GHOST- PLEASE HELP!!

[mulligan]

Hi,

In a nutshell, here is the deal:

I am trying my third and final iui. I took letrozole on days 3-7 and then started 75 units of gonal f on day 7. I went in on day11 and had 3 bigger follicles (maybe 15-16mm) and 3 smaller ones (maybe 12mm). My doctor told me to continue the 75 units of gonal f for 2 more days. So, today I went back and I now have 4 bigger follies (biggest is 20, then two at 18 and one 17) and 2 smaller ones (around 15-16mm). My estrogen is at 534. Here's the problem: my doctor cancelled my cycle because she's afraid that if I do the ovidrel I'll ovulate all 6 follicles and that all 6 have the potential of releasing a viable egg and then will fertilize, etc...Even though the last two are small, she thinks that they could still release a good egg. Here's my question, if I don't do the ovidrel, but ovulate on my own will I still release all 6 follicles or just the one or two that are in the lead? Can my dh and I still try naturally without having sextuplets or is it more likely that I'll just ovulate one or two of them. By the way, I have PCOS so that's why I had a crazy response to the gonal f. Basically, I just have to sniff the gonal f to stimulate my ovaries. Sometimes that's a good thing, sometimes a bad.

One more thing... I am not taking the gonal f today or tomorrow and I'm going back for another ultrasound in 2 days. Is it possible for the smaller follicles to fizzle out by then or will they continue to grow between now and then?

Thank you SOOOO MUCH for any information you (or anyone else) can give me. I've been on this roller coaster for 2 1/2 years, done ivf and had 5 miscarriages. I'm not ready to throw a cycle down the drain unless I really, really have to.

Thanks,
Mulligan

[Ghost]

Hi,

In a nutshell, here is the deal:

I am trying my third and final iui. I took letrozole on days 3-7 and then started 75 units of gonal f on day 7. I went in on day11 and had 3 bigger follicles (maybe 15-16mm) and 3 smaller ones (maybe 12mm). My doctor told me to continue the 75 units of gonal f for 2 more days. So, today I went back and I now have 4 bigger follies (biggest is 20, then two at 18 and one 17) and 2 smaller ones (around 15-16mm). My estrogen is at 534. Here's the problem: my doctor cancelled my cycle because she's afraid that if I do the ovidrel I'll ovulate all 6 follicles and that all 6 have the potential of releasing a viable egg and then will fertilize, etc...Even though the last two are small, she thinks that they could still release a good egg. Here's my question, if I don't do the ovidrel, but ovulate on my own will I still release all 6 follicles or just the one or two that are in the lead? Can my dh and I still try naturally without having sextuplets or is it more likely that I'll just ovulate one or two of them. By the way, I have PCOS so that's why I had a crazy response to the gonal f. Basically, I just have to sniff the gonal f to stimulate my ovaries. Sometimes that's a good thing, sometimes a bad.

One more thing... I am not taking the gonal f today or tomorrow and I'm going back for another ultrasound in 2 days. Is it possible for the smaller follicles to fizzle out by then or will they continue to grow between now and then?

Thank you SOOOO MUCH for any information you (or anyone else) can give me. I've been on this roller coaster for 2 1/2 years, done ivf and had 5 miscarriages. I'm not ready to throw a cycle down the drain unless I really, really have to.

Thanks,
Mulligan

We don't get many IUI questions here.

When you have your LH surge, all of those follicles are likely to ovulate. Your clinic should have mentioned this.

The small follicles just might fizzle (I like that word). In fact, small follicles can be made to fizzle by denying them FSH. Your doctor is probably aware of work by Filicori and colleagues, published in Fertility and Sterility in 2005. Basically, you can use tiny doses of hCG (or presumably LH) to complete the development of only the large follicles, and let the others wither. Large follicles can have FSH-independent development, but they still need some prodding. I think the cutoff was around 14mm, with larger ones proceeding and smaller ones regressing.

PCO is no big deal for IVF if handled correctly, but is tricky for IUI.

Good luck. Let us know how it goes.

[mulligan]

Ghost,

Thank you so much for your quick response- I knew I had a better chance of finding you if I posted on the ivf board. I will ask my doctor about the low dose of hcg- very interesting. I will keep you posted on what happens...

Thanks again, you are very much appreciated on these boards. With all of the uncertainty that we are all experiencing, it's incredibly nice to get an educated opinion from you. Thanks a million.