Trigger for IUI with only 13mm follicle - any hope?


#1

Hi Ladies,

I’ve been reading a lot but don’t post much on message boards. I am in the middle of an IUI cycle with gonal-f. Today is cycle day 11, and I have done 8 days of 112.5 on Gonal-F. I started the cycle with a cyst which is contiuing to shrink. Besides that I have one 13mm follicle on the left and 2 11mm follicles on the right. My estradiol level today is 198 as of this morning. My doc is having me do the Ovidrel trigger tonight with an IUI tomorrow after 12 hours and another on Wednesday after 24 hours.

I realize that sometimes smaller follicles can be mature, as I was successful two years ago with my son and it was a 15mm follicle but my estradiol was much higher at the time.

Does anyone think there is ANY hope of doing an IUI with the largest follicle being 13mm the day of trigger? Seems ridiculous to me. I know they can grow up to 2mm a day, but mine seem not to.

My insurance is covering the IUI, but I’m thinking rather than put myself through all of this over the next few days I may just call the nurse and cancel it altogether.

Last month I did an IUI and I had an estradiol of 150 and one 14mm follicle and he triggered me. I’m all for being conservative, I don’t want a litter of kiddies at once, but come on… this is absurd.

Any thoughts or hope here? He is pretty set in trigger based on the estradiol level of 198 indicating one mature follicle, which is what his nurse says is all they want for an IUI given the lack of control. For one follicle I can just do it on my own, no need for all the medication and monitoring and can just do trigger and IUI. Ugh.

Thanks in advance!


#2

hmmmm… that is strange. I never had my estradiol levels checked when I was doing IUIs and I was NEVER triggered with a follicle less than 18mm (and then they would trigger me the next day). Seems strange to me…


#3

I am in my 2ww with a cycle of Gonal-F as well. My biggest follie was 15 and then I triggered that night, IUI the following day and the day after. So my protocol does seem similar to yours… don’t know if it worked yet or not though.


#4

Thanks for your replies. 13 seems ridiculously low. They always check estradiol levels and I am told that’s how they determine when to trigger more than the ultrasound. Trigger at 15 makes some sense since I was successful with my son with a 15mm follicle, but 13mm just seems ridiculous to me. Unfortunately I have no choice here. Thanks for your input and Brinn good luck!


#5

Brinn: Question for you, what size were your other follies and do you know your estrogen or estradiol level before trigger?


#6

thanks esse. Good luck with your beta! I think that’s not the case here because my estradiol two days ago was 98 and today was 190, so it keeps going up. The nurse said they only want one mature follicle for IUI’s. I told her I wouldn’t do medication if that’s the case, I can get that naturally on my own every month and then just do trigger and IUI for correct timing. She also said it’s based solely on my estradiol level being 198, not based on size of follicles… I’m frustrated and nothing I can do :frowning:


#7

Thanks slc - I don’t know what my e2 levels were, sorry, my other follies were 13 and 11.


#8

Thanks. Good luck! Any other stories out there?


#9

I think its a tad bit to early.

At my RE’s ofice 15mm and over is mature. While a 13mm at trigger CAN grow due to the boost from the trigger, it can delay ovulation due to being immature… meaning your IUI is pointless and will be timed wrong. Is your office also going by your Lh bloodwork also? My office test E2, Lh and P4, plus follie size before triggering.

:cross: Goodluck


#10

Anything around or over 200 estrogen wise will cause them to trigger you as thay tells them your follicle is mature when they triggered my first iui I had one at 15 this time it was 16 they weren’t Any bigger at my iui 12dpo hrs later because once they mature that’s it. My re told me this time around that my b/w and u/s has taught them that I don’t grow follies as big as others and that is normal and ok. Just drink plenty of water and if you really want to be more aggressive you may need to talk to your doc.


#11

13 seems small, but E2 around 200 means it is mature. I know it is frustrating to only have one. As you said, you could do one on your own, but really, all it takes is 1 and the IUI does give you a better chance than doing it on your own. The sperm is washed so you mainly get the prime swimmers, and they are put directly where they need to be. They may have also tested LH and seen that you were close to surging which would add to the thought that it is mature at a smaller size.


#12

Thanks so much, ladies. I had requested b2b IUI’s so I had my first one today. What a disaster. The stupid nurse couldn’t get the catheter in correctly so she used another type. I had terrible cramps afterwards, really bad and also a lot of bleeding. I’ve had over the course of the years about 10 b2b iui’s so about 20 iui’s total and never bleeding or cramping. I know it’s normal but not the pain I felt. She was horrible. AND my DH’s post-wash sperm count was only almost 19 million. Was 60 million pre-wash with 55% motility. Lowest it has ever been for IUI or IVF. The fertility gods are against us on this cycle!

I have another IUI tomorrow so we shall see.

missingmy#2 – I think they do check LH but I don’t know what mine was. I don’t think I would be close to ovulating since I was only CD11 but who knows. I’m not sure about other #'s other than e2, but since I use the ovidrel as trigger that takes the guess work away in terms of when I will ovulate for the most part I think?


#13

[quote=slc11]I have another IUI tomorrow so we shall see.

missingmy#2 – I think they do check LH but I don’t know what mine was. I don’t think I would be close to ovulating since I was only CD11 but who knows. I’m not sure about other #'s other than e2, but since I use the ovidrel as trigger that takes the guess work away in terms of when I will ovulate for the most part I think?[/quote]

19mil is GREAT! They like 10mil for IUI. Goodluck with tomorrow’s IUI. Lets hope its less painful. :cross:

Also, a trigger will yes make you ovulate IF only the follie/s are mature. It won’t make you ovulate IF they AREN’T. Lets hope the 13mm is mature!!


#14

slc- does your RE do blood work 5 days after iui for a progesterone check? If so that number will indicate if you actually ovulated or not.


#15

Brinn: Nope they do no bloodwork until beta test and then they only test HCG levels so I won’t know if I ovulated or not I guess. I could call and ask but I don’t believe they do that at all. I guess I"ll just have to to wait out the 2ww.

Missingmy#2, Thanks! Yes, I realize it has to be mature in order for trigger to ovulate a follicle but I guess I can hope the 13 grew a bit. I had my u/s at 6:30 am yesterday morning and didn’t take trigger until 10:30 last night, so that was 14 hours and then another 36 or so until I ovulate so I’m hoping in two days time it could grow enough to be mature. I guess he’s basing it all on e2 levels as his nurse said the u/s and measurements of follies can be misleading.


#16

hi there,

From what I know minimum should be 1.5, if you want to increase your follicle size and lining , do acpuncture once a week. My follicles both IUIS were 2.2 and linining was 11.

Good luck


#17

hi gizmo. Not sure what 1.1 and 2.2 are in terms of follicle sizes. I did acupuncture for my failed IVF and it did nothing for me. I know some people swear by it, so you just never know. Thanks for your input.


#18

Thanks Brooke! I figured that wa sout but my clinic measures them or tells me them only in millimeters. I do not get print outs of ultrasounds just the results.

My IUI today went MUCH better than yesterday. At least this nurse knew what she was doing. DH’s motility was lower today 48% from 55%… not sure what is going on with that but they inseminated 28 million which is pretty good numbers.

No signs of ovulating none of ewcm or anything like that… so I’m pretty sure I didn’t ovulate due to immature follicles… Thanks for all of your support and stories. I really appreciate it!


#19

SLC, any updates? I’m triggering with folls on the smaller side too, and low E2 (but 6 on the cusp of maturity so have to hedge our bets now)… just wondering how you’re doing.


#20

[quote=missingmy#2]

Also, a trigger will yes make you ovulate IF only the follie/s are mature. It won’t make you ovulate IF they AREN’T. [/quote]

I don’t know why I didn’t know this but I didn’t.

Friday I had two 11 mm follicles (well I had a couple more but one on the wrong side and one way too small)…anyway, so point being, I was convinced I triggered too early (Sunday morning) or I reacted too quickly to the Ovidrel trigger, since I ovulated sometime between Sunday morning’s shot and today’s 11 am u/s already and basically wasted this cycle.

So I am curious…if I had one dominant follicle, at 20 mm on friday, and then ovulated, would my RE have seen the smaller follicles still there if they were not mature enough? He said they had taken off and I am not sure if this means they were mature at that point then in order to do that?

Am I making any sense? I am so confused. :frowning: