Continue iui cycle with 5 follicles?

Suebo · October 2011

Hi, I rarely post here, but I'm nervous and in need of some feedback! I did an injectable cycle (Gonal-F) and ended up with 5 mature follicles (18, 17, 17, 16.5 and 16). It was left up to me whether I wanted to continue with the iui tomorrow. I seriously do not know what to do. I don't want this cycle to be a waste, but I'm scared of higher order multiples. Just a bit of background, we are going on our 8th iui (3 with clomid, 3 with Femara, one with too small a dose of Gonal-F which only let to one follicle). Haven't moved to IVF yet b/c I have unlimited coverage for iui with my insurance and no coverage for IVF. I'm turning 36 in a few days. Any input would be appreciated! Thanks!

Cmartin6706 · October 2011

My wife and I would likely go for it. We had 6 mature follies at one point and went for it. I think that was the 3rd iui. If you think about it the 16 and 16.5 are barely ready. They will likely be ready by the time you iui comes, but I consider them less of a worry.

Good luck!

Reilly626 · October 2011

I would go for it, chance are slim that they will all take. GL and hope one does!

wille2b · October 2011

i would.. i was told at one point with 4 follies to NOT HAVE SEX it was too dangerous and i did anyway and never got pg at all, i would use the chance.. if the clinic is giving you the option i would hope they have enough knowledge to not let you do something totally unsafe. after that many iuis i would do anything..

good luck either way

LuckyClover13 · October 2011

I got 4 follicles my 2nd IUI. We went for it. I still didn't get pregnant so moving on to IVF. I would go for it if I were you. But good luck in whatever you decide. Just know you could get multiples and if you would be okay with that.

Edwina.McDunnough · October 2011

Cmartin6706:
My wife and I would likely go for it. We had 6 mature follies at one point and went for it. I think that was the 3rd iui. If you think about it the 16 and 16.5 are barely ready. They will likely be ready by the time you iui comes, but I consider them less of a worry.

I had 13s at trigger that were mature for IVF cycles, so "barely ready" is not really true.

Getting pregnant with HOM, having to do selective reduction, and possibly losing all your babies is a lot crappier than canceling a cycle. There was a woman on the board that proceeded with something similar. She had many failed cycles and got pregnant with quads even though her RE insisted that proceeding was safe. Even twins carry a big risk. Look around the board a bit and you'll quickly find some very, very difficult situations. I've seen so much heartache on the board, between safe and sorry I know I'd pick safe any day.

GL with your decision.

jmoka7 · October 2011

I would so go for it!! You've put so much time and effort into getting pregnant with 7 previous IUIs! You deserve to be a mommy! GL!

Ann679 · October 2011

Edwina.McDunnough:
Cmartin6706:

My wife and I would likely go for it. We had 6 mature follies at one point and went for it. I think that was the 3rd iui. If you think about it the 16 and 16.5 are barely ready. They will likely be ready by the time you iui comes, but I consider them less of a worry.

I had 13s at trigger that were mature for IVF cycles, so "barely ready" is not really true.

Getting pregnant with HOM, having to do selective reduction, and possibly losing all your babies is a lot crappier than canceling a cycle. There was a woman on the board that proceeded with something similar. She had many failed cycles and got pregnant with quads even though her RE insisted that proceeding was safe. Even twins carry a big risk. Look around the board a bit and you'll quickly find some very, very difficult situations. I've seen so much heartache on the board, between safe and sorry I know I'd pick safe any day.

GL with your decision.

Very well put. I would not go for it. But it's totally your personal choice.

mm29 · October 2011

Ann679:
Edwina.McDunnough:
Cmartin6706:

My wife and I would likely go for it. We had 6 mature follies at one point and went for it. I think that was the 3rd iui. If you think about it the 16 and 16.5 are barely ready. They will likely be ready by the time you iui comes, but I consider them less of a worry.

I had 13s at trigger that were mature for IVF cycles, so "barely ready" is not really true.

Getting pregnant with HOM, having to do selective reduction, and possibly losing all your babies is a lot crappier than canceling a cycle. There was a woman on the board that proceeded with something similar. She had many failed cycles and got pregnant with quads even though her RE insisted that proceeding was safe. Even twins carry a big risk. Look around the board a bit and you'll quickly find some very, very difficult situations. I've seen so much heartache on the board, between safe and sorry I know I'd pick safe any day.

GL with your decision.

Very well put. I would not go for it. But it's totally your personal choice.

This! GL with your decision

DesiraeSunshine · October 2011

Edwina.McDunnough:
Cmartin6706:
My wife and I would likely go for it. We had 6 mature follies at one point and went for it. I think that was the 3rd iui. If you think about it the 16 and 16.5 are barely ready. They will likely be ready by the time you iui comes, but I consider them less of a worry.
I had 13s at trigger that were mature for IVF cycles, so "barely ready" is not really true.
Getting pregnant with HOM, having to do selective reduction, and possibly losing all your babies is a lot crappier than canceling a cycle. There was a woman on the board that proceeded with something similar. She had many failed cycles and got pregnant with quads even though her RE insisted that proceeding was safe. Even twins carry a big risk. Look around the board a bit and you'll quickly find some very, very difficult situations. I've seen so much heartache on the board, between safe and sorry I know I'd pick safe any day.
GL with your decision.

some sound advice right here. So you would be ok with 5 fetuses? You would be ok with deciding which ones you would terminate if needed? You would be ok with them all dying as a possibility? Im not trying to be mean, but all things you need to be ok with and aware of if you chooses to proceed. Good luck.

BeeBee08 · October 2011

As some of the others have said, this decision has some very serious conequences. I would not do it. Would not. Good Luck with your decision!

sarahtoledo · October 2011

I'm 37 and have had failed cycles with 1-4 follicles. I would probably go ahead, at least with TI if not IUI.

Your age makes a difference, as do your past cycles. And you have to consider how you feel about multiples and reduction.

FYI, just one point of view:

Here's a quote, see full link at bottom. Women under 35 were at high risk for multiples when there were six or more follicles 12 mm or more in diameter. However, for women over 35, the pregnancy rate was improved when there were six or more follicles in that size range, without significantly increasing the multiple implantation rate. We need to be careful about this. There is not a sudden change in the egg quantity and quality that occurs on a woman's 35th birthday. The changes will be gradual, and the decision-making regarding a "safe" number of follicles should take that into account.https://www.advancedfertility.com/revmultiplescoh.htm

blueberries8 · October 2011

I would seriously consider TI instead of IUI for this cycle...it seems like that could be some sort of compromise. With your age and several failed cycles behind you, I agree that it is very unlikely that all 5 will fertilize and then stick, but I think I would still be nervous, even by the possibility of triplets. I would think that by skipping the IUI and having TI, you might reduce the risk of HOM but the cycle won't be a "waste". Good luck with whatever you decide.

BreandMikewedding · October 2011

I wouldn't do it. You are at high risk for multiples. Many clinics only care about getting paid and not the outcome of the cycles they do.

Edwina.McDunnough · October 2011

sarahtoledo:
I'm 37 and have had failed cycles with 1-4 follicles. I would probably go ahead, at least with TI if not IUI.
Your age makes a difference, as do your past cycles. And you have to consider how you feel about multiples and reduction.
FYI, just one point of view:
Here's a quote, see full link at bottom. Women under 35 were at high risk for multiples when there were six or more follicles 12 mm or more in diameter. However, for women over 35, the pregnancy rate was improved when there were six or more follicles in that size range, without significantly increasing the multiple implantation rate. We need to be careful about this. There is not a sudden change in the egg quantity and quality that occurs on a woman's 35th birthday. The changes will be gradual, and the decision-making regarding a "safe" number of follicles should take that into account.https://www.advancedfertility.com/revmultiplescoh.htm

I am at the point that I am comfortable transferring 6 good quality d3 embryos for an IVF. This is something that is done when you have had multiple failed IVFs and if you are in your 40s. Knowing that my RE is very aggressive in my treatment, the only way he would let me proceed with an IUI in your situation is if my E2 levels were significantly lower than expected, and if they had plateaued or even decreased over the last few days before the procedure. I understand from your OP that you are nowhere near this situation, nor have you done an IUI with more than 1-2 follicles. Please correct me if I am wrong.

With an IUI you would never really know how many eggs were mature, and looking at 6 you could easily have 8+ if your E2 levels are rising appropriately. I totally understand your desire to move forward with the IUI, however even at this point my RE definitely would recommend no IUI and no TI because of the significant unknowns. This is with my extensive history, mind you.

So regarding the above post, please think about your situation, history, and have a detailed discussion with your RE regarding the state of your cycle and why he thinks that it would be a safe situation to proceed. You should be monitored very closely, with blood work the day of, and additional bw and ultrasound the day after trigger to assess your E2 and follicle growth. Another ultrasound prior to your IUI would also be very informative. I would hope in your situation every precaution will be made to ensure that you are making an informed decision.

Again, I completely understand the difficulty you are being faced with and I wish you much luck.

Suebo · October 2011

I just wanted to sincerely thank everyone for their input and advice. ALthough it broke my heart, we decided not to proceed today with the iui. We just can't risk the possibility of HOM and selective reduction would kill me. Another thing that made me uncomfortable was that it was not my regular RE that I saw yesterday. On weekends I have to go into the city and the REs rotate the weekends. I am going to do my best today to see if I can get a call back from my RE today and see what he recommends in terms of TI and next cycle. It just kills me that there are 5 great eggs inside of me that are going to waste...

Edwina- To answer your questions, my E2 level was 1361, which I believe is high. I have had iui's in the past with good response to oral meds, mostly 2, and 3 follicles but no luck. My first round of injectables (this is my 2nd) was a minimal dosage and I only developed 1 follicle). This time was too much I suppose. I guess we are going to have to try finding a happy medium. Just a quick questions. Is there any benefit of injectables over oral stims if the amount of follicles are the same (2-3 follicles with injectables vs. oral)??

Edwina.McDunnough · October 2011

1361 is IVF territory. It's heartbreaking, I know. Many of us have been there.

Oral meds work by tricking your brain into producing more FSH that it would otherwise. In a non-medicated cycle, your rising E2 from developing follies would slow down your FSH production, so that one eggs matures and ovulates. With these medications, your pituitary gland is ignoring these cues, and the feedback loop is disrupted. In this situation your FSH production is unknown since you're not generally doing daily blood work to monitor your levels.

Injectable meds work by flooding your system with external FSH, so no matter how high your E2 of how low your inherent FSH production, enough FSH is added to your system to keep your ovaries stimulated.

The benefit of injectables is that the cycle can be better controlled and you can be stimmed to a greater extent. Oral meds are not usually effective for those near or over 40, and some of the side effects, like reduced CM and a thin lining, can be detrimental to your cycle. The downside is that it's expensive, invasive, and more monitoring is required. You can also mix FSH and LH to potentially get a better quality of egg, but this is all in theory if you're not observing your embryos in vitro.

Big hugs. Take care and I hope you become a friendly face around here.

Ruthie04 · October 2011

I just wanted to send along a hug, as I know a cancelled cycle can be heartbreaking. I had six measurable follicles and an e2 of 1100 with my second IUI cycle. While the RE that performed my u/s said we could move forward (but only if we were ethically okay with selective reduction), my RE called to say he wouldn't put me through the emotional and physical pain of this scenario. Sure, I wonder what would have happened. But, I know cancelling was the right decision. Good luck with your future cycles.

AmCheri · October 2011

I'm sorry Sue, I know how hard it is to cancel a cycle. It's devastating. For what it's worth, had I been in your shoes, I also would have cancelled.

I've only tried IVF once. Didn't even get to ER after 9 days of stims. I know how awful you feel right now, but it does get better. And you'll be ready to give it another go before you know it. Promise. Hugs to you.

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