Hi all - I posted an intro here a few months ago, but I've only really lurked.
TL;DR version: During my IUI cycles, I noticed that I recruit a lead follicle very early on in my cycle (it's gotta happen between Day 2 and 3). We're trying 2 more IUI cycles before moving to IVF, and I wonder if this early lead follicle recruitment would affect choice of IVF protocol. My doctor has recommended standard antagonist protocol without priming. But I'm wondering if a luteal phase start would be more suited in my case. Any thoughts/suggestions are welcome.
Longer version: MH and I have been doing IUI cycles, some of which have been cancelled because of various issues (follicle too big > suspected post-mature egg; lining too thin b/c of Clomid). Most recently, we've been trying to do Combo IUI, with Clomid/Letrazole plus a low-dose injectable. The goal is superovulation, but for some reason, I only ever develop 1 follicle by trigger day (which is usually Day 9 or 10 for me... VERY EARLY!) I looked back and my history of medicated cycles and noticed that my first two cycles – at a different clinic from where we are now – I started Clomid on Day 2 of my cycle. In those cycles, I always developed 2 mature follicles. But, with my new clinic, my RE has had me starting Clomid and/or Letrazole, on Day 3. Each of those cycles resulted in only 1 lead follicle. So, a secondary question is: has anyone else had this problem in IUI cycles? What did you do to achieve superovulation? I would love to get 2-3 follicles to set ourselves up for greatest change success. My body doesn't seem to want to cooperate.
This is our last Combo IUI cycle (Letrazole and Menopur), and I insisted to my RE that I start on Day 2 (even though she didn't think it would make a difference). If this doesn't work, we're willing to try an injectables cycle. And if THAT doesn't work, we'll do IVF in March. So, I'm already thinking about my best choice of protocol hence the original question: would anything we learned from my IUI cycles impact the choice of IVF protocol?
Thanks!
TTC History
TTC#2
Me: 41; MH: 40 | Met 02/2009 | Started Dating 08/2017 | Married 02/02/2020
Mar 2024 | consult to get established with a new reproductive immunologist (Alan Beer Center)
Apr/May 2024 | required testing & waiting for a protocol
May 2024 | protocol given / decided to go back to my old reproductive immunologist, Dr. Jubiz
Jun / Jul 2024 | more testing, incl. SIS, ultrasound, and endometrial biopsy
Jul 2024 | Dx chronic endometritis; 14 days of 100mg of doxy given
Sep 2024 | Repeat endometrial biopsy; still + for chronic endometritis. 2 more antibiotics + an antiviral
Oct 2024 | Hysteroscopy turned polypectomy; endometriosis consult w/ specialist who confirmed high likelihood of endo based on symptoms and ultrasound; lots of blood tests ordered
Mar 2025 | Endo excision surgery. Stage 3 endo found! Recoveing
Apr 2025 | Planning transfer w/ RE & green light protocol w/ RI; target transfer July or August 2025
May 2025 | Surprise BFP! EDD 1/11/2026
TTC #1
Me: 36, MH: 34 | Met 02/2009 | Started Dating 08/2017 | Married 02/02/2020
TTC #1 02/2020 - 07/2022
2009 | Dx PCOS; likely a misdiagnosis
07/14/20 | Dx Hashimoto's Thyroditis
07/21/20 | 1st RE appointment
07/2120 - 08/20/20 | so much testing; no signs of PCOS
08/20/20 | Dx Unexplained; AMA
09/08/20 | IUI #1 Clomid + Trigger + Prometrium | BFN
09/30/20 | Urology consult; more testing required
10/2020 | Clomid + OPK + TI + Prometrium | BFN
10/26/2020 | Starting 2nd IUI cycle, with Letrazole and with a new RE / different clinic
11/03/2020 | New Dx "poor egg quality"; IUI cancelled in favor of Trigger + TI + Prometrium | BFN
11/26/2020 | Combo IUI (Clomid + Menopur) + Trigger + Prometrium | BFN
12/20/2020 | Combo IUI (Clomid + Gonal-F) + Trigger | IUI Cancelled due to thin lining; TI only | BFN
01/14/2021 | Combo IUI (Letrazole + Menopur) + Trigger | BFN
02/06/2021 | Switched to a new RE (TEW) ; trying naturally until we complete additional testing
03/14/2021 | Hybrid Double IUI, with Zymot (Letrazole, Gonal-F) + Trigger + Endometrin | Ovulated 4 mature eggs but still a BFN ☹️
04/07/2021 | Natural cycle while we regroup | BFN
04/09/2021 | Employer announces fertility benefits starting 05/01/2021! | Search for a new doctor who accepts insurance
05/10/2021 | New RE consult & plan for IVF
05/13/2021 | Mid-luteal IVF cycle #1 interrupted; had to get cancer genetic screening done to make sure I didn't have the same SDHA gene mutation as MH.
06/10/2021 | Aygestin priming IVF cycle #1; opted to Cx after 9 days of stims since only 5-6/12 follicles responded
07/26/2021 | Attempt #2 at IVF cycle #1 (mid-luteal start): 8 retrieved, 8 MII, 6 fert (1 PN3), 3 Day 5 & 6 blasts: 3AA, 3AA, 6AB; 3 euploid
08/09/2021 | Rest cycle / unmedicated TTC | Shockingly, a BFP! EDD: 5/25/202 | CP at 4w4d
09/23/2021 | IVF cycle #2 (mid-luteal start): 14 retrieved, 13 MII, 11 fert, 5 Day 5 & 6 blasts: 2 x 3AA, 2 x 3AB, 3BB; 2 euploid
11/12/2021 | IVF cycle #3 (mid-luteal start): cancelled due to ovaries being on vacation
12/20/2021 | Rest cycle / unmedicated TTC + Pregmune Immunology Testing; BFN
01/22/2022 | Rest cycle / unmedicated TTC + understanding uncovered immunological issues; BFN
02/18/2022 | Mock transfer cycle! ERA, ReceptivaDx, EMMA/ALICE; start Prednisone to address NK activity
03/16/2022 | Final, "Hail Mary" super-ovulation + TI cycle before FET; BFP! EDD: 12/21/2022 | MMC 05/08/2022
05/20/2022 | D&C; recovering...
06/21/2022 | Trying naturally until October 2022
07/21/2022 | BFP! EDD 04/02/2023; 👦🏼 born on 4/5/2023