# IUI too soon after HCG injection?



## JuliaJ

Hi

I really need some advice. I am 32, British but living in Hong Kong so it is hard to find such extensive support groups with professional advice as this one!

I have read the introduction to the IUI thread and my experience has been nothing like that which is described in the thread. I am very concerned that my treatment I am getting has in fact been pointless. I read from numerous sites, for example, that there should be a period of 24 - 36 hours (estiamted time of ovulation) between the HCG shot and the IUI because washed sperm is believed to only live an average of 6 - 12 hours with a maximum of 24(?). Instead my IUIs are being done just several hours after the shot!

Just by way of background I have been trying to get pregnant for 13 months now. I started having IUIs five months ago after one cycle on Clomid. I started the fertility treatment a little earlier than normal because my period was late one cycle which was very unusual for me. I was also exhausted, nauseaus, had lots of cramping and dizziness, but the pregnancy tests came up negative. When my period did finally come it was a lot heavier than usual. My GP wanted to make sure everything was ok and ordered a scan which showed nothign of concern. They did find what looked like a bicorneate uterus though so she said to come back for further investigations if I still wasn't pregnant after 8 months.

After 8 months then I went for further tests and had an HSG which confirmed I had either a bicorneate or sub-septate uterus. Everything else was fine (thyroid/glucose/kidney normal). My husband was also tested and they found he had slightly low motility at 43% - hence trying the IUIs (with IUI the motility goes up to 60%).

I am now at the point where I have justrfinished my fourth round of IUIs in five cycles. For each IUI I take 50mg Clomid for five days. I have an HCG injection around day 11 - 12 after an ultrasound confirms the follicles are ready. I react very well to the Clomid with around three to four large follicles each month. I am having a 23 day cycle with this treatment and without treatment my cytle lasts exactly 25 days. My concern is that *the first two IUIs were administered just 2 hours after my HCG shot * and the third around six hours (the third cycle I also took progesterone suppositiories). On the fourth cycle I took a break because I had a laparoscopy to see if my tubes were blocked, but apart from endometriosis they found nothing of concern that should affect fertility (they did however confirm that I had a large septate in my uterus). On the fifth cycle (this month) the IUI was administered 19 hours after my HCG shot but I think this might still be too early?

Maybe I will be lucky this month, but I am very doubtful. My doctor is keen that if I am not pregnant in the enxt couple of weeks we should move on to ganadotrovin. This is incase the Clomid is creating a hostile environment to sperm, but no tests have been done to check my cervical mucus nor my uterus lining. I have raised this with my doctor but he dismisses it and says it is of no concern if I move on to ganadatrovin. But I feel that perhaps we are taking drastic measures too soon and that the IUIs may be failing because of poor timing In addition, Hong Kong fertility treatment is big business. Each IUI costs £200 -£250 and with ganadotrovin around £950 a cycle. My doctor is also pushing ivf even though I have said time and time again that it is not an option for me (ivf in Hong Kong costs about £5,000 a go it has only been 13 months after all!!)

Sorry for such a long thread but I feel I need to give a full background so you can understand my situation. My doctor says that around 10 - 15% of women with septate uteruses have multiple miscarriages. He says mine is one of the largest he has seen (it is very wide and long so much that it looks like I have two long thin horns off the central cavity). I am nervous I could be one of the 10 - 15% although my doctor has assured me there is no way of telling. This is why I am desperate to get pregnant as soon as possible and I worry that is not going to happen if the IUIs are not being timed properly. I just need my mind putting to rest.

Please help!


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## angel wings

Hi Julia,

Sorry to hear you are having such a bad time with your treatment in Hong Kong, I had 2 IUI's before moving onto IVF. It does sound abit too odd to have the IUI's soon after the HCG, I have never heard of that before, I think I had mine just before the 24 hours were up. Unfortunately mine did not work and I decided to move on to IVF because of my age.

Just want to wish you luck and hope everything works out for you.

Angel wings
xxx


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## Ruth

I would agree that the IUI's have been done too early. Earliest I have ever done is 24 hours.

Ruth


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## JuliaJ

Hi Angel Wings and Ruth,

Thanks for your quick and helpful feedback. I feel much happier now that I know I am not on a wild goose chase! This is really frustrating ... I feel like I've lost four months. I've read so much on this now and all the articles, online fertility clinics etc. say 24, 36 or 40 hours after HGC so I just don't get why they aren't doing the same, especially when my doc is a professor in fertility! Nobody at the clinic ever raised timing as an issue. I will definitely be getting a second opinion. I wonder if it has anything to do with the size of the follicles? If they are very large maybe the doc thinks that they will rupture earlier?

As for moving to ganadotrovin, I think I might try Clomid one more time. *How do you know if Clomid is not working for you?* Is there some sort of test I can ask for to check my cervical mucus and uterine lining? I seemed to be ovulating regularly before starting Clomid and am taking 50mg to boost ovulation. I always have several follicles. This month I had nine follicles: three around 20mm, three aprox 18mm the rest around 16mm. It is usually the same every month. I have pain, cramping etc around the pelvic area for a week every month. Could the Clomid be overstimulating ovulation? Is there any danger with overstimulation? Before taking the Clomid I had two or three very large (20mm) follicles. Sorry for all the questions!

Good luck to you too Angel Wings. I hope the ivf isn't too stressful and you are successful soon. Fingers crossed.

All the best,
JJ


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## angel wings

Hi JuliaJ,

Are Gonadotrophinsthe injectable drugs that you use alongside the clomid, if so I had several cycles of those and clomid with and without IUI, I noticed that you said £950.00, is that right, it's very expensive. I paid around £700 for my 2nd IUI with the clomid and injections and that was done privately.

If you can I would get hold of a copy of Zita West's "Guide to getting pregnant" or "Taking charge of your fertility" by Toni Weschler, these are both easy to read and full of useful facts. 

Also get a free copy of the HFEA guide to infertilty - 

e-mail [email protected]  (request a copy of 2005/06 guide)
website www.hfea.gov.uk

As for tests on cervical mucus and uterine lining, I think I have some info on that somewhere, so i will get back to you on that one. I do remember though when the consultant was actually doing my IUI's , he said he could see there was lots of cervical mucus, which i remember being quite surprised about as most months I never see any.

I will try and get back to you tomorrow if not later tonight.

Angel wings


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## angel wings

Hi JuliaJ,

Angel wings again, I've just dug out some old notes. 

There are tests you can have for testing cervical mucus, there is a "Post-coital" test which basically means you have sex around the time of ovulation and then within afew hours you have a sample of cervical fluid taken from you. this can detect several things the sperms compatability and motility with your mucas and there is another test where you can look at a sample of the mucus under a microscope and it will be anyalised to see if it "FERNS", (ferning is a characteristically pattern of cervical mucus) to see if it is stretchy enough for the sperm to pass through. It's amazing how much info i've collected to do with infertility and with the help of google too.

From what you say, you seem to be responding really well to clomid, I had similar size follies to what you 
are saying.

Hope this is of some help.

Angel wings
xx


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## londonlou

Hi Julia,

sounds like you have a similar cycle pattern to me. It sounds to me too like thr IUIs are done too early. When I had HCG IUI at a private clinic was 36 hours later, at the NHS clinic 24. How is your lining? On a short cycle I struggle to get a good lining level. One of my bug bears is that this isn't addressed by the NHS clinic, they only assist with lining for IVF. Might be another thng for you to check out if you have short cycles as it affect implantation and has higher risk of MC. A lot of clinics don't do post coital tests anymore.

Good luck.

Lou
x


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## JuliaJ

*Angel Wings*, just wanted to let you know *you were right about 'taking charge of your fertility.' * Well I never got around to buying the book but I did decide to 'take charge' and give the doctors a miss while I was on holiday and I have just found out I am pregnant! I used the ovulation predictor kits and it has to be a miracle really because I don't think I ovulated until day 16 (LH surge on days 15 and 16) and only have a 25 day cycle. My husband was away from day 14 so I was really worried there wouldn't be a chance! Maybe it was the change of diet? I ate lots of meat and I think vitamin B helps to lengthen the luteal phase I'm still finding it hard to believe!!

Well I just wanted to thank you and *Ruth* because your comments really helped me to get things into perspective and until then I felt that my decisions to give the fertility doc a miss for a few months were a bit selfish, because there is also my husband to think of. It also gave me a kick to speak to my friend who is also a gyno. I know, you are probably thinking that I am lucky enough to have a friend who is a gyno and I did not speak to her first ?! but it sounds weird I was so embarassed at my situation. She said she didn't know why I was taking the drugs and doing IUI especially when I never had a day 21 test and I guess the fact that I didn't ovulate until day 16 on a 25 day cycle shows there might be a problem in that area!? I am so glad that I did not have to go down the ganadatrovin/ivf route. I know how stressful this all is, but I hope this gives you some hope and I wish you the best of luck...

Well it's odd because I am very excited but also very apprehensive because I do not know if the septate is going to cause a problem. Seven months to go!

JuliaJ


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## Ruth

Mega congrats!!!
It's good to take charge sometimes!!!!

Best Wishes,

Ruth


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