Lemme break it down:
- Frozen sperm lasts about 12-24 hours after it is defrosted. I know, it's astoundingly less than fresh sperm. (I was able to find this info from several sources online, not once have I heard this from my clinic. I thought it would have been closer to a couple of days)
- I ovulate 36+ hours after my Hcg trigger shot. I get the mittleschmertz, so I feel a lot of pressure before I ovulate.
- My last two IUI's have been exactly 24 hours after my trigger.
- Which means by the time I actually ovulate a good portion of the sperm is probably already DEAD.
- I happened to see on TWO other local IF Clinic's websites that the clinics do IUI's closer to 36-40 hours after the trigger. WTF?!
Okay, I know I must seem like I'm grasping at straws to find some possible explanation as to why I still haven't gotten pregnant, but the things I listed above are completely factual. So now I'm left with more frustration over the coulda, woulda, shoulda's. I should have put two and two together a lot sooner, but wouldn't it have been Dr. Rawks' responsibility to follow up with me regarding each mundane detail so that we could "fine-tune" the protocol on our next cycle?! I'm not as mad at him as I am myself. I should have done more research about the longevity of the sperm and sooner. I should have spoken up about the tiny details of my cycle and wanting to be more aggressive with treatments. I could have saved Brian and I a lot of time, heartache, and money.
We have one vial left, and I plan to use it in about two weeks, so there won't be enough time to find a new RE by then. But if things don't work out again next month I can safely say that we will spend the month of January shopping for a new RE. It kinda makes me sad to say that. I do actually like him, he has a fantastic bedside manner, and is incredibly gentle, ahem, down there. But I hate that I haven't gotten the slightest inquiry from him during my FIVE failed cycles. For so long I kept chalking it up to my odds just being low each cycle... But now I think I've kinda been screwed by the lack of attention on my RE's part.
So here's the new plan:
I called this weekend to request an increase in my dosage of Letrozole. The nurse I spoke to said they rarely do that, and Dr. Capableoffindingmycervix is on vacation this week. Which means it's pretty unlikely that another Dr. will trump his orders. So I might have to fight for it. When I go in for my follie check, probably Dec 6th. I'm going to insist that I trigger that night at home and come in 36 hours later. Instead of triggering after my u/s and coming in the next morning. Who the fuck knows if it'll work, but at least I'll feel better knowing that I've done what I can.
P.S. I'd love to hear about your IUI protocol.
29 comments:
My RE does the IUI 36-40 hours after the trigger shot. I think you could be onto something, everything you said makes sense. I hope this change works for you!!
I am on my 7th IUI and my Dr always has me trigger 34 hours prior to my IUI. I usually go in for my day 11 U.S. and trigger that night at 11pm or so then have my IUI on day 13 around 9am. Not sure if this helps but it actually worked once for us then I mc...
Mine are about 36 hours after trigger. With the last cycle I triggered at 8pm on a Monday and went in at 10am on a Wednesday. From the cramping I knew I ovulated in the morning just before we got to the doctor's office.
My IUIs were about 40 hrs after my trigger. I could feel myself ovulating at that time as well. It really doesn't make sense why they are doing your IUIs so soon. The only thing I can figure is if they want the sperm to already be in your tubes when you O. However, like you said, the sperm don't last as long. I've also heard of a double IUI where they inject sperm before and again after you ovulate.
I say you get assertive and voice your concerns and how you want it changed this next time. You are, after all, paying them a ton of money for their services. My previous clinics kept going on and on with the same protocol and never changed it up...so I moved on. I mean, after SEVEN IUIs, you think they would have tried something different. It's sooooo frustrating...good luck and I hope everything works out this time:)
First, I'm so glad that you weren't offended by what I said. It's so hard to put out the right "tone" when typing, ya know?
All four of our IUI's were done 36 hours after trigger. I think you're on to something here.
Hoping your persistence pays off!
Hugs,
Jo
Good luck!
My friend concieved her son on her 6th cycle (as did we through clinical IUIs with my DH's frozen, washed, thawed sperm and her eggs) with IUIs and DS.
ICLW -- Keep the faith!
Good luck with this IUI! And hey, I totally think I know more than my RE too! It is frustrating & ridiculous that so much of this fertility stuff is DIY--if I weren't a good Googler, I don't know that I'd ever have even learned what a reproductive endocrinologist was! And if I weren't my own (very vocal) advocate, we never would have found out that I have endo (diagnosed last month--good times). Good for you for demanding more from your RE!
You go girl - keep advocating for yourself.
My first DIUI - natural, positive OPK in am (I think it would have been positive in the middle of the night), IUI roughly 24 hours later - early miscarriage/chemical pregnancy;
Second DIUI - natural, positive OPK (first am but I think it would have been positive in the middle of the night), IUI roughly 24 hours later - BFN;
Third DIUI - clomid, six follies, positive OPK on CD 19 at about noon, did a home insemination at about 6:00 pm and an IUI the next morning at about 10ish I think - pregnant with twins - one of which did not show up on my 4w5d u/s - so did I get knocked up from my first DIUI or was it the second?? I do not know - but I felt the same as you - they were missing my window - and I had to get more aggressive - so I literally took things into my own hands and did an at home insemination. Did it help - I will never know but I would do it over again.
You have to advocate for yourself - I fully support you.
lol, I always struggle with feeling like I "know" more than my RE! Haha, love the post title!
My b2b IUI's are 18 hours and 42 hours after trigger. It sounds weird compared to what others do, but my RE says they do a billion IUI's a year so I'm trying to trust him with at least one thing... :)
Another here whose RE triggers 36 hours before the IUI. I've read that ovulation can occur within 24-48 hours after the trigger shot (or something like that), so your theory could be correct.
It can't hurt to try something a little different. Good luck!
The protocol where I go is 36 hours, so I trigger at night, then IUI in the morning 2 days later. Myself, I'm actually worried that I'm triggering too early (or doing the IUI too late). I've read that you can ovulate 12-36 hours post trigger, and I feel like I might be more of a 12 hour kind of gal... Good luck with your RE! I agree with everyone else - you must be your own advocate!
I think you may have hit the nail on the head. It is great that you are advocating so strongly for yourself.
Good luck with this cycle.
~ICLW
I agree with all these ladies, I do mine about 36 hours... trigger 10pm one night and go in on the second morning after that...
Although I had an m/c I did get pregnant last cycle, and I always always have felt my ovulation either a couple of hours before or after the IUIs
I think you should definitely bring it up.
I have only done one IUI and it was about 48 hours after the trigger, which I felt was too late. But then again, what do I know? I'm still figuring all of this out.
The one thing I can say though for sure is that you shouldn't feel bad at all about shopping around for REs. If you take this info about IUI timing to your RE and they blow you off, then that is the sign that it is time to go!
I recently left a very big and well respected practice that made me feel like a number and someone they could just try to apply some sort of formula to. I found another doctor, also very well respected, but who is in a much smaller practice with just one other doctor and two nurses. They are SO much more personal and absolutely listen to me. I'm still not pg, but I haven't done my first treatment cycle with them yet. Here's hoping....!!
So I guess the take home message is... don't feel badly about shopping around. You are paying them for a service and if they don't deliver, take your business elsewhere! ;)
Good luck!!!
ICLW
Robin
Definitely keep advocating for yourself! It certainly sounds like you're on to something. Whether you trust your RE or not, there's something to be said for just trying something new, you know? It can't hurt...and I hope it helps you get your BFP! Either way, you'll feel better about the process.
Trust your gut. I agree with everyone else. Your rationalization is extremely solid, and it sounds like your RE isn't up on the latest science. Fight for what you want, they should give it to you, as you are the customer, right?
Good luck this round!
ICLW
I think it's wonderful you are being your own advocate! You go, Girl!
Someone once said...we know our own bodies the best. Yes, our docs have the science knowledge (some more than others), but at the end of the day no one cares more than the patient themself. And, for that reason, we have to be our own advocates.
I remember the day I asked for my med records, I poured through each one and couldn't believe some of the info I never knew before.
Again, you go, Girl!
Go with your gut. I told our
RE that I thought the timing of our DIUIs and trigger were off...he last cycle we did, I did what I wanted (triggered 24 hours prior) and that's the cycle I got pregnant.
You're absolutely right about the timing and the frozen sperm. Our RE had me trigger 12 hours before IUI, but once I did the math between 36-48 until ovulation after trigger and sperm only living 12-24 hours I changed my protocol.
I think REs aren't familiar with frozen sperm. I hate to think where we'd be if I hadn't questioned procedure.
Email me if you have more questions jess.white05 at gmail.com
My IUI protocol was 36 hours post-HcG as well. Is there some way you can demand (nicely, of course) that your IUI be timed for 36 hours? Another (trickier) suggestion: could you somehow inject yourself sooner? Not sure if this is feasible. Or a good idea.
But your RE should listen to your concerns and address them accordingly. Especially if you have past experience/info to give him!
My RE says they try to time the 38-40 hours after trigger, so I trigger at 9pm and then my IUI is usually scheduled for 10:30 (and then they run 1/2 hour late!).
I hope you're able to work out the new protocol and it works for you! Good luck!
Have you talked to your doctor about your concerns with when you feel you ovulate and when the IUI is performed? That is probably a stupid question, but I'm new to your blog.
The bottom line is that if you don't think your current doctor is doing your cycles justice, you should follow your gut and move on. I would definitely follow through with your current plan for this next cycle though. I think when we did our IUI it was 36 hours after trigger, but it has been too long to remember. All I know is I thought it was too long to wait and was worried the egg would be gone by then.
Best wishes with the next cycle!
It sucks when you start to lose confidence that the doc is absolutely doing exactly what's right for you. I'm really hoping that what you think is exactly the adjustment you need to make this IUI a success.
Most FS's (RE's) will do the IUI 36 hours after your trigger shot. With my IUI's I always did a double shot - one IUI 36 hours after trigger and then another IUI 24 hours after that - that way if you are a late ovulator they should still technically catch the egg!
All the best!
(ICLW)
We are all the experts by now!
I don't have any experience with IUIs (we've done IVFs and a FET), but I wanted to wish you the best. I understand what it's like to feel like you have to research everything, and the frustration that comes with thinking that your RE should have told you certain things. Be your own advocate and follow up with everything.
Wishing you the best with this cycle!
ICLW
Wandering in from IComLeavWe. Have a great weekend.
I'm so freaking proud of you, Meg, this is the way to go! I've taken this proactive approach before and it has definitely worked, at least making me feel more in control, although right now taking the opposite approach (ignorance of information) seems to work better...
I think I know more than my RE too. Or maybe I should say my RE's nurses because I saw him twice in a 9 month period and nurses every visit, though they said he monitors the treatments and will change things if he doesn't agree with the nurses' plans. If I hadn't questioned him and insisted on trying Femara before moving on to IVF, I wouldn't be pregnant and due in 2 weeks now. Question everything. Be that pain in the ass patient if you have to.
They always wanted me to do the IUI 24 hours after trigger, which after researching, I felt was too early. I also felt that they had me trigger too early (usually when the follies were 15mm). The cycle that worked, I had a 23 mm follicle.
Definitely question it, especially with the frozen samples having a smaller window.
Good luck!
I think I know more than my RE too. Or maybe I should say my RE's nurses because I saw him twice in a 9 month period and nurses every visit, though they said he monitors the treatments and will change things if he doesn't agree with the nurses' plans. If I hadn't questioned him and insisted on trying Femara before moving on to IVF, I wouldn't be pregnant and due in 2 weeks now. Question everything. Be that pain in the ass patient if you have to.
They always wanted me to do the IUI 24 hours after trigger, which after researching, I felt was too early. I also felt that they had me trigger too early (usually when the follies were 15mm). The cycle that worked, I had a 23 mm follicle.
Definitely question it, especially with the frozen samples having a smaller window.
Good luck!
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