Question 40. How many office visits are required during a typical cycle using fertility drugs and IUI?

TANSTAAFL. This acronym is well known to some. Back in my ill-spent youth I spent a lot of time reading science fiction. One of my favorite authors is Larry Niven (Ringworld, Ringworld Engineers, Children of Ringworld, Fertility Doctors Who Wish They Could Visit Ringworld, etc). He is very fond of acronyms and his protagonists often use these a great deal. TANSTAAFL is an oldie but goodie and means There Ain't No Such Thing As A Free Lunch. In other words, you get what you pay for....In fertility treatment that also can apply. In general, treatments that are more expensive and more invasive cost more than those that are not.

In using fertility drugs and IUI, the number of office visits relates to the goal of therapy and the desire to avoid unwanted complications (Jon and Kate plus 8, OctoMom). So in considering this approach of fertility drugs and IUI we want a couple of follicles but not too many. We also want to catch them before they release the egg so we can time the IUI with an hCG trigger shot. So how many visits does that mean? Or here in DC, how many trips in the HOV lane with an inflatable companion in my passenger seat? Well, that is the Question of the Day from 100 Questions and Answers about Infertility, 2nd Edition....


40. How many office visits are required during a typical cycle using fertility drugs and IUI?


For treatments using Clomid and IUI, only a couple of office visits per month are required. Clomid is usually prescribed at doses of 50-100 mg daily taken on cycle days 5-9. We typically have patients begin monitoring on cycle day 12. At a typical office visit for monitoring, the patient has her blood drawn for hormone analysis, and a pelvic ultrasound is performed to measure the size of the follicles and the thickness of the endometrial lining. The doctor uses this information to determine the optimal timing of the HCG trigger shot and the subsequent IUI. Most patients receive the hCG trigger injection once the follicle size is >20-22 mm mean diameter. This trigger shot will induce ovulation around 36-40 hours later so the IUI is scheduled accordingly or the couple is informed of the best timing for intercourse. Occasionally a patient will demonstrate an LH surge on her own and the timing of the IUI or coitus should take this into account.

For treatment using gonadotropins and IUI, closer monitoring is necessary, perhaps requiring 4 to 6 office visits per treatment cycle. Patients in our practice undergo a baseline sonogram on CD 2-3 to rule out any persistent ovarian cysts from the preceding treatment cycle. If the sonogram is normal, then patients begin the daily injections and usually return to the office after 3-4 days of medication to assess the response to the drugs. Adjustments in the dose of the medications may allow for the optimal treatment response and most patients require 10-12 days of shots before the follicles reach the ideal size. Once again the hCG trigger shot is used to induce ovulation at the appropriate time and the IUI is scheduled accordingly. The actual IUI takes only minutes to perform and is usually painless. We routinely ask our patients to lie on their backs for about 10 to 15 minutes following the IUI procedure. The woman may then return to her normal activities. A pregnancy test is performed usually 14 days following an IUI or 16 days following hCG in couples pursuing timed intercourse.