Sorry I missed the chat last week- my dial up connection may have prevented me from joining. 

Hello Dr. Potter,

I'm an HRC patient.  Last month I had a Clomid, Ovidrel MS/IUI cycle.  BFN.  I will not be cycling until October; I had an 18mm cyst on R ovary and fluid on L.  We are sorting for a girl and had a 89.3% sort.

I would like your thoughts on what would be a good next step both for success and making a good financial decision.

DH and I are 33.  No fertility issues in the past.  My cycle was Clomid 3-7, U/S Day 11 L&R 14mm.  E-2 fine no estrace used.  U/S Day 13 L 23mm, R 14mm E-2 fine.  Day 13 trigger Ovidrel.  Day 15 IUI late afternoon.  My next period started one day early.

My husband had 277,500 motile sperm with prog. of 2.5 for insemmination.

So I understand I basically cycled with only one follicle and a reasonable sperm and sort.  Kelley suggested changing to one U/S on Day 12 (from 13).  Might I still have just one follicle if nothing else changes?  How much does only 1 follicle v. 2 change my success rate?  Is there anything else I should change for the second cycle?  Like adding a low dose of injectables?  Would that be a good next step for success and a good financial decision for Cycle 2?  With the expensive U/S and bloodwork we had, our cycle cost more than expected and so finances will be limited for any future cycles.  I understand injectables can add quite a bit more cost- but if it worked would save us in the long run and be worth it.

I really appreciate your thoughts as we make such important decisions with our very limited experience and knowledge.  Thanks

We were told by Nachet at HRC that 85% of the IUI's will not work with clomid and without clomid (natural cycle) 90% will not work. I asked her could I do anything else to improve the odds and she said no.

Q: How high a sperm count is needed for IUI?

A: A count above one million washed appears necessary for success, with a significant reduction in pregnancy rates when the inseminated is count is lower than 5-10 million (in other words, in most cases one should consider 5 million a lower limit for success, 10 million for cost-effective). Higher success rates are with washed counts over 20-30 million, while increasing counts over 50 million did not appear to offer advantage. Advanced Fertility has a chart of success rates for one month of various treatments.

As you know MS only has about 240,000. 

Good luck.

I forgot to say, I'm hoping you will be able to answer this question before my next cycle.

Thanks

Under 2 Umbrellas:

Sorry I missed the chat last week- my dial up connection may have prevented me from joining. 

Hello Dr. Potter,

I'm an HRC patient.  Last month I had a Clomid, Ovidrel MS/IUI cycle.  BFN.  I will not be cycling until October; I had an 18mm cyst on R ovary and fluid on L.  We are sorting for a girl and had a 89.3% sort.

I would like your thoughts on what would be a good next step both for success and making a good financial decision.

DH and I are 33.  No fertility issues in the past.  My cycle was Clomid 3-7, U/S Day 11 L&R 14mm.  E-2 fine no estrace used.  U/S Day 13 L 23mm, R 14mm E-2 fine.  Day 13 trigger Ovidrel.  Day 15 IUI late afternoon.  My next period started one day early.

My husband had 277,500 motile sperm with prog. of 2.5 for insemmination.

So I understand I basically cycled with only one follicle and a reasonable sperm and sort.  Kelley suggested changing to one U/S on Day 12 (from 13).  Might I still have just one follicle if nothing else changes?  How much does only 1 follicle v. 2 change my success rate?  Is there anything else I should change for the second cycle?  Like adding a low dose of injectables?  Would that be a good next step for success and a good financial decision for Cycle 2?  With the expensive U/S and bloodwork we had, our cycle cost more than expected and so finances will be limited for any future cycles.  I understand injectables can add quite a bit more cost- but if it worked would save us in the long run and be worth it.

I really appreciate your thoughts as we make such important decisions with our very limited experience and knowledge.  Thanks

It depends on whether you are traveling a long distance as far as financial matters go. Assuming normal ovarian reserve MS/Clomid/IUI = 15% pregnancy; IVF/MS/PGD = 65% if 2 normal embryos are available to transfer; MS/injections/IUI = 20%; Look at the total cost, including drugs, travel, MS, etc and you will arrive at a cost per success. With injections and IVF you will have a much higher chance for twins than with CC/IUI. Is this desirable for you?