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!!
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 | 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
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!
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.
Re: IUI and possibility of twins?
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.
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 | 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
(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.).
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."