LH surge, thermal shift & IUI timing

[mayari]

Hello, all.

I am obsessing, and I was hoping for some input.

I haven't started the process of insemination yet. Half of me is convinced it will be a breeze and the other half is already panicking. My doctor wants me to go through the 3-day FSH test and HSG before we try to inseminate because she feels there's no point in spending a lot of money on sperm and insemination if I'm not fertile anyhow. (I'm in IL, she's diagnosed me as infertile, the tests are covered by insurance.) I see the value in this and chose to go the medical route for AI instead of the holistic feminist one for this very reason.

Anyhow, I won't be inseminating until November at the earliest (possibly December depending on the timing of my ovulation and an out-of-town trip), but I can't stop thinking about timing the IUI and can't seem to find the info I'm looking for on the internet although I did find this forum.

So here is my question. How long after ovulation does the thermal shift take place? My charting and pee sticks show a 2-day LH surge, another low temp day, and then my temperature goes up. Would that make ovulation the 2nd day of the surge or the day immediately before the thermal shift? And would the 2nd day of the surge be the best day for an IUI or would it be the day before the shift?

I have a very regular 26-28 day cycle. I have 10 high-temp days every month followed by my period. I'm assuming this means I have an 11-day luteal phase and feeling very anxious about not being able to sustain implantation if I do get pregnant. My doc tells me not to worry ovulation happens 14 days before your period, and I KNOW this isn't true. I've started seeing an acupuncturist, and she also tells me not to worry. She's got me on Chinese herbal medicines to cleanse my system. I've heard Clomid can help with luteal phase defect even though I haven't been technically diagnosed with it. My partner thinks I'm being nutty. I know I have too much information for my own good, but I can't stop worrying. We don't have the finances to undergo a long process here and I'm hoping to make it as effective as possible. If it doesn't work in 3-6 months, we will quit and switch to my partner who's menstrual cycles aren't nearly as regular as mine.

Any advice either on the timing of the insemination or the likelihood of my having luteal phase defect?

[osker]

My quick response (due to lack of time) would be to think about Vitex for your 10-day post ovulation time. It worked for us to go from 9-10 days to 13-15 days.
Maybe look for more info on Vitex? I know, too much info reallly doesn't need more info.. but still...

[FtMPapa]

No such thing as too much information, if you ask me.

I second the Vitex, also, a B vitamin complex can help with luteal phase.

And get 7 DPO bloodwork from your doc - AKA Day 21 bloodwork to check your progesterone levels. Talk to her about supplementing progesterone, too.

Way togo with the diagnosis - that's great! Are you sitting out the cycle of the HSG? You don't need to, medically.

Last, your O is 24-48 hours following the beginning of your LH surge. There's no point in testing after you see the surge, it's the beginning of the surge that matters. So, from the description you've given, I'd say you're ovulating the day before your temp goes up, approx 24 hours following your surge. Your best IUI timing is the second day of your surge and the following day. (Ok, I konw not everyone is, but I'minto two IUIs per cycle.)

[mayari]

Thanks for the advice about Vitex and vitamins. I'm Googling it now.

Because of the clinic's schedule for HSG (only once a week), I most likely won't get the results back before I ovulate. I've scheduled an appointment to discuss the results, and it's for the day after I expect to ovulate. That's why I have to wait a month. Meanwhile, I'll ask about the 7 DPO bloodwork. That sounds like a really good idea for me.

We've decided on one IUI a cycle, although I'm not really sure about that one.

[FtMPapa]

Ugh. Are they at least doing the HSG during the "right" days of your cycle? I seem to remember it had to be between day 7 and 12. It's unfortunate they're not giving you the results right away, if you want to get started right away.

I've heard so much conflicting advice about 1 vs. 2 IUIs, my clinic's protocol was 2, and I feel, personally, so much more comfortable with the odds of getting the timing right when doing 2, but some clinics do 1 per cycle, and I know lots of people who've gotten pregnant with 1, many of them on the first try.

[spcd]

Well, you will know the results of your HSG right then and there. You will see on the ultrasound screen if the dye goes through your tubes or not. If they do, you're all clear. If not, then you would need to meet with your doctor. Keep in mind, the 3 cycles after an HSG are sometimes more successful because of what my DP and me refer to as a "powerwashing".

[basje]

You should move this question to ttc! More people can help you with your question.

[FtMPapa]

Originally Posted by spcd

Well, you will know the results of your HSG right then and there. You will see on the ultrasound screen if the dye goes through your tubes or not. If they do, you're all clear. If not, then you would need to meet with your doctor. Keep in mind, the 3 cycles after an HSG are sometimes more successful because of what my DP and me refer to as a "powerwashing".

You're right on the latter part of that, but you won't see on the ultrasound, because it's an X-ray. They sometimes do an U/S to check the placement of the canula or for other reasons, but results are read off the x-ray, as far as I know, so you can't see it.

You will, likely, feel it though. Often, people who have quite a lot of pain are those with complete blockages on one or both sides. However, the HSG is not only about the tubes, but also about the shape of the uterus, whether it has a septum, or fibroids or something else.

Because of the powerwashing effect, (LOVE THAT TERM!) I would be reluctant to sit that cycle out. I seem to remember the radiologist giving me the all-clear in person right after my appointment, though the actual written report didn't reach my doctor's office until the next week.

You might want to look in the "infertility" forum for more on HSGs.

[jjnoho]

Originally Posted by FtMPapa

Your best IUI timing is the second day of your surge and the following day. (Ok, I konw not everyone is, but I'minto two IUIs per cycle.)

thanks papa for those suggestions...i was trying to figure out the best timing for 2 iuis which we are going to do this cycle. i am of the mindset to cover as many bases as possible.

let's just hope that the opks work for me this week - i don't always get a clear +!

[FtMPapa]

jj - me neither! Dehydration is the key. As in, pee in the AM, drink only a tiny amount of water all day. They typically work better for me if I don't drink or pee for at least three hours before taking one. GOOD LUCK!!!!!

[spcd]

In my experience it was not read on x-ray. I was actually able to see the dye on the u/s screen as it went through the tubes. They used a stomach ultrasound which also guided the catheter in. My dp had the same thing at a different clinic. Of course there could be other stuff going on that a tech would report to the doctor, but we knew we were clear right then and there! Which was kind of a relief when you have so much to worry about.

[FtMPapa]

My understanding was that there are actually two different (but quite similar) tests - one is the HSG which uses dye and an x-ray to check the fallopian tubes, and one is the SHG which uses saline and an ultrasound to check for polyps, endometriosis, adhesions, fibroids, tumours, etc, in the uterine cavity.

I think I might have actually had both at the same time - an HSG to check the tubes, and an SHG to check the uterus.

Maybe it's new that they're doing both with the SHG or a difference between US and Canada? I had the whole powerwash 3 years ago, so it's possible I remember incorrectly which was which, but I know I have xray films in my chart. It's also possible that it's just sloppy terminology, because they're so similar. I just didn't know they could actually see the tubes properly on ultrasound.

But, hey, if I'm not knocked up this cycle, I'm going to do it again, so I guess I might just find out!

So, Mayari - it sounds like you might not have to sit it out if you don't want to! You just gotta get the "instant read" test.

[mayari]

Yeah, I'm thinking I really don't want to wait. Either don't wait or postpone the HSG. I'm going to have to talk to my doc.

The lab that does the test is different than the doctor's office. (We're talking urban university hospital with 3 campuses just for reproductive endocrinology.) That's the major reason for the delay, I think. I'll look into it. Meanwhile, thanks for all the feedback. I'm leaning towards never enough information.

Since I'm going the medical route, I feel like I need to arm myself to deal with the medical system.

[FtMPapa]

Originally Posted by mayari

Since I'm going the medical route, I feel like I need to arm myself to deal with the medical system.

Totally. I cannot agree with this more.

I would go ahead and do it and plan the insemination that same cycle, even without the results if you want to do it. It makes sense to get the powerwashing effect.

Scine it's a huge place, why couldn't they just give you the results the morning of the IUI? Or at one of your cycle monitoring visits, or by phone? Stress to them that you don't want to sit that cycle out because they can't make five minutes to tell you it's Ok. Afterall, the likelihood of something actually being wrong is pretty small.

[mayari]

Originally Posted by FtMPapa

Totally. I cannot agree with this more.

I would go ahead and do it and plan the insemination that same cycle, even without the results if you want to do it. It makes sense to get the powerwashing effect.

Scine it's a huge place, why couldn't they just give you the results the morning of the IUI? Or at one of your cycle monitoring visits, or by phone? Stress to them that you don't want to sit that cycle out because they can't make five minutes to tell you it's Ok. Afterall, the likelihood of something actually being wrong is pretty small.

I'm going to wait until I get my period (expected tomorrow, but don't want to schedule things until it shows up) and then call them and see what they say.

Thanks for all the advice!

[gellybeangrl]

Originally Posted by mayari

(I'm in IL, she's diagnosed me as infertile, the tests are covered by insurance.) I see the value in this and chose to go the medical route for AI instead of the holistic feminist one for this very reason.

Hi Mayari,

I live in IL too and my insurance won't pay for my treatment because they state that being infertile is defined as "being unable to concieve after intercourse between a man and woman for six months" My dr also diagnosed me with infertility {Pcos},but the insurnace company says that her definition and diagnosis does not mean a hill of beans unless I have been having intercourse with a man for six months.

So my partner and I am trying the more holistic way ttc. Good luck with ttc!!!

Gellybeangrl

[AmandaHope]

Originally Posted by gellybeangrl

Hi Mayari,

I live in IL too and my insurance won't pay for my treatment because they state that being infertile is defined as "being unable to concieve after intercourse between a man and woman for six months" My dr also diagnosed me with infertility {Pcos},but the insurnace company says that her definition and diagnosis does not mean a hill of beans unless I have been having intercourse with a man for six months.

So my partner and I am trying the more holistic way ttc. Good luck with ttc!!!

Gellybeangrl

This is really messed up, Gelly. I'm also in IL. My insurance company (BCBS HMO) says that to be diagnosed as infertile, I have to have "tried" for 6 months, and they want some sort of documentation of the inseminations themselves. So my midwife wrote them a letter saying she'd done the IUIs and that I should be referred to an RE. I just submitted that letter today, so I'll let you know how it goes. But it is completely inconsistent (with other insurance practice in IL) for your company to essentially say that someone in a same-sex relationship cannot be infertile and cannot ever be eligible for an RE referral. Holy crap. If you pm, me, I can try to give you more detail, if you think it would help.