Lead follicle (again) after only 4 days of stims - IUI#2 ?'s

solarflare

Hi there,

Thanks in advance for your help! I always ask so many questions at the RE and then I come home and have more so I'd love to hear your experiences with the following.

I am on 150iu Menopur for 4 days so far. I am only on CD7. Today my Estradiol was 180 and there was one lead follicle at 17 and another smaller at 12, and then a bunch under 10.  Last IUI I was on Letrazole/Menopur and also had a lead follicle early on. Both times, the only follicles over 10mm are on the left side.

1.Is it bad for the lead follicle to mature quickly in terms of egg quality? I will probably be doing the IUI at the end of this week around day 10 or 11 because it's going too quickly.

2.Does a lead follicle suggest poor responder? 

3. Do you find that you only produce large follicles on one side? The nurse said this was normal but I find it strange. If you've done IUI's several months in a row, does the one dominant ovary switch sides? 

TIA! 

 

 

Edwina.McDunnough

I am confused by your DOR dx if you have an AFC of 20, and are very responsive to stims. Your FSH is elevated, but in no way high. (I'm not trying to be snarky, I am curious how your RE came to this dx. because your ovarian reserve sounds normal.)

1. 10-12 days of stims is optimal. That being said, I know people that naturally ovulate early and have kids and people on the board have gotten pregnant outside that window.

2. I'm not an RE, but I suspect your stims are too high and that your natural lead follicle is hogging all your excess FSH. Remember that the goal of IUI is not a large amount of mature follicles, very often 1-2 is the goal unless you are very AMA or have severe sperm issues, etc. Also oral medications work very differently than injectable and you can't compare apples to oranges. If you have only done 2 IUIs with different stim mechanisms, you really can't compare them fairly. Unfortunately, all of this is trial and error a lot of the time. 

A poor responder would require high doses of FSH and very long stim schedule.From what you describe I would not consider you a poor responder and IMHO lead follies come from flawed stim protocols (Not that your RE is bad, but the particular cocktail isn't optimum. In the case of IVF you'd either undergo some suppression to keep the cohort together, or lower the dose, or do step down stims, etc.; lots of options, but for IUI they tend to keep it simpler and just adjust the Rx.).

3. Yes. Lefty works harder, but sometimes Righty steps up and is queen. 

solarflare

Edwina.McDunnough:

I am confused by your DOR dx if you have an AFC of 20, and are very responsive to stims. Your FSH is elevated, but in no way high. (I'm not trying to be snarky, I am curious how your RE came to this dx. because your ovarian reserve sounds normal.)

Thank you SO much for your detailed responses! I was suspecting the same about the drug cocktail so will ask about this tomorrow. 

This RE gave me the diagnosis of DOR when I saw her the first time due to my Clomid Challenge results: 6.6 on day 3 and 13.7 on day 10. She is treating me as a DOR patient even though she does comment that my AFC is not corresponding with that (yet another thing I don't get). Although this time my AFC was 14 so I need to change the 20. Also my FSH day 3's have always been close to 10 which raises a red flag for them. 

Thank you again and for sharing about your super-righty. That's interesting to note.  

Edwina.McDunnough

DOR is complex, and you can't look at one test result and make a call. Many different tests and counts and whatevers all factor in, including your response to meds. I am not sure this dx iis helping you out if you are being handled too aggressively. If you don't fit onto one clean definition, you could really benefit for an individualized approach, especially if you have to turn to more advanced therapies. Having AFCs that bounce around is normal, and 14 is still really great. I hope all these pesky numbers end up being moot and your cycle ends successfully.

solarflare

Edwina.McDunnough:

DOR is complex, and you can't look at one test result and make a call. Many different tests and counts and whatevers all factor in, including your response to meds. I am not sure this dx iis helping you out if you are being handled too aggressively. If you don't fit onto one clean definition, you could really benefit for an individualized approach, especially if you have to turn to more advanced therapies. Having AFCs that bounce around is normal, and 14 is still really great. I hope all these pesky numbers end up being moot and your cycle ends successfully.

Thank you. I agree. And I need to talk with her more about this diagnosis. I feel like that pesky patient always asking so many questions, but I know we need to be our own advocates in this process.  Thank you for your contributions and informed explanations. I hope to do the same for you. But mostly, I hope this whirlwind ends for all of us positively, and sooner rather than later. Thank you Edwina.