Should I be stressed out?? IUI timing question

moto611 · September 2014

I went in this morning for monitoring and had two follicles measuring 18.9mm and 15.4mm (my RE says he's looking for 18 and over since I'm on Bravelle). I was hoping they'd let me go one more day before trigger to let the little one catch up, but instead the opposite happened: they said my LH was surging already and I had to trigger immediately and do the IUI tomorrow.

That's three out of my four medicated cycles when my body took over and started to ovulate on its own

I'm upset about it because I really wanted to KNOW that we had the IUI timing exactly right. Now, I'm not sure when I'll ovulate. I took the trigger shot today at 2:30pm and my IUI is tomorrow at noon. I'm fairly confident we won't miss the egg completely because I was showing negative all day on OPKs. (I tested this morning before I went for monitoring and again this afternoon before I took the trigger shot... the afternoon test strip had a much darker test line but still not darker than the control line.) My nurse tells me the blood test is more sensitive so I guess that's why they claim I'm surging even though the OPKs are negative.

What do you all think about this timing? Should I be upset? I was really hoping for a cycle where everything went according to plan

Also, normally they tell me to have intercourse on the night of the trigger, abstain for a day, and then have the IUI the day after that. Now I don't know what to do... my nurse said that since my husband's counts have been okay we are fine to have sex tonight, but that it's not mandatory. Why do they normally recommend sex on trigger night? Is it just that the more sperm are up in there, the better? I can't decide if we should try tonight or save them all up for the IUI tomorrow morning.

Any thoughts would be much appreciated!!

lebradford · September 2014

I don't think it's going to be bad timing at all! Personally, I would skip the sex tonight, but I guess it could go either way.

moto611 · September 2014

Thanks ladies - I'll try to relax about the timing. I got attached to the idea of timing the IUI exactly with ovulation, but apparently that is not in the cards for me so it's nice to hear that it doesn't have to be super exact.

@rainbowbridge14: for my first three medicated cycles I didn't use OPKs or track anything - I figured that was what I was paying the doctors to do - but then last month I felt completely blindsided when they told me to trigger even though my follicle was only 15mm. This month I figured I'd use OPKs so if my LH was surging at least I would know about it ahead of time and I'd be more prepared... but then that backfired. I'm trying to trust my doctors but it is REALLY hard for me that I seem to have absolutely no control over anything in this process.

BunnyBerry · September 2014

They might recommend sex if his counts can take it because it helps cover if IUI is too far from O...since washed sperm don't live as long, for example.

I would ask for an ultrasound before your IUI to see if the follicle is starting to rupture, which could give you peace of mind.

Since YH's SA has improved so much, hopefully you would have good chances of pregnancy even if the IUI wasn't timed just perfectly! I'd BD after IUI as well just to make sure. Good luck!

moto611 · September 2014

I had my IUI this morning and tried to talk to the RE about my concerns... he said there's no way to prevent my LH from surging. He said my body must have a lower threshold for determining when it's time to ovulate. He also said the goal here is mature eggs but we only have limited ways of determining when eggs are mature (follicle size, E2 level). So essentially my body thinks my eggs are mature before I hit their usual benchmarks (18mm, 200/follicle) but that doesn't mean the eggs aren't mature yet. Hopefully my body knows what it's doing

He also said the washed sperm would be alright for up to 24 hours but he recommended having sex tonight and tomorrow anyway. So we'll try that, but I'm worried the sex won't help because I haven't seen any EWCM this month. I think Clomid dried it all up. On top of that my husband had his lowest post-wash numbers yet - the RE said it was still enough (it was 15 million motile) but that was after 3 days of abstinence so it makes me feel discouraged about how many he'll be able to produce by tonight. If washed sperm really do last 24 hours past IUI that would actually be plenty of time because of when I took the trigger shot... but Dr. Google tells me washed sperm are only viable for 6-12 hours after the IUI so I'm not sure what to believe.

I promise I'm not usually this anxious about everything! But this process is SO frustrating... I feel like I'm paying all this money and putting myself through all this monitoring precisely so I don't have to worry about timing... and yet here I am, freaking out about timing

lebradford · September 2014

**loss & pregnancy mentioned**

I just wanted to reassure you again. The cycle I got my BFP was right around 15mil post-wash for the sample. My RE has never once indicated that that count is something to worry about either.

I wanted to reassure you again that I really do think your timing is right. Personally, it seems perfect that your body is starting to surge when once of your follicles is over 18mm. You will usually start to surge when your lead follicle is at the ideal point. In fact, when I got my BFP I only had one 16mm follicle at morning monitoring, and much to my shock, they had me trigger that night. I thought it was too soon and that our timing would be messed up, but it worked.

Also, if you are worried about CM issues with Clomid, you might want to ask about skipping Clomid and doing straight Bravelle if you need another IUI cycle. One of our grads who is pregnant right now was successful the first time she switched from oral meds + injects to straight injects. In fact, she said she didn't even need any or much additional injectable medication because the Clomid (or Femara, I don't remember) must not have really been doing anything for her. I'm not sure if that would be the case for you, but it wouldn't hurt to consider!

Good luck! You're still in this!!

Hollowvic · September 2014

Timing sounds right to me. Good luck To!

loveinkw13 · September 2014

I'm sorry you're so stressed out. I just had our 4th IUI this morning, so I know how you feel about the timing being off. My experience has been both to have sex on the day of trigger, or wait until the IUI. This time around, he had us have sex the night before trigger (in case of an early release) and then to trigger, then IUI. He also told us to have sex tonight, closer to when my egg should release.

It just sucks because we really have no control over our own bodies!

I could be wrong, but I believe there is a shot they can give you to hold the egg in your follie longer. Maybe ask him about that if this cycle is a bust? I'm sure it won't be though. I hope we both get our BFP's! FX for you

moto611 · September 2014

Thank you, everyone, for all the encouragement! My husband claims this is our best cycle yet and I should be optimistic, not worried. So I'm trying to listen to him.

@lebradford thanks all the reassurances and for telling your story! It's nice to hear your 16mm follicle had a mature egg - maybe that means my 15.4mm one is still in the running. When you triggered that night, did you have the IUI the next day? Or the day after that? And I'll definitely ask my RE if I can skip the Clomid, especially since I'm already using Bravelle. If this cycle fails it'll probably be time to mix up the medicines and try something new anyway.

lebradford · September 2014

moto611 said:

Thank you, everyone, for all the encouragement! My husband claims this is our best cycle yet and I should be optimistic, not worried. So I'm trying to listen to him.

@lebradford thanks all the reassurances and for telling your story! It's nice to hear your 16mm follicle had a mature egg - maybe that means my 15.4mm one is still in the running. When you triggered that night, did you have the IUI the next day? Or the day after that? And I'll definitely ask my RE if I can skip the Clomid, especially since I'm already using Bravelle. If this cycle fails it'll probably be time to mix up the medicines and try something new anyway.

We had the IUI 36 hours after the trigger shot. I wasn't starting to surge on my own though. :-) Even if you had the IUI the next day, I would definitely say your 15.4mm follicle could be in the running, along with the larger one. I wouldn't have wanted to wait any longer for an IUI though, because of your larger follicle.

curve31 · September 2014

Now I'm stressed. I had my U/S today. Had a 12mm and a 19mm. She wants me to trigger Friday night and come in for IUI Saturday morning. I feel like that's not long enough. I don't have the shot yet, it's being delivered tomorrow. I think I'll do it as soon as I get it instead of waiting til night time. So say I get it at noon and do it. That wouldn't even be 24 hours. Maybe it will come in the morning. Should I call and see if they can do the IUI later or should I just trust them?

moto611 · September 2014

@curve31 - personally I would probably take the shot as early as possible but then do the IUI as scheduled at noon... but before you do that I would call your doctor and ask them about it. I'd be really interested to hear what they say - maybe they had some logic when they asked you to trigger in the evening? I've had my trigger shot at all different times... last month when they called to say my LH was surging they told me to trigger between 8pm and midnight and come in for the IUI the next morning. This month they said "take the trigger as soon as you can get to the shot" so I took it at 2:30pm and had the IUI the next day. I've even read that some REs have patients take the trigger shot AFTER the IUI, which makes no sense to me at all. Since I've been anxious about it I've found all kinds of studies about IUI timing and honestly the results are all over the map. So maybe it doesn't matter as much as it seems?? That's what I'm telling myself!

curve31 · September 2014

I will definitely ask them about it and let you know. I think I'm just gonna go with my gut and do the shot as soon as it gets here. Like you, I've been reading up and everything says 24-36 hours. I wanna get as close to the 24 hours as I can.

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