitoring appointment was CD 7. Progesterone was started the day after the second IUI. I always tested at home and never went in for my beta because my HPTs were always BFNs and they did a beta with CD 3 b/w anyway during the next cycle.

2. No temping. I hear temping while taking meds can lead to some wonky numbers but I've never experienced this for myself because I didn't temp. Now, if my clinic had not done as much monitoring with me and I wasn't comfortable with their care, I might have. 

3. Yes, I've been to 4 REs in the last 8 years and all of them have always told me that your follicles will continue to grow 1-2 mm/day after trigger until ovulation. I had concerns with my RE triggering me too early and asked him to only trigger me after my follicles were 20 mm and he was happy to do so. Your RE should be open to your questions and concerns and shouldn't have a problem with triggering you earlier if that's what you want. There is nothing wrong with advocating for yourself.

I hope your RE is open to hearing your concerns. I wouldn't hesitate to switch clinics either if you have to pursue IVF. GL with whatever you decide! 

mockingjay1

mcgeeva said:

Hi! Jumping on here. For IUI my clinic always did day 3 bw, then started stims and would come in every other day for ultrasounds and bloodwork until my follies were a 19-20 (which for me was 13-17 days of stims) to then use the trigger shot and do IUI in the next 24-36 hours. I never tempted because with PCOS and the stims the temps won't really be accurate. I trusted my doctors information and daily calls from my nurse to confirm what was going on. Did they use clomid or anything else or just trigger shot? 

We've always done femara. I've always had a very clear temp shift with my PCOS (on meds, I don't ovulate without them). The nurses at my clinic said temps don't matter/aren't accurate, but I have a hard time believing that when my temp shift is so clear and lines up with other signs of ovulation. I don't take progesterone suppositories until after I confirm ovulation with temps, so that wouldn't be making my temp go up (and that's the hormone responsible for increased temps after ovulation). 

I think it would help ease my mind if they did lab work. I will definitely ask for better monitoring next cycle if we do one more IUI. I think after being told contradicting information multiple times by different nurses doesn't give me a lot of faith in the information they give.

mcgeeva

I would definitely push for extra monitoring. Also with PCOS the last thing you want is too many eggs to drop. But 27 def sounds really big to be doing trigger then. I would hate to ever miss the window. Are you PCOS with insulin resistance? 

mockingjay1

tosh24 said:

Hey! I know we've briefly discussed this before, but I just wanted to say that I am sorry you are so frustrated with your clinic. You definitely don't need any added stress during this process.

1. I always had a CD 3 ultrasound (AFC and lining) and blood work (e2, FSH, LH, prog, hcg). On Femara alone, I would go back CD 10 for u/s and b/w and sometimes again CD 12 if needed. Always used a trigger and went in for b2b IUIs the day after trigger (so about 18 hours after trigger) and the day after that (about 36-40 hours after trigger. On injects my first monitoring appointment was CD 7. Progesterone was started the day after the second IUI. I always tested at home and never went in for my beta because my HPTs were always BFNs and they did a beta with CD 3 b/w anyway during the next cycle.

2. No temping. I hear temping while taking meds can lead to some wonky numbers but I've never experienced this for myself because I didn't temp. Now, if my clinic had not done as much monitoring with me and I wasn't comfortable with their care, I might have. 

3. Yes, I've been to 4 REs in the last 8 years and all of them have always told me that your follicles will continue to grow 1-2 mm/day after trigger until ovulation. I had concerns with my RE triggering me too early and asked him to only trigger me after my follicles were 20 mm and he was happy to do so. Your RE should be open to your questions and concerns and shouldn't have a problem with triggering you earlier if that's what you want. There is nothing wrong with advocating for yourself.

I hope your RE is open to hearing your concerns. I wouldn't hesitate to switch clinics either if you have to pursue IVF. GL with whatever you decide! 

I think I'd be comfortable triggering at 20-22 if it didn't take me 3 days post trigger to ovulate. I also think if I had better monitoring (like this cycle where one got to 27), I'd have a better chance at success. I've mentioned my concerns to the nurses and doctors before and they get annoyed. Why not at least humor me and bring me in or do lab work to confirm (or not) what I was saying was/wasn't true? I'm not a complete idiot. I know my body well and have a healthcare background. I just want some peace of mind knowing what my body is or isn't doing so I don't feel like I'm wasting time and money. Thanks for letting me vent, friend (as always). 

I just wanted to make sure I wasn't being a complete pain in the butt patient by asking for more monitoring. When I've asked before the RE basically said that's not how they do IUIs there, that they are very hands off. I think if I tell him this is the last time, he'll agree to more monitoring. 

mockingjay1

mcgeeva said:

I would definitely push for extra monitoring. Also with PCOS the last thing you want is too many eggs to drop. But 27 def sounds really big to be doing trigger then. I would hate to ever miss the window. Are you PCOS with insulin resistance? 

I had one at 22 also. I definitely agree, and I am happy with just two follicles, (I think I've had 1 follie 3x and 2 follies 3x, never more) but I wish the 27 hadn't gotten so big. I don't know that i have the insulin resistant diagnosis, but my HbA1c was slightly elevated. I started metformin 1500mg as soon as I started with the RE last year. 

mcgeeva

I could not handle metformin that stuff tore up my stomach like crazy! I'm trying Ovasitol now which has been really good. Well hopefully your next cycle will be much better. I would say if they won't do extra testing I would switch places. Most RE places know anyone with issues will ask a lot of questions so I wouldn't worry about pushing for more. It's a struggle mentally, physically & on your wallet so you deserve the best.

kistra

At my previous RE I always had a CD3 u/s, then a single u/s at day 10 and based on that was told when to trigger and come back for IUI. No bloodwork. I used clomid and ovidrel and still tracked temps and saw a rise the day after ovidrel trigger. I don't know if it is different with different meds.

I am starting with a new RE and they don't do day 3 u/s, may or may not do day 3 bloodwork and want to day daily ultrasounds from day 10 until I have I have 3 follicles over 18mm. The lack of CD3 u/s weirds me out as my RE said that was very important to avoid giving clomid while I might have a cyst and I did have a cycle cancelled based on that CD3 ultrasound with my first RE.  I don't know if this is helpful or not.

ginny_203

Hi, my RE does blood work and an ultrasound anywhere between CD2-5 which helps them to know whether we're ready for another IUI. I take Clomid for 5 consecutive days starting usually around CD 3 or 4. I follow up with another round of blood work and ultrasound on CD 10 and from there they let me know when to trigger and when the next IUI will be.

J1006

We did 4 IUIs with donor sperm with my OB/GYN. She made it seem like the Fertility clinic only did IVF or treatment for other diagnoses. I tested in normal ranges on CD 3 blood work every time I had it. My doctor only did CD 3 blood work before we started IUIs not every cycle. I was on Femara and had one u/s around CD12. I think once I had a follow up u/s.  I did a trigger and then IUI 36 hours after. No meds or monitoring after the IUI. I was just supposed to test 2 weeks after IUI and call if I got a positive, which never happened.  I regret a lot from our cycles. I feel like we just wasted a lot of money and time. If you have any concerns I would definitely voice them. 

Irisheyes81

*** lurking *** I hear your frustration and had those same concerns with that exact protocol with my first RE. Do you use OPK’s? High AMH and double dosing famera can make follicles grow at abnormal rates. The 1-2mm a day is an average but one of my follicles grew 5mm in one day during my IVF stims. Medication and PCOS can be the perfect storm. Most people don’t want to pay for extra monitoring but if that’s what you think will help, demand it. I fired my RE that sounds just like yours and it was the best decision of my life. Good luck! 

mockingjay1

@J1006 & @Irisheyes81 - Thanks! I think you were both on the IUI boards when this last spring when we started doing them. 

J1006 - Your OB/GYN did as much monitoring as my fertility clinic likes to do    Looking at your siggy - good luck with your IVF cycle! 
Irisheyes81 - I don't use OPKs since I have PCOS. Not sure if being on meds would make them more accurate for me or not, but without meds I get positive OPKs without ovulating since my LH is so high. I can't remember what exactly my AMH is, but I remember it was only .6 (ish) higher than the high cutoff of "normal." Two out of my three cycles post m/c they've had to re-dose me due to no response. I don't know if that means I need a higher dose or what. At this point it appears we'll be heading toward IVF anyway. Looking at your siggy too... Congratulations!!! Hope everything is going well! 

Orlaa

With my IUI I had a baseline US before starting injections, to make sure I had no cysts. I went back for US on CD6 and it's lucky I did because after just 3 puregon  (FSH) injections I already had an 18mm follicle and my ovaries were quite swollen so they told me to stop the injections. I went back a few days later for the trigger.
 
I'm slightly PCOS as I have high AFC and AMH is quite high for my age, so I tend to over-respond to meds which makes frequent monitoring so important. Everyone is different so I don't think your RE should be so laid back especially since your follies are obviously quick to grow.