Monday, August 16, 2010

To IUI or not to IUI?

After our last failed IUI + injectables cycle, MM and I agreed to take a couple of cycles off due to summer travel plans we had which we feared might interfere with monitoring, etc.

Today is CD 7 of the third cycle after that most recent failed medicated cycle, so we have been discussing the utility of doing additional IUI + injectables cycles.  Our insurance pays for a portion of up to six IUIs, lifetime, and we have used four.  So in theory, we have two left which would be partially covered.

I'm having a bit of a hard time deciding whether it's worthwhile to do additional IUIs.  This cycle is our 30th cycle TTC.  In each and every cycle, we have had intercourse during the appropriate "fertile" window.  So far as I know, I ovulated during each one of those cycles.  (I know for sure that I ovulated during the six cycles when I was monitored and our RE told me I can reasonably conclude that I ovulated during most of the others due to cycle length, + OPKs, etc.)

In 29 cycles of TTC, we have had a single BFP which ended in a chemical pregnancy at about 5 weeks.  (That was about this time last year.)  That pregnancy was the result of a break cycle. . . . a true break cycle, when I wasn't even using OPKs or charting or making sure we did "the deed" at the right time.  Other than that one very early miscarriage, whether medicated/monitored or not, I have never been pregnant.

I suppose one of the pros of doing additional IUI + injectables cycles is that they will slightly increase our odds of conception.  Our RE has estimated that we have a 5% chance of natural conception each cycle and a 10-15% chance with IUI + injectables, depending upon the number of follicles I produce.  If his estimates are correct, we are doubling or tripling our chances of success with this type of treatment.

On the other hand, I have done four IUIs so far, three of those after using injectables with Clomid (one Clomid alone), as well as two cycles of timed intercourse after ovarian stimulation, and have absolutely zero to show for them.  I have read a few research studies that show that IUIs are not very effective in women around age 40; I'm currently 39 and will be 40 in March.

In my mind, I'm not sure that IUIs are even indicated for us.  MM's sperm count is normal (actually, well above the threshold for all our IUIs).  His motility and morphology are also normal.  I have no reason to believe there is any problem with my cervical mucus making it difficult for his sperm to reach the eggs; in fact, our RE told us that the fact that we did conceive naturally once makes it extremely likely that there is no barrier to conception caused by my cervical mucus or anatomy.

Another potential pro is the feeling that we are doing something to increase our chances.  Although it is not impossible that we could conceive on our own, it seems highly unlikely.  And even if we decide to go the DE IVF route, it will be months and months--perhaps more than a year--before we can afford to do it.  But on the other hand, I don't know that it will really make us feel good to know that we are doing something when what we are doing is something that we doubt will work.

Also, while insurance pays for a portion of these IUI + injectables cycles, it does not pay for all of it.  Each cycle will cost us several hundred dollars of our money. . . . money that might be better put toward saving for DE IVF (or something else, who knows what) down the road.  I'm not fond of throwing good money after bad, and the fact that IUIs have not worked so far makes me inclined to think that they won't work for us, period.

Assuming our RE is correct, the main issue preventing us from conceiving a pregnancy that can continue past 5 weeks is poor egg quality.  Neither IUIs nor ovarian stimulation will remedy that problem.

So that's where we're at.  MM has said he will defer to me in making the decision, since I am the one who will have to take the drugs and do the monitoring if we decide to do more IUI + injectables cycles.

Thoughts?  What would you do?

(Bear in mind that IVF with my own eggs is out of the question for us, for all the reasons I set forth here.)

16 comments:

  1. Hey S, although I have "heard of women" getting pregnant with IUIs, I only did one. We knew that IUIs had such a low chance of success even at the age of 30. I think it was like 10% per IUI cycle and 30% success within 6 IUIs. So I did not feel that we got "good value" for our dollars to continue with IUIs. For me it felt like money wasted and time wasted and missed work for something that did not seem worthwhile pursuing. So we jumped straight to IVF. I'm still waiting to do IVF but alot has happened from July 2009 to present day. Our donor starts her stims in less than two weeks. Good luck with your decision.

    ReplyDelete
  2. It's a tough call. I do personally know two people who got pregnant with IUI's (one with Clomid and one with Follistim) but they were both under 35. That is what has made me decide to keep doing them, though I'm paying a ton out of pocket. On the other hand, like you said, good money after bad and all that. If it were covered by insurance, I would probably try at least one more.

    ReplyDelete
  3. My RE says that he will try IUI's some where between 3 to 6 times before moving on, does your RE have a suggestion like that? I am wondering if you are considering IVR without donor egg? I know your RE says that egg quaility is the likely issue, but I have found that there is so more information available from an IVF cycle when they can see your eggs and your embryos and tell you what is what. I know this is a very personal choice, but I do think that breaking out the big guns makes sense and will give you the best odds. If you questions about IVF, please let me know.

    ReplyDelete
  4. cgd, no, we are not considering IVF with my eggs. We aren't interested in gathering more information about why I can't get pregnant at a cost of $12-15K.

    Our RE originally suggested the same 3-6 IUIs you reference. He likely would've recommended IVF for us by now but for the fact that we have made it clear to him throughout that we won't do it because of the low success rates at my age.

    ReplyDelete
  5. S, I am the same age as you (39) and just want to add that the IVF rates for our age group aren't *that* low if you get to the right clinic. At my clinic, which costs $10,500 for IVF plus stims, at age 38-40 if you make it to transfer you have a 47% chance of pregnancy, and then an 82% chance of a live birth. Plus if you fail to get pregnant you can do as many additional cycles as you want to half price (plus meds). I have tried everything to get pg for three years and have high FSH to boot. After cycling once I am now 8 weeks pregnant with a singleton and have two frozen blasts for later. Just food for thought.

    ReplyDelete
  6. Jamie, congratulations on your pregnancy.

    I appreciate that you are trying to be helpful. But my husband and I are absolutely, 100%, not-still-thinking-it-over, that there is no way we will do IVF with my eggs. A 47% chance of pregnancy--even a 67% chance--wouldn't be enough to convince us.

    My only decision at this point is whether to do more IUIs or do nothing until/unless we decide to do a DE IVF cycle.

    ReplyDelete
  7. S, I think it is a very personal decision whether to move forward with another IUI. I guess you need to decide how upset you would be if it didn't work. If a BFn will destroy you, then maybe hold off as 15% are not good odds and the money will be better spent with DE IVF. Another thing to consider is doing a shared risk program can be done for IVF or DE IVF that way, if it doesn't work after the tries, then you get the money back.

    Good luck with your decision, it is not an easy one to make.

    ReplyDelete
  8. Fair enough S. I wish you the best in whatever path you choose.

    ReplyDelete
  9. This is such a tough one. Does your clinic have a standard number of IUIs they will perform before "moving on" to IVF? It seems like IUI is frequently a stepping stone since it doesn't increase your odds nearly as much as IVF. I think it really depends on what your true, deep-down feelings about the donor egg IVF possibility are. It seems to me that that's a large part of what you're working out in this blog over time. If donor egg IVF is really what you want, then I don't think there's any real advantage to doing more IUIs as some kind of intermediate step. But if you're not sure about donor egg IVF, IUI might be a good way to increase your odds without having to take that step.

    It's such a hard decision, but please remember that you don't have to make it just once (until you get pregnant!). You can keep choosing and changing; don't feel locked in.

    ReplyDelete
  10. I used to have a similar type of coverage. When I was 36, my first two attempts at IUI were successful, but the pregnancies did not last. I have done so many IUI's after that, and nothing. Although it sounds nice that insurance pays for something, it really doesn't matter if it doesn't work at all. Insurance = stress in the world of infertility. You have to use this place or that place and the meds still aren't cheap. I am guessing you have a fifty percent co-pay. I hope that you also have testing covered.

    Sometimes, I wish I did IVF sooner, as this may have resulted in much better outcomes. It is such a shame that we make our decisions based on what insurance pays for, instead of what will be best for us.

    T

    ReplyDelete
  11. Sometimes I wish we wouldn't skipped out IUI's and saved the money for other procedures. We can't go back now... We did get pregnant on our own just a few months ago, only to lose it. We're hopeful that we can do it again soon. Just have to give it time, I guess.

    You'll make the right decision. Just have to do what's best for you.

    ReplyDelete
  12. I never even did one IUI. I started TTC at 38, saw the RE at 39, and went straight to IVF...which didn't work, as you know.

    I just don't see that IUI is such a big help at all. The drugs, yes. The IUI itself..nah.

    Just me (because you asked what I would do) - I would do medicated cycles with TI. You can do lots of those considering that you can buy drugs on freegaragsale, and you already know what to take...

    xoxo

    ReplyDelete
  13. I think that you have to do whatever you feel won't make you look back with regret in the future. Will you always wonder "what if we'd tried those last two IUIs?" If so, then for peace of mind alone you should do them.

    I completely understand your decision not to go through IVF with your own eggs. I did one and attempted a second just because I wanted to make sure we'd tried everything before moving to DE. Now I look back and wish I hadn't wasted time on procedures that were destined to fail for me. When we finally moved to DE, I felt like I was finally in the game and had a real shot at pregnancy. The odds moved from 20 to 25% with IVF (at the end even less than that) to somewhere between 65 and 70% - the odds were more likely to get pregnant than to fail - a first for me.

    Only you and your husband know what's right for you. I think from what you've said previously about your husband's parental yearnings that doing the IUIs will provide the necessary peace of mind to move on. And, people do actually get pg from IUIs... stranger things have happened!

    Good luck with whatever decision you make!

    ReplyDelete
  14. I wouldn't invest any more time or money in IUIs. In your case the chances are more or less identical to those of trying naturally. I would try naturally and support the attempt with 'at-least-it-won't-harm' measures such as charting, vitamins etc.

    ReplyDelete
  15. I appreciate that your thoughts on IVF with your own eggs are well thought out and explained. But I have to say, I'm not sure I would go straight to IVF with donor eggs. It could be there is a problem with fertilization that ICSI could be the answer for. Perhaps IVF with ICSI is the answer that you'd skip straight over if you went straight to donor eggs. It's just a thought.
    I gave up hope on IUI's, too. Then I was forced to convert IVF #2 to and IUI because the stupid embryology lab was closed during the exact two weeks we'd be growing a baby in a petri dish. I had no faith in the IUI whatsoever. Then boom, it worked. I know,it makes no sense to me, either.

    ReplyDelete
  16. Oh, sorry, S, I just saw your answer to Jamie above. Sorry to pose the same question. In that case, I'd definitely finish out your partially-insurance-paid IUI's before going to to DE IVF.

    ReplyDelete

I love comments! Just one caution: if you want to leave a negative comment on this blog, I would ask that you question the motive for doing so; I will not publish it. Thanks.