Intro, IUI vs. IVF question.

WhiskyandWhiskers

Hi Everyone! 

I'm Kelsey, and I hope to join your board if you'll have me. I am moving forward with infertility treatment and am stuck in indecision. A little bit about me- I'm 30 and my husband is 40. I am regular and ovulatory, my husband's SA's have come back within normal limits. We've been trying for a year and a half, and in that time had one pregnancy that ended in a loss at 9 weeks due to a chromosomal abnormality (Had a D&E so they were able to genetics test). All of my blood work is within normal limits (TSH, ovarian reserve etc.) and my tubes are patent. So, I guess the 'unexplained infertility' diagnosis would fit us, minus the pregnancy that ended in loss. 

My RE has offered monitored cycles, IUI with meds, or directly to IVF. My dilemma is that my insurance covers up to 25,000 in fertility benes lifetime cap.  So, do I take the IUI route and whittle down my lifetime cap and have to do IVF anyway? Or do I jump head first into IVF to maximize my benefits and outcome?

I don't have friends/family that have been through this, so I really appreciate all of you who have and share your wisdom.

tlateef

IVF is very invasive and it might be worth a few IUI cycles to see how it goes. It'll also allow you to get used to taking the meds and not worry about making a mistake that jeopardizes an expensive IVF cycle. I would say don't worry about maxing out your benefits on IUI because it is SO much cheaper. A few failed IVF cycles will blow out your lifetime benefit so beware of that. Better to start less invasive and then go to more extremes if still not effective. I got pregnant after 3 IUI cycles and I have PCOS which is somewhat tricky. It's possible all your body needs is a little boost from some meds and you'll be pregnant before you know it. Also they do a semen wash for the IUI so you'll get Hugh quality sperm and possibly less likely for chromosomal abnormalities. Good luck!

WhiskyandWhiskers

Thanks tlateef! I'm such a 'what if' person, its paralyzing. Do you have any suggestions on meds for IUI? My RE is a proponent of clomid, have you tried it or other meds?

MrsBwIVF

We were in the same thought process as you with a lifetime cap of I think $20,000 each and were worried to waste it on iuis.
As PP said, ivf is much more invasive and difficult on your body and emotions. We did two iuis before going on to ivf and I'm glad we tried those first anyway because ivf is a bi**h.
Also, when the bills started to come in, DH noticed something great that could help your decision.
When we first started each process, our clinic had a financial specialist sit down with us, explain what they believed would or wouldn't be covered and also gave us an actual list of what each part got charged at. She explained that would be the highest amount possible, barring anything happening. She also said that a lotof insurance companies have a deal where they don't pay the same amount as you would out of pocket. So say one part got charged $1,000 and then was sent to your insurance, well your insurance will basically say "nope, well only pay $300 for that" and that'll be the end of it.
When we got our insurance info back on how much they paid and compared it to what they were originally asked to pay, it was mind blowing! I think they told us it could cost around $15000 towards our bank for our ivf and it only got charged $5,000. Also, a lot of stuff we thought would go towards our bank, ended up being covered under regular medical, like blood work and u/s. Just something to think about.
I'm hoping that all makes sense, been struggling with a nasty headache all day.

WhiskyandWhiskers

I really appreciate it MrsB! This kind of golden info is difficult to find! I am feeling better with the IUI route first, and what you've said makes a whole lot of sense. Considering I'm going from doing nothing to considering invasive-ness, I'm feeling contented with less invasive first. I'll be scouring the medical bills when they roll in and keep track of my lifetime cap. The hospital I work at has a partnership as well, so fingers crossed in a big way treatment costs will be reasonable. 

lilmissslp

I have to say you all are lucky to have such good insurance. I work for the state so I thought I'd have good benefits but don't! My insurance will not cover any medication. They will cover three IUIs in a lifetime but nothing towards IVF. We have one IUI left. Best of luck to you!

WhiskyandWhiskers

Thanks! I actually left a job and sought this one out solely because of the benefits. It's really shitty how insurances work. Last straw for me was having a medically necessary D&E and it costing over $2,000 with my insurance that I thought was half decent. I thought the state would have better benes too, infertility sucks. 

lilmissslp

Yeah it really does suck. It seems so incentive. I had a polyp removed which is D&C and very similar to a D&E and almost cost me $2,000 with insurance as well!

MrsBwIVF

You're welcome! Glad I could spread some useful knowledge on this subject.
I wish I wouldn't have been too worried to come on here and ask questions before all of our procedures. Keep asking questions on here, even if you think they'll seem silly. It's a really long, daunting and confusing process.

tlateef

The FSH (follicle stimulating hormone) I used in my IUI cycles was letrozole. That was paired with dexamethazone, metformin (not diabetic but it helps the PCOS) and other supplements my doc recommended such as prenatal, vitamin D (most people are deficient), coq10, fish oil, and folic acid. Then my injections of ovidrel which is a once a cycle trigger injection taken the day before the insemination. Finally I had Crinone which is a nasty progesterone vaginal gel you have to take after the insemination or even the IVF. It's a lot of meds but it's much less than IVF which usually requires many more injectables and creates more havoc on your body. (You're gonna have crazy hormonal mood swings regardless). Depending on the doc they may recommend a different FSH but essentially the process is the same. Any of the supplements are good to start taking ASAP though since they all contribute to fertility in different ways.

lilmissslp

Oops I meant insensitive.

marygz3

Depending on your plan with your re the iui meds are usually the same as ivf just a little less. If you look up the statistics on iui's it has extremely low success rates, especially for unexplained infertility (that was our diagnosis). Going through one iui cycle will help you and your doctor see how you react to the meds but if you don't have success right away I would move on to ivf. Ivf is not as scary as it sounds. I've been through several iui's and had success with our first ivf cycle. I'm now 30 weeks pregnant. I wish I could go back and tell myself that ivf is not that scary and totally worth it! Lots of luck to you with whatever you decide.

WhiskyandWhiskers

Thank you everyone, I really appreciate all of the advice. I think I'll see how I feel on clomid (I'm prepared to feel terrible), then go from there. I asked my NP at the RE about the chances of pregnancy from IUI, and she said that it 'improves already existing chances'. I was monstrously confused by wierd math. 

tlateef

One more thing to check into is if your insurance requires a certain number of failed IUIs before they will cover an IVF. I learned that was the case with mine but the insurance never told me. I hadn't pursued IVF within those first 3 cycles so I guess it didn't matter but it may to some. And sometimes if a doctors office isn't super attentive to that stuff they may go ahead and do the procedure and then you find out from your insurance too little too late and you're stuck with a big bill. It's worth a phone call to your insurance just to double check before you do anything else. :-)

przemosbabe

I would try' two or 3 iuis with clomid or letrozole and then move on to IVF.