Confused, advice please
5 Replies
DB_33 - May 8

Dear Dr Smith,
I wonder if you may offer a little expertise please.
I had DIUI on 13th April (i had lowest dose possible gonal-f stimulation and a trigger of 6500iu choriogonadotrophin alfa)
I had 4 follicles and thus my cycle was due to be cancelled but since only 3 were large I was told i could be scanned on the day of IUI and since it was unlikely all follicles would rupture i may be able to contiinue.
On the day of IUI (36 hours post trigger) only 1 follicle had ruptured, I was told the others would be re-absorbed.
15 days post IUI i had a beta HCG.... 1,275 !!!

I am terrifed that perhaps more follicles ruptured after the IUI and that this may be a multiple pregnancy. I am worried about molar pregnancy although at 5 and half weeks i feel well. I had a pyrexia of 38.5c which developed suddenly five days post IUI which last 12 hours then resolved with no pother symptoms.

Please Please can you advice if pyrexia is usual?
if other follicles could have ruptured more than 36hours post trigger?
Is a hcg level that high anything to panic about? could it be 3 babies? or even a singleton?

I understand there is no guarantee but my scan isnt for another 2 weeks and i am extremely anxious.

Many thanks indeed if you are able to offer any info



Dr Smith - May 9

The pyrexia is a medical issue, so I will defer to Dr Jacobs (Infertility 101 Message Board).

It is possible that more follicles ruptured, since ovulation is not a fixed-time event, but rather lasts a period of hours as the follicles rupture one at a time. Whoever told you they would be resorbed was misinformed. The beta-hCG value is relative to the day of the insemination. At 15 days post insemination, 1275 is a rather high value, indicating more than one embryo implanted.


DB_33 - May 10

Thank you Dr Smith,
Our clinic is one of the most respected in the UK (the first test tube baby etc) hence why we trusted them and went ahead with IUI
We were advised that 36 hours post trigger injection any follicles that had not ruptured would be re-absorbed into the body. We would not have progressed (nor been allowed to progress is more than 2 follicles ruptured). I had one dominant, two slightly smaller and a fourth much smaller follicle.

In your opinion (and i apreciate it is only that) do you think this could be more than a twin pregnancy? Is there any chance of it being a singleton still?

How reliable are HCG values? Surely if the blastocyst implants very ealy HCG levels would higher on day 15 than a late implanting one? (i understand implantation is around day 8 but can be earlier or later)

Can follicles still rupture after 36 hours post trigger injection?

Your advice is extremely appreciated at this vey anxious time. Thank you !


Dr Smith - May 10

hCG induces ovulation about 37-42 hours after injection. During a stimulated cycle, ovulation is not a single event. Ovulation is a process of multiple folliclular rupture over a period of several hours. In other words, they don't all pop at once. Follicles smaller than 16mm in diameter do not [i]usualy[/i] release their eggs. These follicles are reabsorbed into the ovary. However, follicles over 16mm are mature enough to undergo ovulation in response to the hCG. Because these follicles are smaller than the lead follicles of >18mm, they may be delayed and release their eggs (i.e. closer to 42 hours post hCG). Hence, a single ultrasound examination at 36 hours is not definitive.

The hCG values we get are not all that predictive. Hence, it could still be a singleton pregnancy with "early" implantation. However, in my expereince, a first hCG value of over 1000 usually indicates at least twins.


DB_33 - May 10

Dear Dr Smith,

Thank you once again for you advice. It has been most informative and helpful. I will wait for my scan and know for sure then. I wish perhaps the clinic had been a little more specific with us prior to allowing us to proceed in the belief only 1 follicle had/would rupture. Glad to be pregnant just terrified of premature babies and the problems they can encounter (i am a paediatric nurse).
Thanks !


ghazal - April 11

Last i had no flow, and after scan ther were two ovarian cyst sized5.9*5cm, I used wobenzym N for 10 days, now they are follicles sized 2*2 cm on right overy, And one more mature follicle on left overy, Dr said this follicle failed to rupture this month. What should i do, now this was 21st day today, will i get menses this month, oR should i take primolute n again, as i had taken it last month.



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