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Hyperstimulation/IUI cancelled due to high-order multiple & health risk

clomid hypserstimulation iui ohss

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#1 Treker313

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Posted 26 September 2017 - 05:27 PM

Hello,

 

First off, I'm a newbie to the board. I hope I do this posting thing properly. Please forgive me for my newbie-ness.

 

I'm posting because I'm pretty shaken up and I've found very little information online about my most 1st experience on my clomid/IUI journey. 

 

Overview:

37yo, unexplained infertility (ttc for 2 years)

current action plan: 1st round of clomid/iui 

dose: 50mg/daily days 3-7.

 

I had blood monitored for ovulation Day 8-13. Due to high levels of estrogen and lack of ovulation, an ultrasound was completed yesterday and 10 mature follicles ranging from 22-30mm in size each were located. IUI cancelled for this month due to high-order multiple risk and health risk. I'm told this is an extremely rare reaction to clomid and I would no longer be eligible for this medication (the dr. at the fertility clinic explained she has only encountered this extreme of a reaction on a low dose of clomid 1 other time in 25years of practice).

 

Due to the size and amount of mature follicles, the dr. is concerned about damage to my ovaries (torsion) and has recommended I be on light duties for the rest of my cycle (including no exercising...which is pretty much how I keep sane). The dr. also seemed so surprised, that no action plan was recommended any further other than it's a waiting game to see how my body recovers from this. 

 

I feel pretty terrible, physically. The dr. implied I will be feeling worse once I actually ovulate and make my way through the rest of this cycle. I'm trying to learn more about what happened and what to expect - but the only information I can find about this is the term OHSS but I'm really not clear if that is the same thing...and OHSS seems to be extremely rare on clomid.

 

Just wondering if anyone has had similar experience with this.

 

Thanks in advance :-)



#2 ENF

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Posted 26 September 2017 - 08:06 PM

Welcome to the forums, although I'm sorry you're having such a rough go on your first try. I have no experience with IUI's (I've just done a round of IVF) but wanted to post anyway.

 

With 10 follicles all that size it makes sense that your doctor would put you on reduced activity to prevent ovarian torsion. Women who undergo IVF (and hope for 10 great sized follicles like you have) are also routinely asked to abstain from anything other than light activity. 

 

OHSS is different, and can be very serious. Since you've already looked it up keep an eye out for any symptoms you may be experiencing and call your clinic if you have them. 

 

Good luck as you move forward to your next cycle. 


Me - 37   DH - 45 (Paraplegic)   
 

FET planned for spring 2017


#3 quandry

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Posted 26 September 2017 - 10:52 PM

Has there been any talk of converting to an ivf cycle?
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#4 Treker313

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Posted 27 September 2017 - 09:57 AM

Thank you both for your reply.

 

Good to know ENF! Very appreciated.

 

quandry: The dr. didn't mention it as an option at this point. IVF is not an option at my location, so I'm guessing it would involve a lot more prep time to coordinate at their partner clinic in another city.


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#5 jtstan

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Posted 27 September 2017 - 06:10 PM

Hi Treker....wow that is quite a crazy response to clomid!  Did they do a day 3 ultrasound and bloodwork at the beginning of the cycle, or just when they noted your estrogen was high?  Have you had an AMH done?  Sometimes there are clues to indicate you might be an incredibly high responder, have PCOS or PCOS-like ovaries before the start of a cycle so they can do the appropriate monitoring during. The follicles size range of 22-30 would mostly be post mature...did they give you a trigger shot so you could ovulate?



#6 Treker313

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Posted 27 September 2017 - 07:31 PM

Hi Treker....wow that is quite a crazy response to clomid!  Did they do a day 3 ultrasound and bloodwork at the beginning of the cycle, or just when they noted your estrogen was high?  Have you had an AMH done?  Sometimes there are clues to indicate you might be an incredibly high responder, have PCOS or PCOS-like ovaries before the start of a cycle so they can do the appropriate monitoring during. The follicles size range of 22-30 would mostly be post mature...did they give you a trigger shot so you could ovulate?

That's what I thought (about it being a crazy response)-and it seemed like the doctor thought so too-especially on only 50mg. They did blood work only day 8-13 (my usual ovulation day is 11) but when I wasn't ovulating and my estrogen went over 10,000 they called me in for the ultrasound the next day (day 14) and noted all of the follicles.

PCOS has never been mentioned.

I have had Day 3 blood testing and Day 21 blood testing done (in the summer) and everything appeared 'normal' in both those tests ('normal' meaning that there were no alarming numbers or identifiable links as to why we are encountering issues).

I am concerned how I was just sent home with the warning that it'll probably be a painful couple of weeks until this cycle ends. I'm not sure if this is normal or not. I'm reading more about triggers now and OHSS (thank goodness for this forum).



#7 jtstan

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Posted 27 September 2017 - 09:18 PM

Having so many post mature follicles that haven't ovulated on their own makes me wonder why you didn't get a trigger shot to induce the ovulation and unload of all those eggs...maybe they thought it would further increase the risk of OHSS?  It might be a good idea to switch to a larger clinic that does IVF etc....not because you need IVF, but it would be good to be under the care of a more experienced RE that would be able to tailor a better treatment plan for you and have you more adequately monitored and evaluated.  If the first ultrasound of your ovaries was during this cycle after they noticed the high estrogen that'd be a bit of a red flag for me!  Its common practice I think in most clinics for bloodwork and an ultrasound to be done on day 3 of your cycle to identify any potential issues before starting medications.  The ultrasound is important to see how many resting follicles, identify any cysts, size of the ovaries, or any other funny business etc...Also its good the day 3 bloodwork was normal earlier in the summer but it should really be done on the onset of the current cycle as well.  Now that you know you are a super high responder to medications it would be good to have a more complete evaluation done to check your AMH, FSH/LH ratio, testosterone etc...  Im sorry this cycle didn't work out for you...hopefully things go much smoother for you in the future!







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