Lupron trigger and IUI....

I had my ultrasound and blood work this morning. All of my 30+ follicles are continuing to grow. In an effort to save this cycle from being canceled and preventing OHSS (ovarian hyperstimulation syndrome), we will trigger with Lupron tonight and go for an IUI Tuesday morning. We are triggering and moving forward with IUI despite the high chance of multiples. (It is likely I will ovulate 6-8 mature eggs from my right side Tuesday.)

From what I understand, lupron works by suppressing the pituitary gland's ability to produce LH, which causes ovulation. So why would I use this for ovulation if it suppresses ovulation? It has to do with lowering the risk of developing OHSS. In a natural ovulation cycle using no drugs, the follicle develops over about 2 weeks, and then a strong surge in LH causes ovulation. While Lupron causes the pituitary to cease LH secretion, in the first 1-2 days of Lupron use, there is a strong release of LH. It is this strong release of LH that makes Lupron great as an hCG substitute for the trigger shot. The quick surge results in a very short blast of LH, which could take place over 1-2 hours. This is very similar to the body’s LH surge that takes place in a natural cycle. After that, the LH has left the system, ovulation occurs 36 hours later, and ovarian stimulation stops. hCG, on the other hand, stays in the body for days, even up to 2 weeks. All of this time, hCG stimulates and stimulates the ovaries, which is too much for ovaries that have released many eggs.

So, why give an hCG instead of a LH injection? For IUI and IVF, hCG is often used as opposed to LH because hCG is easier to make and cheaper than LH, and hCG works just as well. The molecules of hcg and LH are very similar and act in similar ways.

One down side to lupron is that, in very small percentage of cases, it may not cause ovulation. This is a rare occurrence and is more likely to happen in women who are hypothalamic, i.e. they do not get regular ovulation due to exercise, dieting or some other factor. In these cases, there is no LH in the pituitary for Lupron to trigger.

Another detail of Lupron use as a trigger is that for luteal support, progesterone and estrogen are supplemented. The ovaries just shut down after Lupron use, and therefore estrogen and progesterone are produced in very low quantities. Typically progesterone is prescribed post IVF, and when using Lupron, estrogen is also prescribed. Daily, I will inject PIO (progesterone in oil) in my butt. The estrogen is simply a pill taken orally twice per day. I used PIO after my IVF, but I've never used Estrace (estrogen).

I feel good about this cycle again as I've said all along that you can't do the same thing over and over and expect different results. Changing things up this cycle leaves me with renewed hope.

As for the risk of multiples, we will cross that bridge if and when we get there. Right now we have our hopes set on this cycle working and resulting in a viable pregnancy, and ultimately, a take home baby.