Iui how many follicles are normal

Infertility specialists and patients both should be very careful when considering treatment options, and when deciding whether to proceed with an IUI cycle — or cancel it — when several follicles are present on ultrasound. This is a good and needed study in our field. Although other studies have investigated similar issues, this study was large and fairly well controlled, as well as prospective looking at what happens in the future, after the study is designed, rather than looking at patient charts to see what happened in the past.

Women under 35 were at high risk for multiples when there were six or more follicles 12 mm or more in diameter. However, for women over 35, the pregnancy rate was improved when there were six or more follicles in that size range, without significantly increasing the multiple implantation rate. We need to be careful about this. No study can ever tell us what will happen in an individual case. The information in this study can help us to regulate the ovarian stimulations in our patients more appropriately.

We also need to be willing to cancel cycles that are at high risk for triplets because of development of too many follicles or convert these cycles to IVF if the patient prefers.

Ovarian hyperstimulation syndrome, or OHSS, is a condition with enlarged ovaries and fluid build up. Ovarian hyperstimulation syndrome, OHSS, is a complication that can occur with in vitro fertilization The. Patient Resource Center. Patient Portal. Request a Consult.

Number of follicles as a risk factor for multiple pregnancy with IUI cycles. IVF - Blog. Infertility article review and discussion Title of article: Relationship of follicle numbers and estradiol levels to multiple implantation in 3, intrauterine insemination cycles Authors : Richard P. Background on ovarian stimulation for infertility and multiple birth risks: Multiple pregnancy — particularly triplets and higher — is a very significant problem in the world of infertility treatment.

So how aggressive should we be we be with the ovarian stimulating drugs? How much do pregnancy rates differ according to how many follicles there are? What about effects on multiple pregnancy rates?

Should we try to stimulate so that there are 2 eggs per month instead of the 1 that matures in a natural menstrual cycle? Or, should we try to get 3, or more than 3? Does the age of the woman matter much?

Does the type of stimulating drug matter? This ultrasound sets the schedule for the cycle. This medication is an injection with a small needle in the abdomen. The IUI is scheduled 36 hours after the trigger medication is injected. Awaiting Natural Ovulation: Blood work or urine-based ovulation predictor kits OPKs can predict when a woman will naturally ovulate.

In this case, the IUI occurs either later that day or the next morning. Anovulatory Patients: Can start medication at any time.

In this case, a 7 to 10 day course of progesterone like provera or aygestin can be given to cause the onset of a period and clomid or letrozole would be started thereafter.

Unexplained Patients: Can start medication on day 3 or 5 of the cycle. If the patient is having her treatment cycle monitored, she will come in on day 3 for bloodwork and an ultrasound. On ultrasound, the doctor will be checking to make sure that no follicles have already started the process of growing because once one follicle is already growing, it is unlikely that others will also start growing in response to clomid or letrozole.

The doctor will also look at estrogen levels through blood work to confirm this. Once the patient has started taking clomid or letrozole, they continue for 5 days, and 4 days thereafter the woman may return to the office for monitoring and blood work. Increase dosing if no follicles are growing or switch to gonadotropins if no follicles are growing and the patient has reached the maximum dose for clomid mg or letrozole 7.

Continue waiting if the cycle looks promising. Patients may return the next day for insemination if the follicles are large 18mm or in 2 - 3 days if follicle growth is slower. The patient comes in on day 3 of her cycle for blood work and ultrasound to make sure that all of the follicles are resting none have started down the developmental path toward ovulation and that the lining of the uterus is thin which means the lining is ready to start growing in preparation for a possible pregnancy.

She will begin the injectable medications later that night. She will continue the same dose of medication for 4 nights and then come back to the office for an ultrasound and bloodwork to monitor her progress. Specifically, the doctor is looking for the rate of estrogen growth to inform what to do. In this case, the doctor has three choices:. Increase the dose: Estrogen levels are not climbing and follicles are not growing.

Blake; Stentz, Natalie C. May 4, The study is very helpful for those interested in pursuing IUI treatment as it provides some key items of note: Clinical pregnancy rates per IUI attempt per age group and number of mature follicles Multiples per pregnancy per age group and number of mature follicles It is important for patients interested in IUI treatment to understand the success potential of this type of treatment and the potential risks related to multiple gestational pregnancy.

The known risks associated with multiple gestations including twins include: Complications to the babies of being born premature under-developed brain and nervous system, digestive system, and lungs in particular Gestational Diabetes Pre-eclampsia and high blood pressure during pregnancy More complicated deliveries with more cesarean section complications Expenses related to bed rest, hospital stays for the mom and very long hospital stays for babies Bottom Line: IVF can be a good initial option, omitting IUI entirely, for patients at high risk for multiple follicles developing, those that have limited access to sperm samples ie donor , or for older patients.

Mira Aubuchon, M. The total height of each column represents the total clinical pregnancy rate per IUI based on follicle number and further divided into singleton blue and multiple yellow pregnancies per IUI.

The yellow columns are also the absolute risk of a multiple gestation per IUI, further categorized by number of follicles 1—5 that are 14 mm or larger on the day of ovulation trigger. Generalized estimating equations were used to adjust for multiple cycles per patient. Obstet Gynecol