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My RE suggested to do a round of iui with no drugs.  We checked for ovulation with an opk and such, and perfomed iui day after surge.  10 days post iui, I got my period HEAVY with terrible clotting. So besides being really sad, Im confused.  I am not 1 to get my period early, usually I have a longer cycle which is why we tested to make sure I ovulated at the right time.  Is there any questions I should be asking my RE to check since I got my period 4 days before the 2WW was even up? Im unsure how to ask them to make my hormones really are ok before trying an iui again since its costing me thousands of dollars per try (sperm and procedure charges)
I dont know if they should check for anything wrong with my levels or if Im just over reacting to getting it only a week and a half after iui.  Ive had my period now for 3 days and am going tomorrow for ultrasound because I want to go on CLomid for my next round of iui since obviously a natural iui just doesnt seem best for me.

thanks!

Answer
Hello Melissa from the U.S. (Illinois),

Since you pretty much know when ovulation occurred, then the period after ovulation, called the luteal phase, should be two weeks.  This is basically a progesterone deficiency.  If it is less, it is called a "luteal phase defect".  To treat this, progesterone supplementation is used.  I give progesterone to ALL my fertility treatment patients so as not to lose any pregnancies as a result of the luteal phase defect.  So you might want to ask your RE if he thinks you might have had a luteal phase defect, AND warrant taking progesterone supplementation.

Just a side note, I do not recommend "natural cycle" IUI's because that is essentially like trying on your own (except the sperm is placed into the uterus).  That is an expensive way to "have sex."  Since you are using donor sperm, your costs are significantly increased as well.  It will take the normal woman under the age of 30 years old, 8-12 months to get pregnant when trying naturally (assuming no fertility issues).  Are you willing to do IUI's for 8-12 times because when you are doing natural cycles, that is what it might take?  There are three things that IUI helps that increases the per month chances for pregnancy: (1) the sperm is injected into the uterus and tubes to await the egg,(2) timing is better by virtue of ultrasound surveillance and (3) the number of eggs ovulated is increased.  By doing these steps, the pregnancy chances increase from 18-20% naturally to 25% by IUI.  Most of that increase is from the increased number of eggs.  When one ovulates, the egg doesn't necessarily go directly to the tube.  In fact, it falls into the space behind the uterus and between the ovaries and tubes, called the culdesac, where the opening to the tubes (fimbria) lie.  So the egg now has to find a fimbria to get into the tube or pregnancy does not occur.  By increasing the number of eggs available, you increase the chances that one of the eggs will find the tube.  That is the purpose of the fertility medications.

I hope this gives you some insight to help make some decisions about the next cycle.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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