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oct01 - March 20th, 2006 11:18 PM

Dr. Smith,

My IUI was cancelled and I think it was due to the stimulation protocol. I was on 75 IU of Follistim CD 3-7, on CD 8 I had 4 dominant follicles at 12-13 mm, E2 283 and good lining (3 stripes). I was instructed to take 37.5 IU of Follistim on CD 9. On CD 10, my E2 dropped to 127 and the follicles failed to grow so my cycle was cancelled.

My RE says it was a "fluke, unexplainable, and happens to some women, regardless of age." I think it was due to a premature LH surge or because the Follistim was stopped so suddenly. I'm 31 yrs old with normal bloodwork except 24% ASA.

At a previous clinic, I responded well during 2 cycles of Letrozole CD 3-7, with 150 IU of Follistim on CD 3 and CD 7 and Antagon-- no cancellations. Based on this history, I don't understand why my new RE would modify the protocol. My only guess is that it was a complete oversight of my previous records.

We're now getting ready to do ICSI but I'm concerned that my RE will not be able to manage my protocol effectively, based on our recent experience with the cancelled IUI. I'm really worried about going through 5 weeks of treatment only to get the cycle cancelled in the last hour.

My RE is board certified and belongs to a very reputable clinic, but I feel like I've lost some faith. However, I also don't want to jump to the wrong conclusion about the abilities of this clinic, based on one protocol if it really was a "fluke".

Does it sound like I need a new RE?

Is response to stimulated IUI less predictable than for ICSI and therefore more susceptible to cancellations?

Thanks


shansy - March 21st, 2006 5:11 PM

Oct01-

What state do you live? This sounds very similar to something I am going through right now as well... I just want to make sure we are not at the same clinic.

Thanks!

oct01 - March 21st, 2006 8:45 PM

Hi, I'm in Central Florida... where are you?

Did your RE provide you with an explanation as to what went wrong?

shansy - March 22nd, 2006 6:50 AM

I'm in Michigan. My cycle hasn't cancelled yet, but they started me on only 75 units and yesterday I went in on CD 7 to check everything and nothing is happening. Now they want to up my dose to 112 units, but I still feel I should be at 150 units like most people start at. I know they are the experts, so I am following their plan. I am just worried that this cycle will end up not working due to the stimulation being delayed.

Dr Smith - March 22nd, 2006 11:13 AM

oct01 - your situation may be different from "shansy" because she has PCOS (see reply to "shansy").

If you do not have PCOS, I can't imagine why you received such a low dose of Follistim. The usual minimum dose to start a cycle (in a non-PCOS patient) is 150-300. If there is an inadequate amount of FSH (i.e. Follistim) in the first few days of stimulation, and then the dose is further reduced even more, the stimulation will predictably fizzle. Better get a second opinion before proceding to IVF/ICSI.

My suspicious mind conjures up an ulterior motive: cancel the IUI cycle and move you to IVF/ICSI to make more money off your cycle. Since I don't have [i]all[/i] the facts, this is only conjecture.

oct01 - March 22nd, 2006 12:04 PM

Dr. Smith,

Thank you for your thoughts on this.

I have yet to speak with my RE regarding what happened (she is on vacation) but I'm scheduled to meet with her next week. The nurse called me and said that the other RE at the practice reviewed the protocol and is recommending 50 IU of Follistim from CD 3- 7 for the next round of IUI, which is even lower than what you (and others online) have suggested, leaving me completely baffled!

I am 31 with 2 normal E2/FSH tests done a year ago at my previous clinic. In Oct 2004, my FSH was 5.2 (can't find the record for E2 but it was normal). In June 2005, my FSH was 6.0 and E2 was 21.9. The only "quirky" finding was that my LH levels tended to rise quickly during stimulation protocols at my previous clinic (and I think that's why they gave me Antagon, which worked fine).

The reason we're seeing an RE is because of female factor ASA 24% and male factor DFI and HDS 20%.

My current clinic is fairly large and "nationally recognized" and all 3 RE's are board certified so I'm really confused as to why their IUI Follistim protocol is so different from others (unless their motives are as you speculate). I have no idea how to get to the bottom of this but I definitely do NOT want to go to a clinic where they employ those tactics.

My other option is to travel by car to another "nationally recognized" practice in Jacksonville for a second opinion, but whose to say that they won't tell me I am in better hands with them just because they want my business?

Do you think this error was significant enough to cut my losses with the local clinic? I know it's a personal decision but I'm at a loss and would really appreciate an expert's opinion.

Dr Smith - March 22nd, 2006 12:23 PM

See what your RE has to say when she gets back from vacation. Ask specifically for the justification for the unusually low FSH starting dose. Maybe I'm missing something here, but it is a puzzle to me.

I personally know Dr Michael Fox in Jacksonville. I think he'll give you a straight, unbiased answer, if you seek his opinion (North Florida Center for Reproductive Medicine).

oct01 - March 23rd, 2006 9:23 AM

Dr. Smith,

Thank you so much for the information-- I will definitely look into this further. Do you also happen to know/recommend a RE in the Orlando area?

Dr Smith - March 23rd, 2006 9:37 AM

No, sorry. I know [i]of[/i] the folks in the various programs in Orlando, but I don't know any of them personally. I don't want to steer you one way or another based on heresay or perceived reputation.

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