Was My IUI Triggered Prematurely?

Question:

Hello, I just had my first IUI (intra uterine insemination) this past Tuesday and although the doctor was not happy with my follicles after Gonal f, he decided that I should trigger anyway with Ovidrel. The ultrasound the day of the trigger showed follicles 16.5mm, 16mm, 15.5mm and also some 13's, 12's and 10's. Were my follicles sufficient enough in size to produce a viable egg or two? :(( also do they continue to grow after Ovidrel? I had my IUI 34 hours after the Ovidrel injection.

I so desperately want a child and am not sure whether I even have a chance with this IUI! Please help. V. From the U.S.A.

Answer:

Hello V. from the U.S., I have to admit I don't understand at all why your doctor triggered you at this point? Why not wait for the follicles to grow bigger? Were they not responding to max stimulation? If you weren't on max stimulation then why not increase the dosage and wait?

In general, in order to achieve maturity, we will wait until the leading follicles are at least 18 mms. It is known, however, that if the follicles reach 16 mms then there is a chance that they will be mature at aspiration (retrieval) during IVF. But, I do think that the trigger was premature with your IUI. Yes, you might get three mature eggs, but all the follicles that are less than 16 mms will be immature. With an intra uterine insemination as opposed to in vitro fertilization, the picture is different. If the follicle does not reach 18-20 mms, it is unlikely that the follicle will ovulate despite HCG (Ovidrel). They do continue to grow a little, but the follicle has not reached ovulatory size.

I hate to burst your hopes, there is always a chance that a pregnancy can occur, but in general, I would not expect you to achieve pregnancy with this cycle because the trigger was premature thereby lessening the chance that ovulation will occur. I think you need to have a serious talk with your doctor and ask why he triggered so early! Was it a scheduling issue i.e. you would have reached maturity on the weekend and he would not have been able to do the IUI? Real infertility doctors work the weekends as necessary. I know that one of the local Ob/Gyn's in my area does not work the weekends. He cancels the cycle or turns it into a timed intercourse cycle if it falls on the weekend. If this is the case, I think you need to consider whether you want to continue to expend time and money on this doctor.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.comMonterey, California, U.S.A.