PCOS and IUI

Hi everyone,

Just about to start my next IUI cycle again in January and I remember that the last time around the FS boosted the Puregon injections to 150 before things started to happen.

My question is - is this dosage usual for all women, or only women with PCOS?

The reason I ask is this level really played havoc with my emotions and I'm just wondering if everyone goes through this, or only those with PCOS. And if so, why PCOS people have to have the higher amount.

I can wait to ask my FS, but I'm simply curious...

gargy - i too have PCOS - and had to be on doses of 150-200 to get even a minimal response. i think it's more common for PCOS sufferers to need higher doses - although not everyone has to!!! i guess it's just another of those nasty little implications of PCOS! how rude!

i got 1 dominant follie at 150 (resulted in chemical pregnancy), 1 at 175, 3 at 200 - have now moved to IVF - and got 22 eggs at 300iu - but something along the lines of 60 follies - so was super uncomfy!!

good luck with it - i just read your boo hoo - and to be honest, i would think it's best to either tell her it's not possible for her to stay due to work commitments, or tell her you have to have some tests or something, and would prefer the time alone to recover. as far as most people know, i had minor surgery that resulted in complications when i had the IVF EPU - no need for them to know i chose to have time off to deal with it all! if we ever have to do another epu i'll again take time off work - but to be honest, i found i was fine through the IUI's - had to juggle work a bit, but no one guessed that anything was going on, so you may find you're ok... if insemination isn't til the 21st, you won't know results til the first week of feb anyway - might be better to get the visit out of the way!

Gargy,
what happens with PCOS is that your body is less likely to behave as predictably as someone without PCOS so that sometimes you might understimulate but next cycle, overstimulate on exactly the same dose. For a person without PCO, the dosage of FSH varies according to age and weight but then with people with both PCO and PCOS the FS has to take that into account and adjust the dose. Typically for a first cycle they would generally tend to give a lower does as PCOS people are more likely to overstimulate and be at risk of OHSS.
I am not sure if they use the same dosages with IUI as they do with IVF, as they don't try to get as many eggs with IUI but to give you a comparison, my donor was given 300 on her first cycle and my FS says that is the typical dose for a person of 35 years old.
Sounds to me like your FS was making sure you would not overstimulate when giving you 150, as that is more of a typical dose for a person in their 20's rather than their 30's so my guess would be he will start you off on something higher this time.
good luck.

Hi Anney and BG,

I was actually trying to figure out why I get very messy when I'm on the puregon (crying, anger etc) and I thought that it was because I was on a higher dose. Sounds like the PCOS is the problem, as it is so unpredictable (thanks Anney for your brilliant explanation BTW).

BG, I had a big talk with my Mum too and she said it was just easier to go with the flow and my MIL will have to cope with whatever is going on. Mum said 'are you really going to postpone this forever' and I realised I was going back into old patterns and putting myself last. As I said to her, this is probably why I am 38 and in this situation. She said the only two important people in this situation is you and DH, everyone else is a lesser priority. That made me feel a whole lot better.

i'm glad your mum has been able to help you see that point hun - she is 100% right - you and DH are the only ones that matter!!

keep in mind that the puregon will stop a few days before the IUI, so by the time you get around to having the MIL visit, it should have settled bit...

i'll admit i'm more emotional when the hormones are being pumped into my system - in some ways i think it's cos i usually have no cycle at all, so the introduction of hormones, especially at high doses, just messes with my head! i'm learning to cope with it though... kinda...

good luck with the iui - and the mil visit! have everything crossed for you hun

Hi BG and Anney (and anyone else reading out there),

Just wanted to double check my understanding (I was a bit stressed out last time as you probably gathered LOL)

Anney, did you mean that your donor had 300microL over the period of her injections? I assumed you meant that she'd had 300microL each night - but then I suddenly realised this would be a whole vial!

I'm just a bit confused, as I've been having 75microL over 9 days which is 675microL. I'm sure it at least went up to 100microL per night, not sure if it went to 150 as I originally said (actually looking at the vial that would be highly doubtful).

I go in for a blood test tomorrow, but the nurse said last time around in 2006 I had 1180 (I presume she meant amount of puregon, not something else like hormone levels - I'll double check tomorrow).

Thanks again.

Gargy, at our clinic they use gonalF instead of Puregon. But my understanding is they are exactly the same and come in the same size pens and require teh same dosages. I could be wrong but I am 98% sure on that.
anyway our donor did have 300 (of whatever the unit is, I guess microL) every night for the 9 days she was on the stim drugs. So she got 3 doses from one pen. (900 microL in one pen). But remember she is doing IVF where they want lots of eggs, as they want to make EPU worthwhile whereas in IUI they are only trying to get a few eggs. I am really unfamiliar with dosages for IUI as we did not do it so I am sorry I can't help more.
good luck with the cycle - I will be looking out for your progress

Thanks Anney that makes sense. I'm glad I can call on you!

Gargy, I suspect that the 1180 your nurse mentioned was your E2 level, not some record of how many units of puregon you'd had total. I may be completely wrong, but that seems to fit in with what happens on an IVF cycle. They'll change your dosage of puregon/gonal F in order to get your E2 level where they want it for what they are going to do - obviously an IVF cycle will need a much higher E2 level than an IUI cycle. The actual vials of puregon come in 900IU, 600IU and 300IU amounts - I've never seen a 300IU vial, but I have had both of the others - what you get I guess depends on the individual doses they expect to be giving you.

BW

i'd be on the same page as BW with this one hun - i think the 1180 would be your E2 reading - they look for a level of 1000+ to show that the eggs would be mature

with my IUI's i had doses varying from 75 to 200 depending on the cycle - unfortunately, i'm one of those PCOS sufferers that doesn't respond well to low dose puregon. my first two attempts at IUI with down reg, they checked hormones on BT before moving to u/s to check numbers of follies, so i'm assuming that is the point you're at.

all the best for todays test hun

Hey Gargy.........Am also PCOS and am on 300 puregon..

i think the puregon dosage varies greatly from person to person - and from iui to ivf - they want ideally one or two follies for iui - many more than that for ivf so higher dose required...

Hey everyone!

I had a really great nurse this morning that was quite willing to discuss things with me. BW and BG you were right - the 1180 was the E2 level last time around. She also helped me double check - I was given 100microL from day 16 to 19 to push up the levels.

(Unfortuantely she couldn't find my veins and had to get another nurse - I now have 3 small bruises around the areas she tried - ouch!)

The nurse has just called and told me I am up to 500 E2, so more puregon tonight and then in for the blood test and ultrasound tomorrow.

Thanks eveyone for the explanations!

so glad things are travelling along ok for you gargy!

good luck tomorrow!

Hi Everyone,

its been a while since ive been on here.

Me & hubby have been TTC for 1 yr & half, & we are desperately wanting a child, it upsets me, day in & out to the point i can cry at the drop of a hat, not good in situations where im out hehe.. anyways i have PCOS & am currently in the middle of IUI injections, for the women who have done this you will understand how emotional it is, i guess i never figured it would get to the point where i have to stick a needle in myself everyday. Im currently on 75mls as my FS says she does not want to increase it in fear that i may get too many little folicles & not 1 dominant one, i go back on Tuesday, (which is frustrating to say the least) for a blood test & a Ultrasounds, ahhh the joys hey ladies!!

if anyone has any success stories, or anything positive to say about IUI please drop me a line, i need the encouragement cos at the moment i do not think this will work for us.:shakehead:

i wish all you lovely ladies all the best!

Jess X

Hi Jess, and all the other ladies,

First time on this site.

I am 35 and i am currently on FSh injections (75) started today and go back in 8 days to have u/s.
I have had 3 attemps at iui , two have not worked the third was a m/c at 6 weeks.
So my fingers are crossed that this cycle IS THE ONE.

I do have 2 beautiful girls from a previous marriage and they were conceived naturally after having treatment.
So if I have not gotten pregnant by end of year i will be trying on our own.

I do think you will have success with IUI it can take a few months but you will get there.
Good luck.

Ange

Hi Angela,
Thank you for your reply & your confidence! thats really warming to me, & thats what i need, My Husband & family always try to perk me up saying "it will happen" I guess my problem is When? im 25 & hubbys 28 have been together for 10yrs this yr, Married for 2, unproctected for abour 3 or 4 (just guessing).. Im on my 8th day today of injections, & am also on 75, today i seen my FS & iui Nurse, they said i am not ready yet, i have 3 bigger Folicles that are growing, but not yet to the growth it needs to be. im waiting on my blood test results to show my estrogen Levels.
I can understand why you'd want to give it a rest for awhile, these treatments can be very tiring emotionally, maybe thats what you need a rest, well thats what they all say anyways.

All the best of luck with this month, i hope it will be the last month you will have to endure.

xxJess:pray:

Hey Jess,

I know its so frustrating isn't it.
Do you know what size your follicles are at now?
He measured mine and they are 6.5mm so need to get to 18mm so a long way for me, although i only normally need around 8-10 days of injections.

So what is your story, how many iui's have you had?

I go to qld fertility group at everton park (dr watson)

Who do you see?

I am happy to be trying again, sometimes after i go back after a cycle, i end up having cysts and then i have to wait for them to disappear, but luck would have it this time i was able to start again.

I go back next wednesday for a scan and see how they are all growing.

Good luck and keep in touch jess

Hi Angela,

this is my first IUI & praying to god i will not need a second, wishful thinking i guess, though im not very positive at all.. On tuesday was my 8th day of injections, & i had my appointment, the u/s showed i had little follicles, but the 3 largest came in at 7.5x2, & 1 at 6.9mm though my blood test came back for my estrogen levels at 198, & that has to be anywhere between 800-900 i was told, so they have up'd my dosage to 112.5 & i go back tmro morning for a blood & u/s.
how many dominant follicles are growing at 6.5 or yours?
why is it that when you have a cysts you cant do it? i have one? or had one, dont know if i still do but it wasnt that long ago that they found it.
i live in Sydney, my FS is Georgiana Tang.

can i ask, how does your husband react to all this? my husband is very sweet & supportive, though i do sometimes think, when is he gonna get frustrated about it all..

I also quit my long term job to have a baby, it was getting very stressful the travelling part, & everyone always says stress is no good, so i resigned.

take care!! hopefully hear back before you wednesday app.

xx;)

Hi Jess,

Im guessing you will have to stay on the injections for a few more days.

On day 7 of my cycle I aleady had one at 6.5mm, they have to get to around 18-20mm to be able to be released.

You will get there.

When you say cysts, do you mean from the pcos or a normal cysts.

I had 2 massive cysts a few months ago, there were around 34mm, had to go back on the pill for a month to get rid of them.

We have cysts on our ovaries because of the PCOS and thats stops the ovary from producing hormones properly.

Good luck with your scan today, please let me know how you went and what is going to happen for you.

Angela

Hi Angela,

How are you?

sorry its been awhile, i was having trouble with my password to here. anyways!.

How was your appointment on the wednesday that you went? would have been last week..
what stage are you up to at the moment?

i dont know where i was up to, so they increased my injections to 112.5ml, which improved my bloods, on Monday i went in & i had a follicle at 17, so FS decided it was time, my bloods level came back at over 2000 so i had the procedure done on Tuesday, gosh it was painful, but it was quick which was the good thing, i had my sister with me for support. Afterwards had pain on & off all day, which i read is normal.
But now i have sore boobs, have you had this? i have read blogs etc, & apparetly few women get sore boobs, reason why i ask is cos i normally get sore boobs a week before my periods are due, without fail. Im hoping its a symptom of iui & not my periods.

I haveto go back Tuesday for another blood & trigger, but these few days are gonna kill me till i go see FS but whats gonna be hell more, is waiting to know if its worked.

chat soon xx

Hi Jess,

You mentioned another blood test and trigger? What is the trigger for?

So you had one follicle and they gave you the trigger shot hcg and then u went back into the docs the next day and had the iui done?

Just trying to understand where you are up to.

Well thats great news, I never get sore boobs before a period, the only time i get sore boobs is when i get pregnant.

My news, well went to doc on wednesday and had 2 follicles at 17mm and 15mm, he asked me to go back this morning and went in today and i now have 3 follicles 2 x 18mm and 1 x 20mm.

So I had the hcg trigger shot this morning and we go in tomorrow morning for the iui.

He has also got me on progesterone pessaries starting from sunday evening for 2 weeks. To help support the implantation. Take a pregnancy test in 2 weeks from tomorrow.

NEver had 3 follicles before.

So when do you do a pregnancy test?