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Confusion with injectables and follie size (long)


Forum: Trying to Conceive with Medical Assistance

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  #1  
February 25th, 2013, 11:26 AM
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Hi everyone,
*
Iím feeling confused and was hoping all of your experiences can help me.* Hereís a really quick background on me.* Iím 35, DH is 31.* We tried Clomid 3 times with no success so went onto Gonal-F 900 pen with dosage of 150 and Lupron.* We had 3 follies when I triggered and did IUI, got a BFP on our first try!* We now have a beautiful 2 year old daughter.* We decided we were ready to try for #2.* My dr said the injectables worked so well last time we would start with them.* He prescribed the same dosage and I started my shots 2/20.* I have been monitored every few days and after Saturdayís ultrasound he said I have a lot of follies, so dial the gonal-f down to 75 instead of 150 and continue the Lupron.* I went today for blood work and ultrasound, the tech told me I had 4 follies on my right, and a lot on my left.* She started rattling off sizes but the biggest was 15mm with a bunch of 14mmís and then smaller from there.* She said the dr would be calling me once he reviews the results and blood work.* Well hereís my confusion:* the nurse just called and said the dr is really happy with how things look, it looks great so tonight no gonal-f just Lupron, come in tomorrow for blood work and another ultrasound, bring your trigger shot, cause depending what he seeís there might be IUI on Wednesday.* Iím confused because I thought they like to see the follies be between 18-22 in size.* If my biggest is on 15mm tomorrow is might be 16mm but I feel like itís too small.* Also, I was really hoping for more than one good follie.* Iím wondering if because I had so many 14mm he wants only the now 15mm to ovulate because if he waits longer the 14ís might all grow and Iíll ovulate them all???* I have no idea. I wish he had called instead of the nurse.* Iím sorry, I know this is long and confusing, Am I right that the follies are supposed to be between 18-22?* Do you think heís having me trigger early because he wants to avoid cancelling the cycle b/c thereís so many follies?
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  #2  
February 25th, 2013, 12:28 PM
onlybygrace's Avatar Mega Super Mommy
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It could very well be that he wants to avoid cancelling the cycle due too many follies.

For each of my IUIs, my doc did not want more than 2 follies at a time.

Hope you manage to find a good balance between follie size and number!

GL!
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  #3  
February 25th, 2013, 12:38 PM
KMH KMH is offline
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That is my guess, too...if you time it so that only the biggest one or two release with the trigger, you can avoid cancelling the cycle.

I don't want to be a Debbie Downer, but I do want to point out a couple of things. First, there is always the possibility that you trigger too soon and you don't ovulate. Second, more follies may release than you plan. Have you discussed with DH and your doctor what your plan would be if you found out you were pregnant with higher order multiples. It is an important discussion to have. Lastly, the follies that do not release during this cycle can become cysts, and there is the possibility that you'll have to rest next cycle and/or take BCP to let the cysts go away before stimming again (of course if you are pregnant then that won't matter...let's hope that is the case ).

I hope at your next appt things are a lot more clear and a decision is easy!
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  #4  
February 25th, 2013, 12:40 PM
*Leah*'s Avatar TTC the newfashioned way
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With Clomid, they want follies around 20+, but for injectibles 18 is what my clinic went by. And remember the follie will grow a little more by the time you have your IUI. I think they don't want those other ones catching up and you having quads or something.

If your follies are all around the same size, is it possible to have to cancel the cycle or possibly switch to IVF. I had this happen to a friend, who now has twins and a couple frosties waiting for them, as they chose the IVF route.

Best of luck to you! So glad your first IUI worked fine!

Thanks for joining us!
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IVF#2 BFP 4/2013 M/C 6/2/13 (8 weeks)
FET #1 BFP 8/2013 - Chemical Pregnancy
IVF #3 - Retrieval Oct 31st, Txferred 2 on 5d - a Blast and Morula - Chemical Pregnancy
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  #5  
February 25th, 2013, 02:31 PM
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Thanks for the feedback. My ultrasound is at 9am tomorrow so I'll fill you in after with what the dr decides. Not feeling very optimistic.
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  #6  
February 26th, 2013, 08:17 AM
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Just got back from the drs. and it went really well. I have a 20, 19, (2) 18ís, 17. So I got my trigger, and will have an IUI tomorrow morning. Iím not really sure how yesterday the tech said the biggest I had was a 15 and today I have 20 unless she measured wrong or something but Iím not going to question it. Excited for the IUI tomorrow!
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  #7  
February 26th, 2013, 08:26 AM
Lucy S.'s Avatar POAS addict
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Any update?
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  #8  
February 26th, 2013, 08:42 AM
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Update in post #6
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  #9  
February 26th, 2013, 08:44 AM
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That's alot of follicles for an IUI! Normally they tend to grow around 2mm/day and the trigger can speed that up some apparently as well. I'd be concerned about a Dr that was OK with triggering 5 mature follies and no failed cycles with that protocol to be completely honest with you.

Question for anyone else too: Is 24 hours from trigger the standard timing for IUI at your clinic? We do 36 hours here.
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Me: Autoimmune (Hashimotos and Fibromyalgia), vitamin D and calcium deficiency. Treated with Synthroid, supplements, TCM and acupuncture.

DH: Severe MFI (low counts, low motility, poor morphology and high antibodies), likely caused by poor liver function. Treated with Clomid to increase total counts.

DD: Conceived after 1 year of TTC with progesterone to correct LPD (likely caused by undiagnosed thyroid dysfunction). Born Aug 2009 via c/s after an induction due to pre-e and HELLP.

TTC #2 since Oct10 with an early loss in Aug 2011. Post-wash counts are too low for IUI to be successful, so moving on to IVF/ICSI in May 2014!

IVF/ICSI #1 (May 2014): Estrogen priming and antagonist protocol, including acupuncture and prayer!
17/05/14 - Baseline looks good, start Gonal-F 225iu and Luveris 75iu
28/05/14 - 18 eggs retrieved, 14 mature
29/05/14 - 13 fertilized!!! All are looking great still on day 3, so we're going to blast!
02/06/14 - Transferred one 1BC blast, with 3 other blasts and 3 morulas to watch and freeze
03/06/14 - All embryos have arrested. None to freeze
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  #10  
February 26th, 2013, 09:03 AM
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The place where I go did 36 hours with me.
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  #11  
February 26th, 2013, 09:25 AM
Lucy S.'s Avatar POAS addict
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Wow! That is a lot of follies!! Are you okay with twins?
Good luck!!!

Our clinic does 24 standard but I think thats because most people don't trigger themselves
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  #12  
February 26th, 2013, 12:54 PM
KMH KMH is offline
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My RE did IUIs 36 hours after the trigger.

I'm also surprised that you were told to trigger...that's a lot of follies! Good luck!
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  #13  
February 26th, 2013, 01:08 PM
*Leah*'s Avatar TTC the newfashioned way
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My Dr. did the trigger at 36. Maybe they are doing 24, because you have so many follicles?

I agree, get ready for twins. That is a lot! I didn't even get that many follies with IVF! You are an egg MA-CHINE! Best of luck to you!
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TTC#1 since 10/2006, 5 failed IUI's, 1st IVF successful BFP!! Baby Girl 2/2011
TTC#2 BFP 9/2011, Natural Pregnancy! 3/30/12 M/C'd on 5/15/12 (9 weeks)
IVF#2 BFP 4/2013 M/C 6/2/13 (8 weeks)
FET #1 BFP 8/2013 - Chemical Pregnancy
IVF #3 - Retrieval Oct 31st, Txferred 2 on 5d - a Blast and Morula - Chemical Pregnancy
IVF #4 - ER scheduled for 4/4/14 retrieved 4 eggs. Txferred 3 embryos 4/7/14!....BFN...NOW WHAT?
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  #14  
February 26th, 2013, 02:01 PM
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Could it be that not all 5 of my follies are mature? I'm confused as to how yesterday the biggest I had was 15. Could the tech be off? I'm still confused as I was yesterday only this time I have lots of follies abd yesterday I was worried that I might only have 1 barely mature follie. They def said today a 20, 19, and 18 I think two. It's weird seeing how yesterday's was a 15 with a bunch of 14's. I'm going to ask tomorrow how that can be.
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  #15  
February 26th, 2013, 02:11 PM
Lucy S.'s Avatar POAS addict
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I haven't really seen it but I think it could vary from person to person measuring. It does seem like huge difference tho! I would call and ask what's going on!!

side note: So while it's best practice not to do so many follicles, the cycle I conceived #2 I had 7 mature and only got him. Granted we worked up to that number and I had no idea at the time it was a bad idea.
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  #16  
March 3rd, 2013, 12:51 PM
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i agree, i think that is a lot of large follicles to trigger, they could all release and you could have 5 babies. of course, some ppl would want 5 if they couldn't have any. i just know my RE will not trigger if there are more than 4 follicles total albeit small or large or what. i had 2 (14) and 2 (12) and got pregnant with twins. i mean we ideally wanted one because that is the healthiest but of course we couldn't say no to two.
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  #17  
March 3rd, 2013, 01:41 PM
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I didn't ask the day of the iui about the difference in follicle size between the Monday and Tuesday like I had planned. My dr said everything looked good, and my estradiol was 1800. I've been doing a lot of reading and isn't there a possibility that not all 5 of those follies could have a healthy egg in there? And What does the estradiol tell exactly?
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  #18  
March 3rd, 2013, 04:58 PM
Lucy S.'s Avatar POAS addict
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Absolutely- Not every eggs will be healthy and not every fertilized egg will always implant. So it's definitely no where near a 100% chance of 5. but since the chance is there and often more so of a % that most people are comfortable with (esp. Dr), they opt to not do IUIs with 5. Most stop at 3 to 4. After 4 it just increases your chance of multiples. But multiples could be 2 y/k?
I just think for next cycle you need to find out what your Drs goals are and policies are so you both are on the same page!
Good luck to you!! KUP!!
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  #19  
March 3rd, 2013, 05:52 PM
KMH KMH is offline
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Lucy is right...not every egg could have been mature or healthy, and not every follicle produces an egg. Your Estrodial (E2) is an indicator of mature follies...it should be 200-600 per mature follie. Based on that, you had at least 3 mature follicles, but probably more.
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  #20  
March 3rd, 2013, 06:02 PM
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Thanks ladies for all the information! I'll definitely keep you posted after my long 2 week wait is over. I know I won't be able to wait the full two weeks though
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