Infertility
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IUI and possibility of twins?

Hi all - we are likely going to try IUI in the next couple of months. Do most people use medication to help with the IUI? I am 40 and recently had a pregnancy loss. I am worried about the potential of twins with medication - do you know how likely this could be? I want the IUI to work... but twins would be nuts given all we have going on in our lives! Thank you!!

Re: IUI and possibility of twins?

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    It depends on the medication and dosage. If you're using an oral medication like Letrozole, you won't grow too many follicles. I only ever had 1 follicle reach maturity during my IUIs.

    If it's injectables, you're likely to get many more, but that's only used with IUIs of you are a poor responder to meds and/or you do not have the best egg quality.
    *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
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    It depends on whether your doctor uses medication to stimulate and induce ovulation prior to the insemination (usually depends on the patient - most IUI's I've seen use either oral or injectable meds but it's possible to do it without meds in what's called a 'natural' cycle). Your doctor will likely make the choice of what meds to use (if any) based on your testing -- AMH, AFC, ovulation indicators - during your natural cycle. You should also be monitored, especially if they give you injectables, to keep track of how many follicles are developing. To avoid high risk of multiple pregnancies, if you have too many mature follicles, they may cancel the IUI. 

    (I've done 3 IUI's with injections, but none of them were successful. The protocol was called a 'mini' stim by my clinic. I rarely had more than one or two mature follicles during the cycles. My AMH and AFC were normal during the testing I had prior to the IUI's but prior to my IVF cycle - two years after we did IUI's - my AMH was very low, so I don't know if that had any impact.).
    ~~ Our Story in Spoiler! TW loss/child~~
    Fall 2012 -- started TTC
    Summer 2015 - no BFP yet, labs normal, referred to RE
    Fall 2015 - Summer 2016 - Further testing all normal. 3 IUI's -- BFN. Recommended move to IVF. Planned cycle for fall 2016.
    September 2016 - Surprise natural BFP. MMC @ 8 weeks. RE expressed confidence that we just needed the 'right' embryo.
    Fall 2016 - Spring 2017 -- Break from TTC
    June 2017 - Started IVF; egg retrieval for freeze all cycle. 9 mature eggs retrieved, 5 fertilized. 2 4BB embies on ice.
    August 2017 - FET transfer both embies. BFP.  Twin pregnancy confirmed by ultrasound. EDD 4/28/18
    September 2017 - Twin B stopped developing; Twin A doing perfectly! Graduated from RE @ 10 weeks
    March 2018 - Baby Girl born via C/S due to pre-eclampsia -- strong and healthy!

    TTC #2
    January/Feb 2021 - Freeze-all IVF cycle 
    March 2021 - FET of 1 PGS normal female embryo. BFP! Beta #1 156,  #2 472, #3 1241, #4 5268 EDD 12/5/21 - Christmas baby!


    "When all is lost then all is found."


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    While IUI alone will not increase the risk of twin babies, the use of fertility medication does make it more likely that patients will have multiples pregnancy. If a woman releases many mature eggs at ovulation, it is more likely that more than 1 egg will be fertilized, thus resulting in twins or multiples. While the procedure of IUI treatment itself doesn't increase your chances of having twins, certain drugs associated with it might.
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