Warning a little controversial but need advice...

mckiernk · May 2011

Hey ladies,

I went for my u/s and bw this morning after having 5 days of 150 IU follistim. They said I am responding slow and steady like they wanted but the nurse had some concern this morning because I had quite a few follicles. On Left: 1@15 and 3@13 and then on the right there are 2@13 and the nurse said that the doctor might make me cancel the cycle or switch to IVF. I mentioned to her that we had discussed the option of selective reduction in the case of more than 3 and since the risk is on the lower % range that we would rather stick with IUI this cycle and see how it works out rather than go through IVF. When I said this she seemed to think that the doctor would probably let me go through with the IUI then.... However, I didn't really know what the procedure entailed and I researched it and now I don't think I could do that... I know this topic is hugely controversial and I know there are many out there that do not and could not even think about it and I completely respect that .. I am torn and I need some advice .... ladies??!!

SmlTownGirl87 · May 2011

I honestly wouldn't be able to do it. But like you said, every one is different. With that being said... last cycle I was supposed to have an IUI but was converted to an IVF cycle for the same reason. It wasn't so bad. They were able to get 7 eggs. This cycle we did a full IVF cycle and they were able to get 10. So it really is up to you. IMO - I would take the conversion. Hope this helps.....

jessican08 · May 2011

I'm sorry you're faced with this decision. If you're feeling now like you don't think you can go forward with selective reduction, chances are you're REALLY not going to be able to do it once you've seen your babies on an ultrasound.

Without knowing your background it's hard to say what I would do in your situation. Have you had previous IUIs that have failed? Does your husband have a very low sperm count? If you've had less than 3 IUIs, and your husband's sperm count is just on the low side, if I were in your shoes, I would cancel or do IVF with that many follicles. Maybe next time they can lower your dosage now that they know how you respond.

GL in your decision.

andrea817 · May 2011

I know everyone has VERY different opinions on this, but personally while I am not morally opposed to selective reduction, I don't think I would risk an IUI w/ that many follicles. I would convert to IVF or skip the cycle altogether.

amor_eterno · May 2011

andrea817:
I know everyone has VERY different opinions on this, but personally while I am not morally opposed to selective reduction, I don't think I would risk an IUI w/ that many follicles. I would convert to IVF or skip the cycle altogether.

I feel exactly the same way, it just sounds like too many follicles. GL with whatever you decide.

hunterjumper102 · May 2011

LGLDVM:
My advice and it is certainly not what everyone believes:
If you choose to go through injectable treatments with IUI you need to be prepared to either have high order multiples and deal with what that entails OR do selective reduction. If you are uncomfortable with (well, no one is comfortable with those things--if you are completely opposed to) those options, you should do IVF. This is a deeply personal decision and one that you and your SO need to agree upon before moving forward.
The reality is, you can end up with quads even when the u/s only shows 2 follicles over 15 mm (and not 2 identical pairs, actual fraternal quads). Converting cycles where response is too high can reduce the liklihood of multiples, but it cannot eliminate it, there is always a risk with this type of treatment.

This! You put into exact words how I feel. If you are ok with HOM and the risks that go along with it or are not opposed to selective reduction then go for it. If you are not ok with those risks and procedures I would convert to an IVF.

ChicagoWeded2007 · May 2011

Hi,

I chose to cancel this cycle because we had 4 follicles. I knew I could not go through selective reduction. And then I found out they don't do it until 12 weeks when the baby is really a baby in my mind.

I was a gut-wrenching, difficult decision. We decided that since it was only our first medicated cycle and my Dh's numbers had been very good that we would rather wait a cycle than risk triplets. Good luck with your decision.

jstrat53 · May 2011

ChicagoWeded2007:

Hi,

I chose to cancel this cycle because we had 4 follicles. I knew I could not go through selective reduction. And then I found out they don't do it until 12 weeks when the baby is really a baby in my mind.

I was a gut-wrenching, difficult decision. We decided that since it was only our first medicated cycle and my Dh's numbers had been very good that we would rather wait a cycle than risk triplets. Good luck with your decision.

I never had a strong opinion one way or the other on selective reduction but I never knew this! Wow, that is kinda crazy! I don't think I could do that.

ChicagoWeded2007 · May 2011

jstrat53:
ChicagoWeded2007:

Hi,

I chose to cancel this cycle because we had 4 follicles. I knew I could not go through selective reduction. And then I found out they don't do it until 12 weeks when the baby is really a baby in my mind.

I was a gut-wrenching, difficult decision. We decided that since it was only our first medicated cycle and my Dh's numbers had been very good that we would rather wait a cycle than risk triplets. Good luck with your decision.

I never had a strong opinion one way or the other on selective reduction but I never knew this! Wow, that is kinda crazy! I don't think I could do that.

Yes, I believe they would want to check for down syndrome before deciding which one to terminate.

sbrowns08 · May 2011

If you want strictly my opinion I would convert to IVF as I would never reduce. We've been through way too much.

That being said, you have to do what's right for you. Best of luck with your decision.

ChicagoWeded2007 · May 2011

LGLDVM:
ChicagoWeded2007:
jstrat53:
ChicagoWeded2007:

Hi,

I chose to cancel this cycle because we had 4 follicles. I knew I could not go through selective reduction. And then I found out they don't do it until 12 weeks when the baby is really a baby in my mind.

I was a gut-wrenching, difficult decision. We decided that since it was only our first medicated cycle and my Dh's numbers had been very good that we would rather wait a cycle than risk triplets. Good luck with your decision.

I never had a strong opinion one way or the other on selective reduction but I never knew this! Wow, that is kinda crazy! I don't think I could do that.

Yes, I believe they would want to check for down syndrome before deciding which one to terminate.

Not everyone has genetic testing done prior to SR, it is left up to the parents or advice of the doctor based on risk factors such as age and medical history. Generally the procedure is performed between the 8th and 11th week. The reason they wait is because with HOMs it is very common for one or more of the fetuses to die naturally (spontaneous abortion) and they want to ensure that they only terminate if they have to. Once the heartbeats are detected the likelihood that a fetus will die on it's own is much lower. But---at 8 weeks, the fetus looks like a little baby and has a beating heart (obviously) so the difference of a couple of weeks would not make it any easier for me. It is a real loss and a decision that cannot be taken lightly.

If you are going through these treatments, you need to sit down and think about the 'what-ifs'. I get the impression that many women on this board think that they are 'safe' from HOMs if they cancel cycles or convert to IVF, but I am telling you, the risks are still very much there.

Thanks for the extra info. That is good to know.

ChicagoWeded2007 · May 2011

LGLDVM:
ChicagoWeded2007:
jstrat53:
ChicagoWeded2007:

Hi,

I chose to cancel this cycle because we had 4 follicles. I knew I could not go through selective reduction. And then I found out they don't do it until 12 weeks when the baby is really a baby in my mind.

I was a gut-wrenching, difficult decision. We decided that since it was only our first medicated cycle and my Dh's numbers had been very good that we would rather wait a cycle than risk triplets. Good luck with your decision.

I never had a strong opinion one way or the other on selective reduction but I never knew this! Wow, that is kinda crazy! I don't think I could do that.

Yes, I believe they would want to check for down syndrome before deciding which one to terminate.

Not everyone has genetic testing done prior to SR, it is left up to the parents or advice of the doctor based on risk factors such as age and medical history. Generally the procedure is performed between the 8th and 11th week. The reason they wait is because with HOMs it is very common for one or more of the fetuses to die naturally (spontaneous abortion) and they want to ensure that they only terminate if they have to. Once the heartbeats are detected the likelihood that a fetus will die on it's own is much lower. But---at 8 weeks, the fetus looks like a little baby and has a beating heart (obviously) so the difference of a couple of weeks would not make it any easier for me. It is a real loss and a decision that cannot be taken lightly.

If you are going through these treatments, you need to sit down and think about the 'what-ifs'. I get the impression that many women on this board think that they are 'safe' from HOMs if they cancel cycles or convert to IVF, but I am telling you, the risks are still very much there.

Thanks for the extra info. That is good to know.

b2b999 · May 2011

After going through our loss last year there is no way we would ever be able to choose which 1 of our children should be killed. For that reason alone I would either switch to IVF or resign myself to dealing with the consequences and the chance that we could end up with a hom situation.

blueberries8 · May 2011

I am sure your doctor will have some good counsel for you, but I would likely cancel or convert this cycle. Have you had previous failed IUI cycles and if so, with how many follicles? If you have no history to go on, I would be especially wary of continuing with an IUI cycle in light of those follicle numbers. I think to do IUI with injectables in the first place you have to be at least willing to consider SR in the worst of circumstances, but if you can limit the chances of those worst-case circumstances becoming a reality, I say go for it (though I understand that it is a really difficult choice with so many variables and it is crushing to feel like you are throwing out a treatment cycle in the case of canceling). Let us know what you decide.

bhead81 · May 2011

I was in a similar situation a couple cycles ago when I overstimmed on Menopu and we chose to stop the cycle and try a different med combo as it was just our first cycle. Given what I know now I wish I converted to IVF.

99luftballoons · May 2011

If it were me, I would cancel the cycle, no question. I am not anti-selective reduction for couples who make that decision, but I guess for me there is a difference between the remote chance of HOM with say 2 or 3 follicles, vs your situation were you have the potential for SIX mature follicles. That's the exact amount of embryos that octomom had actually... I know she did IVF, not IUI, but that's still enough to make me want to stay very far away from that.

Is your RE leaving it up to you to decide? I am pretty sure that my doctor would never allow me to do an IUI with that many mature follicles...

99luftballoons · May 2011

LGLDVM:
99luftballoons:

If it were me, I would cancel the cycle, no question. I am not anti-selective reduction for couples who make that decision, but I guess for me there is a difference between the remote chance of HOM with say 2 or 3 follicles, vs your situation were you have the potential for SIX mature follicles. That's the exact amount of embryos that octomom had actually... I know she did IVF, not IUI, but that's still enough to make me want to stay very far away from that.

Is your RE leaving it up to you to decide? I am pretty sure that my doctor would never allow me to do an IUI with that many mature follicles...

I personally think it's too early to make that kind of judgement. With the largest follicle still days from reaching maturity it is not only possible, but likely, that growth of multiple follicles will stall. Since 18+ mm is considered mature, I think the difficult decisions come in when there are multiple follicles over 18 or even over 15. If the next monitoring appointment were to show 2 at 18 and the remaining 4 below 14, I would be very likely to move forward, especially if the estrogen level is below 1000.

As someone with PCOS, I have gone in for monitoring and had more than a dozen follicles/cysts between 10 and 15 mm, but none of them actually mature or ovulate.

Agreed. I wasn't saying that I would cancel the cycle after that one appointment, perhaps I misunderstood her post. I assume she won't have to decide until the follicles are closer to maturity (I have never had any follicles that were 13mm or bigger stall, but I also don't have PCOS so that is a good perspective). My opinion would obviously be based on her having 5 or 6 mature when she does the IUI, not 2 or 3.

99luftballoons · May 2011

LGLDVM:

I get the impression that many women on this board think that they are 'safe' from HOMs if they cancel cycles or convert to IVF, but I am telling you, the risks are still very much there.

LG- Can you explain a little? If you cancel a cycle because there are too many follicles, how are you not safe? Presumably this means that you will be waiting until the next cycle were there are less follicles. From what I have read, doing an IUI with 2 follicles does not increase your chances of having twins more than a percentage or two. And HOM chances from 2 follicles is extremely rare.

Also, if you convert that cycle to IVF and then implant say 2 embryos, yes the can split (remote chance), but I think the risks of having more than 2 are also pretty low? Just looking for your insight. Thanks!

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