Trying to Get Pregnant
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IUI with multiple follicles

Hi everyone,
I am starting my first IUI cycle after our last timed intercourse cycle failed and I will be taking clomid (day 5-9) then gonal-f injections and then trigger shot. I am wondering since I only had 1 mature follicle (20mm) and 2 smaller ones (10 and 11mm) with these same medications last cycle, if you did IUI and had multiple follicles (and resulted in multiple pregnancies) could you please share with me what helped you get more follicles? My doc does not want to increase my dose yet because she said I responded well but I feel like having at least 2-3 mature follicles would increase our chances and we would be happy with multiples too if we are blessed to have more than one baby.

Re: IUI with multiple follicles

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    Your response to medication and dosages is going to be different from others. Regardless of what others took for meds and dosages and had multiple follicles does not mean you will see the same number of follicles.

    Back when I did IUIs I did the same dosage of letrozole for all 3 IUIs. My first round I had 2 leading follicles developing but in the end only 1 was mature at the time I was ready for the trigger shot. The following IUIs all showed only 1 follicle growing the whole time. So same dosage, different results.
    *TW* History:
    Me: 34 DH: 36 | Together since 2007 | Married July 2016

    TTC #1 since 7.2017
    Dx: low morph (1%), ANA positive, low decidualization score, high TSH and testosterone, histone antibodies

    IUI #1-3 all BFN
    IVF #1 | 6.11.19 | 24R, 17M, 15F, 6B, PGT-A tested - 5 normal, 3 girls & 2 boys
    FET #1 | 9.10.19 | BFN "I know you, but we've never met. I'm with you, but I don't know your name"
    RPL, Receptiva, & ERA testing | all normal/negative, recommended going on gluten and dairy free diet for next FET
    FET #2 | 3.31.20 | Opted to cancelled due to pandemic, continued diet and tried naturally over the summer
    2nd Opinion with another RE | 8.20.20 | Not immune to measles (received 1 dose); SA results similar to 2 years ago; decided to move forward with FET #2 redo at start of next cycle
    Surprise natural BFP! | 9.22.20 | MC 10.23.20 at 8 weeks
    TTCAL naturally | starting 11.22.20

    Initial consultation with Reproductive Immunologist | 9.14.21
    Decidualization score biopsy | 10.1.21 | abnormal - low score of 1; endometrial scratch recommended and progesterone supplementation
    Saline sono | 10.15.21 | normal
    Bloodwork | 10.21.21 high TSH, high testosterone, positive for anti-nuclear antibodies and histone antibodies, high protein S, multiple genetic mutations
    BFP! | 11.3.21 | EDD 7.14.22 B) | biopsy provided same effect as endometrial scratch; added supplemental progesterone and estrogen, prednisone, levothyroxine, and MTX Support to maintain pregnancy
    DS born 7.19.22 after induction


    TTC #2 begins 6.2023
    Consultation with RI | 6.6.23
    Saline sono, endometritis biopsy, skin & eye check | all normal
    Labs | high TSH, Factor XIII mutation, high %CD56
    Follow up | 8.8.23 | prescribed metformin, prednisone, plaquenil, and levothyroxine
    Repeat labs after 3 weeks on meds
    Follow up | 11.9.23 | Green light!, increase in prednisone, added lovenox
    Repeat labs in 8 weeks
    Follow up | 1.16.24 | Green light continues
    TTC put on pause indefinitely
  • Options
    From what I’ve read, there isn’t a substantial increase in pregnancy rates when stimulating multiple follicles, so standard practice is to aim for one follicle or two at the most.
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    I have not yet made it to term with multiples. However I’ve one had ONE iui over the years that we know was a singleton pregnancy. The doctor was hesitant just this past Monday because I had so many follicles neck and neck. Hopefully I’ll get my positive next week and can see what’s going on in three weeks time :)
  • Options
    *lurking* 

    @prayingforbabyt23 starting Letrazole earlier should help with more follicle recruitment. I used to always start on Day 2 or 3 at the latest, because my body recruited a lead follicle SUPER quickly. I don't know how old you are, but the chance of multiples goes down pretty quickly the older you are. To the point that when you're in your early 40's, having 4-5 mature follicles has a very low risk of multiple. 

    Note: mulitple pregnancies is nothing to "wish for" as it usually results in lots of complications for both mother and the babies, like vanishing twin, early delivery, etc. 

    My experience with superovulation (the medical term for growing more than 1 follicle) *TW* loss

    I twice did "superovulation" cycles: 

    1st time, 4 mature follicles at the age of 37. Trigger shot and double IUI with Zymot. No pregnancy.

    2nd time, 5 mature follicles, at the age of 38, Trigger shot and Timed Intercourse. Single pregnancy that resulted in an MMC at 7w4d. 

    MY CHART
    TTC History
    TTC#2
    Me: 40.5; MH: 39 | Met 02/2009 | Started Dating 08/2017 | Married 02/02/2020
    TTC #2 ... preparing as of March 2024


    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


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