SUMMARY: Cora and Anthony have just failed their first IUI cycle and are here to discuss the next step.
Failing a single IUI cycle is not necessarily the end of the line when it comes to IUI’s. Just because the first one failed doesn’t necessarily mean it’s time to give up or to go to IVF. However, there is something special with Cora in that we know her tubes are not in the best condition. I told them that if we’re going to try IUI again, let’s at least consider doing it more aggressively, so that we get a lot more eggs than we did last time. The downside to this strategy is a higher risk of twins and multiples and a higher risk of Ovarian Hyperstimulation Syndrome. But with careful monitoring, we can avoid too high of a risk. In actuality, I reminded them again that I still think IVF is best for them, but they opted for an aggressive IUI.
IUI CYCLE #2
Day 3: Cora came in and got a baseline ultrasound. Both ovaries were quiet. There were no cysts. Her lining was thin (as would be expected since she just got done bleeding away her lining). Many times, right after a failed cycle, there are cysts left over from the previous stimulation, but not in this case. Very good.
Cora was instructed to take 150 IU of Menopur every day for five days and then return for another ultrasound. 150 IU is not necessarily a high dose for everyone, but for a 25 year-old, that is a pretty high dose. I would not be surprised if she made six or more mature follicles.
Day 8: Cora came back after five days of injections. This is what we saw.
RIGHT OVARY: (14×12) (14×13) (11×11)
LEFT OVARY: (15×12) (12×12) (12×12) (12×12)
Lining 8 mm triple-layer.
This is a good start. Maybe it’s not as vigorous as I would have guessed, but if the 12′s and 11′s all grow, we’ll have seven, which is a healthy number of eggs. I toyed with the idea of lowering her dose. Why? If I lowered her dose, I might be able to keep it very safe at just three follicles. However, that’s not what we wanted. We wanted more this time, so I maintained her on 150 IU for the next three days. Had we really been worried of her overstimulating, I could have brought her back in two days, but as it was, the plan was set: 3 more days of Menopur 150 IU.
Day 11: Cora came back after three more days of injection. I asked her if she was feeling bloated with a lot of eggs and she answered "not really". This is what we saw.
RIGHT OVARY: (19×15) (17×14)
LEFT OVARY: (17×15)
Everything else was less than 12mm on both sides.
Lining 10 mm triple-layer.
This was a bit unexpected. Out of all the 12′s and 11′s, I would have expected at least 1 or 2 of them to have continued. Instead, we saw that all the of the three lead follicles did fine, but everything else fizzled out. Cora had mixed feelings. She had been a little nervous about the plan of aggressive stimulation, but once she got her mind set on it, she was now disappointed that the stimulation was so light. This was even less of a stim than her previous cycle, which as you recall, was a combination of Clomid and 75 IU of injectables.
One thing to keep in mind is the unpredictability of the human body. Yes, you would expect that a higher dose would mean a better stimulation. However, haven’t you all had an experience when you studied much harder for a midterm exam than you had for the previous one, but wound up doing more poorly than the one that you hadn’t studied for? Those of you who are basketball fans might remember game five of the 1997 NBA playoffs between the Chicago Bulls and the Utah Jazz. The Bulls had just lost the last two games, allowing Utah to tie the series 2-2. Michael Jordan woke up that morning deathly ill with the flu or food poisoning. He had the big game that night and he could barely sit up. He slept until a few hours before game time and miraculously crawled out of bed. Even though he made it to the game, he was clearly wobbly, pale and weak. So what happened? The rest is history. He wound up playing almost the entire game (44 out of 48 minutes), scoring 38 points and leading his team to a 2-point win before collapsing into his teammates’ arms. The point is that the performance of the human body is unpredictable. There is a random factor that makes you bowl 120 one week and 189 the next without anything having changed about your skills.
I consoled Cora that this was not something terrible and that this did not say anything bad about her ovaries. In fact, it could just be a fluke. She was instructed to continue one more day of 150 IU and then take the trigger shot of hCG the next day. Triggering today would have been OK, but it was slightly better to grow them out one more day.
On Day 14, she came back for her insemination. It was another good sample with 10 million total motile sperm present. I don’t believe I mentioned that Anthony’s sample last month had consisted of 11 million total motile sperm.
Ultrasound right after IUI showed that everything had ovulated. The largest follicles anywhere were an 11mm on the right and an 11mm on the left. She had successfully ovulated and we began the long wait.
Twelve days after the IUI, Cora was scheduled to come back for her pregnancy test. I acknowledged that this stimulation didn’t appear on the surface to be any more vigorous than her first IUI, but it did have the advantage of been untainted by any Clomid.
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