What shall I do next?

wishiwaspreggo

Hello, ladies!  I come seeking your sage advice again...

So I've had 3 failed IUIs on Clomid.  Clear HSG.  My doctor is calling me for a consultation tomorrow to talk about the next steps.  When I had my HSG she said "If this cycle fails we'll try to switch your medication to Femara.  Or if you want, we can try more aggressive therapies like injectables.  We'll discuss that if/when the time comes."

I responded well to Clomid (usually I'd get 2-3 follicles matured).

Should I go straight to injectables?  I'm getting sick of going in all the time and I really just want to get KTFU.  But at the same time, I shouldn't allow my impatience to cause me to make a rash decision when Femara may be more prudent.

I don't really know what to do.  I'm trying to do some research now so I'll know what I'm getting myself into.  I read a study that Clomid + IUI has an 8.5% success rate and Gonal-F + IUI has a 17% success rate so... that's attractive.

What do you ladies think?  Would I be putting myself at risk using injectables?  Do you think switching to Femara first may be wiser?

Many thanks, as always, for your help.

ky29

If you responded well to Clomid, I'm not sure about the injects.  Personally, I wouldn't want more than 2-3 mature follies, so I'm not sure what the advantage would be with injects.  Does your insurance cover anything?  Because injects are quite a bit more than Clomid/Femara. 

Hopefully some of the other ladies will have better advice than me.

wishiwaspreggo

I switched donors for my last IUI.  I definitely don't want to increase the number of follicles, but I didn't know if injectables increased the quality or not.  Or if Femara acts differently and would work better for some reason.

And yes, I know injectables cost a lot more which is another reason I'm asking

ETA: I read somewhere that Femara improves egg quality.  Anyone know if that's true?

marshaleigh

I was just switched from clomid to arimidex (like fermara) and we almost cancelled the cycle because I had no mature follicles. Finally, on day 19, I had one large enough to trigger. I just had my IUI today and if it works, great. If not, I'm switching to injections. Best of luck making your decision!

jszy10

Are you OOP?  Femara is MUCH more affordable than injectables.  I didn't respond to clomid, but responded well to Femara at first.  I would worry that injectables would give you more follies than you want.  Femara would probably be comparable to the results you got with Clomid.

ebwhit

I don't really get why you would go to injectables when you are getting good follicles. Has your RE expressed concern about egg quality at all? I know the IUIs are a lot to deal with but 6 months and 4 cycles isn't that much when ttc. I assume they did a full fertility work up for you? 

honestly, I pay no attention to IUI success percentages. It's a crap shoot and every clinic and every person is different. RPL only affects 1% of couples...but I'm that 1% so what does it matter that 99% of people won't go through this. 

wishiwaspreggo

ebwhit said:

I don't really get why you would go to injectables when you are getting good follicles. Has your RE expressed concern about egg quality at all? I know the IUIs are a lot to deal with but 6 months and 4 cycles isn't that much when ttc. I assume they did a full fertility work up for you? 

honestly, I pay no attention to IUI success percentages. It's a crap shoot and every clinic and every person is different. RPL only affects 1% of couples...but I'm that 1% so what does it matter that 99% of people won't go through this. 

My question exactly!  I don't want to have triplets or anything crazy.  I just want one.  It was just something she said in passing.  We'll have our actual consultation tomorrow afternoon.  I wanted to prepare myself as much as I could to ask questions and be knowledgeable rather than say "Injectables sound great!" 

They have a packaged deal for injectable IUI at my RE's office so I wasn't as concerned about pricing (it would be a couple hundred bucks more than what I'm doing now with Clomid, which in the scheme of things isn't that bad).  But it sounds like the consensus is to stay away from the injectables for the time being.

I don't know about my egg quality.  I guess that may be a concern of my doctor's.  I'm not sure why my IUIs keep failing when they're well timed and I have a couple follicles each attempt.

It sucks something awful though, not knowing.

wishiwaspreggo

Rumbera28 said:

I also don't know why you'd get put on injectibles if you're responding well to Clomid.   Menopur does improve egg quality somewhat, but nothing so far points to an egg quality problem .

Injects are more expensive, but chances are you would be on very low levels since producing eggs is not your issue.    If I was in your shoes, I would probably ask about back to back IUI's.   I know that studies show that the difference is not significant, but somehow I just don't believe this.

I'm not a doctor so I could be wrong, but my understanding is the sperm outlives the egg which is why there's really not a statistical difference between 1 IUI vs. B2B IUI.  If it made a difference I would do it in a heartbeat, but with DS costing as much as it does it doesn't seem practical for me to try that...

wishiwaspreggo

Thanks @calindi what's weird is my lining was totally fine on Clomid (12-14 mm each cycle) so I don't know why Femara would benefit me... Perhaps it's just been bad luck or something.  I noticed in my last cycle that my temp spiked the day I got my IUI.  I was worried I'd ovulated too soon.  I did it based off my OPKs.  I think I'll mention that to the doctor.  I probably should've gotten my IUI the day of the surge, or very early morning the next day (I'd done the IUI in the early afternoon).

sunlavender

I did one Clomid+trigger+IUI cycle.  I had two mature follicles.  My RE, however, switched me to Letrozole (Femara) this cycle.  I responded much quicker to the Let.  Monitoring on the same cycle day, I had two follicles again, but my they were significantly bigger (15/18mm on Clomid, 22/24mm on Let).  We ended up not triggering, since I was obviously so close naturally, and I ovulated on my own two days later.

I know everyone's experiences are different, but Let was better than Clomid for me.

Lillovebug79

wishiwaspreggo said:

Thanks @calindi what's weird is my lining was totally fine on Clomid (12-14 mm each cycle) so I don't know why Femara would benefit me... Perhaps it's just been bad luck or something.  I noticed in my last cycle that my temp spiked the day I got my IUI.  I was worried I'd ovulated too soon.  I did it based off my OPKs.  I think I'll mention that to the doctor.  I probably should've gotten my IUI the day of the surge, or very early morning the next day (I'd done the IUI in the early afternoon).

I would definitely ask about an HCG trigger shot to better time your IUIs. Timing is so critical and the trigger isn't crazy expensive so it's worth it to increase your chances.
I also had great response to clomid, 2-3 mature follicles each time, nice thick lining, and an awesome 7dpo progesterone level. Once I was done with Clomid, I moved on to Follistim. On that, I've had 4-5 possible mature follicles and great lining but our problem is really with sperm so it doesn't matter how great I ovulate if they can't get one of the eggs fertilized. I would think about trying Femara and a trigger for at least a cycle of two if I were you. Maybe you will get lucky if your timing is more exact! Good luck!

edited:sorry I just saw that you had been doing a trigger! In that case, I would probably try injects next. My RE said that sometimes the quality of ovulation is better with FSH. I've never taken Femara but I think it's a lot like clomid and if you respond well to clomid, it will probably be the same on Femara.

BabyKsMommy

So it seems like you definitely need a conversation with your RE to see what they think is the next best step for you. 

This is my experience, I did 3 Clomid IUIs, but didn't get KU. So I did a clomid + menopur cycle and didn't O. So next I went to just menopur and 2 out of 4 cycles were cancelled because of no O. So for me menopur hast been that great, but my clinic is very conservative with dosing especially with my high AFC. So I decided to try femara, last month I O'd but no BFP so this month we are trying Femara again. 

For me a femara cycle costs $5 for the meds and a menopur $800+. So its a big cost difference and with half of my cycles not making it to O, I decided to try something else. I felt like going into injects would be like magic and it wasn't at least for me.

wishiwaspreggo

Thanks everyone!  My RE decided to try a hybrid cycle with Femara and Follistim.  We'll see how that works out I won't know until next cycle - benched for a bit but that's okay.  If I get KU next cycle my BM will be December.  It would be awesome to have a child born on December 23rd.  Then I could call our child our Festivus miracle.

wishiwaspreggo

calindi said:

wishiwaspreggo said:

Thanks everyone!  My RE decided to try a hybrid cycle with Femara and Follistim.  We'll see how that works out I won't know until next cycle - benched for a bit but that's okay.  If I get KU next cycle my BM will be December.  It would be awesome to have a child born on December 23rd.  Then I could call our child our Festivus miracle.

I'm a December baby, and I never wanted to do that to my child! But at this point, full speed ahead.  If I am so lucky as to get pregnant with a December due date, I'll spoil that child rotten to make up for lousy birthday timing.

Yeah, I know My big brother was born on the 26th and his birthday always gets looped into Christmas.  C and I talked about skipping cycles that would result in a winter/holiday birth but... I want a baby, and I don't want to keep waiting.  I've thought up a few solutions, and I was thinking maybe celebrating their birthday in June (like a half birthday or something)... C hates that idea but I don't know what else to do.  We should at least making a point to not let Christmas overshadow our child's birthday.

It may be a moot point - this cycle could certainly fail just like the others, but I'm trying to mentally prepare myself for a December baby in case it does happen!

wishiwaspreggo

Thank you for the tips, @calindi!  I'll remember them, should I have the happy dilemma of figuring out how to best honor the birth of our first child in December

BabyKsMommy

The plus side to having a December baby is you get to have a baby THIS year. If you have a January baby you won't get to have a baby till next year