11 Replies
shansy - March 25

Hi Dr. Smith,

I wrote an earlier post and I wanted to update you on my situation to get your opinion.

I was started on 75 units of Gonal-F CD 3-6, went in on CD 7 and my E2 was 71, so they increased my dosage to 112 units for CD 7-9. Went back in on CD 10 for blood/us and there are not any dominant follicles emerging yet (though there are many small ones) and my E2 came back at 101. They instructed me to increase my dosage to 150 units and return on CD 13 for another check. Yesterday I started to feel sick and now have a fever of 100 degrees which I think came about independent of the stims.

In your opinion, will this slow progress of my follicles affect my IUI? Also, is it "normal" to proceed slowly with the stims? (I know they are being careful b/c of my PCOS) Finally, do you think this fever I have will affect my body's reaction to the stims? Is it safe to take fever reducer medication along with the Gonal-F?

Sorry for all of the questions, I am just feeling like this cycle is going all wrong. :(



Dr Smith - March 27

The stimulation (number of days of stimulating medications) should probably not exceed 14 days in total to avoid "post-mature" eggs. Looks like you're getting pretty close. You may want to consider canceling this cycle. As a rule, before you take any medication (even OTC meds), you should check with your doctor. Sorry to hear that you've got a flu bug. There's a nasty one going around. I got hammered last week.


shansy - March 29

Dr. Smith,

I went back yesterday CD13 (day 10 on stims) for an u/s and bloodwork. U/S showed that I have many follicles, but not any are dominant yet. My E2 came back at 242 as compared to 101 on CD10. I have been instructed to continue with 150 units of Gonal-F and to go back in on CD16 for another u/s and bloodwork.
My normal cycle without stims usually lasts about 30-35 days.

I asked the nurse about "post mature" follicles seeing how long my cycle is going and she said that I'm fine b/c it would show up in labs. She told me that everything is going along smoothly and they want me to go slow b/c of the risk of OHSS.

As far as I know, the only thing they are testing in my bloodwork is my E2 level. Would my E2 level indicate "post mature" follicles? Does this make sense to you or do you think I should consider switching doctors? I am currently at University of Michigan.



Dr Smith - March 29

Rule #1: Never ask a nurse an embryology question. They are not qualified to answer and invariably pat the patient on the head and say "Don't worry".

Blood tests cannot measure the maturity of the eggs in the follicles. The maturity of the eggs is determined after they are retrived from the follicles and are in the lab. I agree that it is prudent to go slow on the stimulation considering your PCOS, but there is an upper limit. When doing IVF, eggs from extended stimulations (i.e. post mature) may have to be ICSI'd to achieve satisfactory fertilization rates. Since you are doing IUI, fertilization rates may be low. However, this is not necessarily a really bad thing since PCOS patients produce an abundant number of eggs.

No, its not time to change doctors. Ovarian stimulation is not an exact science and there is considerable patient-to-patient variation and even cycle-to-cycle variation for a given patient. Hang in there.


shansy - March 31

Thanks Dr. Smith for your earlier reply.

We went back to Dr.'s office today and had another u/s and bloodwork. The u/s showed 4 follicles- 3 on right, 1 on left. My E2 level is 892. Our problem is that my right tube is blocked. In your opinion, should we continue with the IUI or cancel it due to very low chances?

We were hoping to have more follicles on both sides this time as the number of follicles we have is similar to that when we were only doing Clomid or Femara.



Dr Smith - March 31

I'd recommend canceling the cycle because there is only one follicle in the left. Your chances of a successful pregnancy are slim at best. Better luck next time.


rpoirier - April 1

Dear Dr. Smith,
I have recently done an iui on march 7,2006. I had no luck it didnt work. I was on clomid and folostim shots. My cycle started for 2 days one of the days it was light and the other day it wasnt much heavier. I am going back to the doctor April 4,2006 we are starting all over again. I only have one tube on the right side because in july last year i had one removed due to endometriois. this time my doctor is tring 2 iui's on the same day. do you think i will maybe have a better chance this time doing 2 with the condition's i have.


shansy - April 2

Hi Dr. Smith,

Well, we went in on Friday for u/s and blood and it showed 2 dominant follicles on left and 3 on the right. We were very pleased with this...I had cramping that day and night...then we went back yesterday and u/s showed only one on left...??? Later in the day RE called to give me my E2 levels and confirm Monday's IUI- however instead, he told me that I had ovulated the night before on my own! I am still in shock. He said they were waiting for the follicles to grow a bit more and they waited too long. I can't believe this happened as we were going to RE everyday for the past 3 days. My husband and I had been abstaining b/c of the IUI, so the chance that we fertilized the follicles is pretty small. Just thought I would share this update with you. Thanks for all of your responses.



Dr Smith - April 3

Shannon, usually, premature ovulation is prevent by using medication. Weren't you taking something to prevent this?


Dr Smith - April 3


The main concern is how many follicles are developing on the side with the open Fallopian tube. If you are under 35, then at least 2-3 mature follicles should be present on that side to make IUI worthwhile. If you are over 35, 4-5 would be the bare minimum.

Double inseminations are unecessary, if the time of ovulation is accurately predicted.


shansy - April 3

Dr. Smith,

I am 29 years-old. I had two follicles on my open side. I was taking Gonal-F and Metformin, and it was CD 17 when I ovulated. Is there something else I should've been taking? The RE said he was waiting to allow my two follicles on my left side to grow a bit more as on CD 16 they were 15-16 mm.

Thank you,


Dr Smith - April 4

Centrotide and Antagon are medications that may be used to prevent premature ovulation in patients who are not on the tradition long Lupron protocol (not flare).



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