Follicle growth, triggers, and the craziness of IUI


#1

Hi everyone,

I’m trying very hard to keep things low stress… but you all know how this goes.

The most frustrating part of having to rely on IUI, particularly with DS when timing is SO important, is being SURE your timing is right… particularly when it’s pretty expensive to do!

And it doesn’t help when signs seem all off.

So… I have endometriosis. I had four endometriomas removed in October and have not had an IUI since. We were supposed to start after two cycles (this is now the 6th cycle post surgery!), but I keep having problems with my cycle…

And so now I’m in a position where I can’t actually talk to my doc, because she’s away. I have instructions through her nurse, but I feel like I need more information… mostly because according to the u/s my follicle has grown 11 mm in two days. So, my underlying question is: is that at ALL possible? Or is this not a follicle, maybe just a cyst related to the endo?

This is how it looks:
Cycle I had surgery - 28 days
First post surgery cycle - 34 days, very light, but spotting never stopped.
2nd: 14 days, very very heavy - doc put me on estrogen to stop the bleeding. So on BCP for 3 weeks, making…
3rd: 23 days (controlled by BCP, not an IUI cycle)
4th: 15 days, no positive OPK… was still testing when AF came.
5th: Added Clomid, 19 days, no positive OPK… was still testing when AF came.

So, we’re monitoring this cycle - and that felt like such a relief because maybe finally we’d figure out what’s going on. But I’m wondering if the endo is confusing things.

First u/s was day 4 - I was scheduled to start clomid that night. Got a call that afternoon - don’t bother with clomid, you have a 14mm follicle. Come back tomorrow and check for LH surge. Perhaps our problem with OPKs has been starting too late (started when doc told me to!) and my cycles have become seriously shorter…

Came back - no LH surge (was, in fact, slightly lower - but really just stable). So, come back for another blood test and u/s.

Today’s u/s showed 25mm follicle. 25? It was 14 two days ago, and now it’s 25? No clomid (at least not this cycle, but was last cycle), no other medication…

Like I said earlier, my RE is out of town. She was told the results of the U/S and ordered a shot of HCG for me, told me to trigger tonight (this would be the first time we’ve triggered).

I’m worried that this isn’t a follicle. I’m worried it’s a cyst related to my endometriosis, and that the 12mm things they’re seeing are follicles working on developing. I’m worried because I’ve gone from 32 day cycles to… 20 or less? I really don’t want to take the trigger, have it trigger ovulation on follicles that are way less than ready and get nowhere… particularly given that I don’t think I’ll get to monitor another cycle (insurance…). So I expressed all this to the nurse, who tries to get my doc back on the phone… but doesn’t manage it. She DOES talk to the doc on call, who says if I’m worried it’s not a follicle, don’t trigger, come in tomorrow for another LH test and u/s.

So that’s the plan… I’m hoping for more clarity tomorrow.

I realize most people have the opposite problem, follicles not developing enough… but anyone ever heard of 11mm in two days? And a 25mm follicle on day 6 of my cycle?

(Other signs, fyi: CP is high and soft, CM is watery - no other CM data, first day post AF. LH was a little higher today than yesterday - 4.7 vs. 3.4, but still not a surge. Perhaps I’m about to go?)

Argh. :grr: This would be so much less frustrating if BD were an option, or if it didn’t cost so much to try each cycle…

Any BTDT, thoughts, ideas?


#2

It sounds like the surgery really messed with your hormones. Unfortunately BCP’s will do that to when you come off of them. Do you know how thick your lining is & your E2 level? That will help give you more information. I’d be concerned if they want you to trigger & your lining is thin (should be at least 6mm).

Honestly, if your E2 was not low at cd4 & you had a 14mm follicle I’d assume it was a cyst (and clomid can cause cysts). Especially with that fast of a growth afterwards without meds. Hopefully tomorrow will shed more light on your situation, but you definitely have a right to be concerned about it.

The only other thing that jumps out at me is that the bleeding you had might not have been a real AF (in the sense that all of your hormones reset to baseline & your lining completely sheds). Maybe your body thinks it’s cd25 & not cd6?

I do DI & the only cycles I’ve regretted doing are the ones where I knew the timing wasn’t right, but I did them anyway. “Just in case”. Now I look back at them & think "well that was a waste of $$$ ". However at the time I just wanted to try & have a chance. The thought of cancelling a cycle & waiting to try again was always hard to accept.

Anyway, I hope you have better news on your next RE visit. Ultimately it’s up to you & how comfortable you are (financially & emotionally) on taking a risk with a cycle that’s not following “the norm”.

Good Luck! :cross:


#3

It does sound like that, doesn’t it? Yet there has not been a single blood test post surgery that indicates anything off in my hormones. We tested when I had that heavy period, and my levels were all normal.

My E2 was in the 300s on day 4 - if anything, a little high for day 4, but not much. My lining was 8mm on day 4, despite still menstruating, and was 13mm today, so that’s really not a concern. Don’t know what my E2 is, we’re not testing it at this point (guess the level at day 4 was high enough to not be a concern.)

It’s the fast growth that worries me…

Except my levels all make sense for day 4 on day 4… and AF was pretty typical for me, if a day shorter than it used to be (again, pre-op, used to be 6-7 days, now I seem to be down to 5)

Yeah - I don’t want to waste the money, but if I have 6 failed attempts insurance starts covering things (well, not the DS, but the rest), so it’s not really a waste that way.

See, that’s where I’m stuck. I feel like maybe my norm has changed and I just haven’t figured it out yet… I mean, it’s certainly not “the norm” to be close to ovulation on day 4, but maybe I’m actually built for short cycles that haven’t been short because the endo made a difference? I don’t know… this is the first time I’ve had surgery and removed cysts.

I want to try this cycle. It makes sense for a lot of reasons, not the least of which is to have a 2nd cycle done so we can be moving towards insurance covering stuff. We’ll see what tomorrow brings…

Thanks.


#4

Today’s ultrasound tech was much clearer with me. She’s been doing this more than twenty years, seen follicles grow at all sorts of rates and get to all sorts of sizes. Showed me that she sees THREE follicles, two on the left, one on the right - sizes 31, 25, and 22mm!

My LH was 7 - not a surge yet. Doc says I can wait for it or I can take the trigger, but she can’t guarantee I WILL surge, so doing the trigger tonight, IUI on Tuesday.

My lining is 11mm today, multi-layered. Yay.

Wish me luck - guess my ovaries are being super-powered this cycle! Wonder if it’s a result of last cycle’s clomid.


#5

I guess your body just wants to stay in the fast lane. Good Luck! :babydust: