So, I know many docs, including ours, recommend moving on to IVF after 3 failed IUIs. Now, here we are, 3 failed IUIs later. Last cycle, though, my husband's count was much lower than it ever has been before for many reasons. Basically, we just had an off cycle. So, now, I'm feeling like it might be worth trying a 4th IUI given the circumstances of last cycle. We are completely OOP, so obviously that's a factor, too. For those of you who have done more than 3 IUIs or have made the switch to IVF, what factors did you take into consideration? How did you make your decision? We are going to meet with the RE this week for our WTF appointment and I want to have already thought through some of my options because I get flustered just thinking about going to the appt so I'm worried about staying focused during the actual appointment.
**siggy warning**
3/09 Clomid 50mg - no O
5/09 Clomid 100 mg - no O
7/09 HSG partial blockage, SA passed with flying colors
I did 6 iui's cause my insurance covered it. I'm moving onto if cause I'm physically exhausted and I'll also be out of pocket. You have to move on when you feel ready. I'm also taking a long break so I can feel more mentally and physically prepared. Good luck with your decision.
Me and DH: 32, TTC since 2/2012
Dx: lean PCOS, low hormone levels, 2 CP's before seeing RE, MTHFR heterozygous
IUI #1 with clomid and ovidrel: BFN
IUI #2 with clomid (unresponsive), femara, ovidrel and novarel: Possible CP
IUI #3 with femara, ovidrel and novarel: BFN
IUI #4 with Follistim (115 iu) and ovidrel= BFN, developed OHSS, benched- 2 weeks of birth control pills
IUI #5 with Follistim (75iu) and ovidrel= BFN........Taking a medication break for a few months
IUI #6 with Follistim (75iu) every other day, femara and Lupron trigger= BFN
*Taking a long break to get healthy and research/prepare for IVF*
Goal: gain 5 lbs, gluten/dairy/soy/nut free
3T June Siggy Challenge- Celebrity Crush: Woody Harrelson
After my 2nd IUI, my RE suggested we move onto IVF. My husband has always had it in his head that we would do three IUIs and since we are OOP, I knew he would have trouble moving on ahead of schedule. I just told my RE that we wanted one more IUI before IVF and she was fine with that.
She also told me that she wanted me to try an unmedicated IVF cycle first (which makes no sense to me since I have ovulation issues) and I told her that I didn't have the time to waste an IVF cycle (or the money!). I insisted that we approach this cycle aggressively and she said ok. Maybe it's different overseas, but generally you get what you ask for over here. You just have to be prepared and know what you want to do so that you can advocate for yourself. Good luck!
Me 36 with endometriosis, PCOS, fibroid and ovulation issues, DH 40 TTC #1 since 04/12, BFP 10/12. Missed MC/D&C at 10 weeks 11/12 TTC #2 since 12/12 6 clomid cycles since 7/13, all BFN
IUI #1 (2 b2b) with clomid and trigger shot on 1/20/2014 BFN
IUI #2 with arimidex and trigger, B2B IUI's 2/24 and 2/25, BFN IUI #3 with menopur injections and trigger, IUI 3/23, BFN 7 month break
Fibroid surgery 10/14
IVF cycle 1 beginning Nov. 1st...cancelled due to follicle issues. On hold for Dec. due to holidays.
After 3 failed IUIs we moved onto injects with IUI since that is the path my insurance covers. I have to do 3 rounds of this before moving onto IVF. I could tell my doctor would be prefer ivf since they can control multiples easier and since PCOS patients tend to over respond to injects, but since IUI is covered that made sense for us. I did read somewhere that if your only problem is ovulation issues it doesn't really hurt to try a few more IUIs, but I think if I were you I'd move onto injects as I **think** you are supposed to get better quality eggs.
*** SIGGY WARNING ***
Happily Married Since 10.2006 • TTC since 07.2012
HSG Good & SA mostly Normal • DX lean PCOS
MAR - NOV 2013 • 5 Cycles Clomid + TI = 2 Late O's/BFN & 3 Big Fat FAILS
DEC 2013 - FEB 2014 • IUI #1-3 • Femara 5mg + Trigger = 3 BFNs
We are 100% OOP so we didn't do any IUIs. I have endometriosis and the chances of success are 5 times greater with IVF than with IUI. If I had a different diagnosis or some insurance coverage, we would have tried IUI.
What protocol were you on? If it was just clomid/Femara, I would try an injects cycle or two if for no other reason than it could provide your doctor with information about how you might respond to stims during an IVF cycle.
If you've already tried injects then I think most docs would agree that it's time to consider moving on. That said, how you feel is really important and if you're not ready for IVF you shouldn't feel pressured to move on yet. Just take your time to decide what feels right for you. If you need one more IUI to feel like you gave it your best shot, do it.
I am working on a 4th IUI because the first one was unmedicated and my RE wants to do three using the medication. Since you are completely OOP, do you feel like you could afford IVF right now or are you going to have to wait? If IVF is plausible I would do that, but if you wouldn't able to do that for a little while I would ask to do another IUI.
Me: 32 DH: 33 Married: March 2004
July 2006: started TTC 2008: HSG (normal), couple rounds of clomid through gyno 2008 - 2010:dragging my feet out of fear and procrastination October 2010: first consultation with RE, dx PCOS and fibroids (DH slightly low count/motility) Oct. 2010 - Dec. 2012: In DENIAL! avoided the issuebecause I was scared of surgery January 2013: returned to RE, fibroids grew significantly February 2013: second HSG, fibroids pushed on tubes which blocked them somewhat March 2013: MRI to determine what type of surgery may be necessary July 29, 2013: fibroids (5) removed via robotic laparascopy August 2013 - Nov 2013 : benched due to recent surgery
IUI #1, Dec. 24, 2013, BFN
IUI #2, Jan. 25, 2014, BFN IUI #3, Feb. 25, 2014BFN IUI #4 canceled due to lack of response to letrozole IUI #4.1April 28, 2014, BFN May 16, 2014:wtf consult, start prepping for IVF in June and add injects for one last IUI in the meantime IUI #5 started letrozole and bravelle but canceled after HSG led to new diagnosis May 21, 2014: third HSG, tubes blocked, one at the beginning, one hydrosalpinx??
June 11, 2014: consult, approved to move on to IVF because the hydro is not completely blockedtherefore allowing fluid to move through slowly rather than backwards IVF #1 August 8, 2014 - 3dt of 2 embryos, BFN September 17, 2014 - 4th HSG, the right tube is very patent (open!!) dye went straight through this time. Weird! October 2, 2014 - started metformin treatment November 14, 2014 - blood work, brought A1C down from 5.8 to 5.5 November 26, 2014 - RE finally back from vaca and reviewed my chart, no more IVFs for rest of calendar year December 1, 2014 - Right after Thanksgiving, I called a new clinic and got in right away! Plan for IVF December 17, 2014 - ER! 29 retrieved (!!), 16 mature, all 16 fertilized (ICSI) IVF #2 December 20, 2014 - 3dt of 3 embryos, BFN
We did 3 injects + IUIs, all BFNs. At that point we had the IVF talk with the RE, but we are a little timid to go that route right now. I decided to start doing acupuncture while trying naturally for a few months, and if that doesn't work we may do acupuncture with one or two more IUIs, just because. If none of that works, we will probably look more seriously into IVF.
When we had the IVF talk with the RE, he totally left it up to us what we wanted to do. I had a good response to injects, DH's sample was decent, so he was fine with us doing a couple more IUIs. He was also fine if we wanted to move onto IVF. He said it was our choice.
We did 4 IUIs, but the first was with my OB (Clomid w/ no trigger). My first IUI with my RE was thrown in last minute during an unmedicated monitored cycle after he discovered that I have some issues with hostile CM. I did two more IUIs with my RE, but these were clomid + trigger + IUI. After the second clomid + trigger + IUI my RE recommended moving on to IVF.
I don't think it's unreasonable to do another IUI.
DH (32): SA is ok, slightly low morph, normal SCSA Me (32): Slightly low progesterone, hostile CM, carrier for CF, Moderately high NKC, High TNFa, heterozyogous mutated Factor XIII, and +APA
October 2012-May 2014: 4 failed IUIs, 3 failed IVFs, and 1 failed FETw/donor embryos
November 2014: IVF w/ICSI #4 Agonist/Antagonist with EPP and Prednisone, Baby Aspirin, Lovenox, and IVIG for immune issues. Converted to freeze all due to lining issues. 2 blasts frozen on day 6!
January 2015: FET #2 Cancelled due to lining issues
100% OOP here. I did 3 IUIs with Clomid and they all failed. I did one unmedicated cycle, and let me tell you what a tremendous waste of money that was!
Anyway, my doctor called me and said she wanted to try a hybrid injects + Femara cycle with me. Doing a hybrid cycle is as effective as all injects, but much less expensive so there's that. I responded well to Clomid but my doctor seems to think there was either an issue with egg quality or lining quality. Now that I think about it, my cycles with Clomid have been lighter than usual without medication so... that could've been my problem.
I think it may be worth your time to try injects (looks like all your cycles were Femara only). As another poster said, if nothing else this will at least demonstrate how well you'd respond to IVF medications! Good luck!!
Thank you all for your input/advice/knowledge. I have only been on Femara and trigger with all 3 IUIs. I only had one mature follie with 5mg and 7.5 mg and then this last cycle with 10mg I finally had 2 mature. We did speak briefly with the RE about injects, but he didn't seem to think it increased our chances all that much. He said because of the small increased chance, he thought it made more sense to save our money for an IVF cycle. Although, as @Milagros315 pointed out, it does make sense that a round of injects could give us valuable information for an IVF cycle if we get there.
As far as finances go, we could make IVF work - not without some growing pains, but we could figure it out. My IUI cycles have been less than I expected because it turned out some of my monitoring was covered and thanks to GoodRX, my Femara cost next to nothing. Truthfully, emotionally, I'm just not sure I'm ready for IVF. I'm leaning towards doing a 4th IUI with injects. I do think if that were to fail, I would feel like I did everything I could before moving on.
Thank you all for being so honest about your decisions. There are so many factors - and I so wish $$ wasn't one of them!
**siggy warning**
3/09 Clomid 50mg - no O
5/09 Clomid 100 mg - no O
7/09 HSG partial blockage, SA passed with flying colors
From what I've read, the highest odds are in the first 3 (and about equal odds for each). Then, tries 4-6 still have a chance close to the first 3. But after 6, on average the results drop off. Again, those are averages.
You mentioned sperm analysis wasn't great this time...if I knew something had messed up one of our tries (we only plan 2 to time IVF during a teaching break), I would definitely try IUI again and then hold off IVF until winter break.
Good luck with whatever you choose!
January 3T Siggy Challenge - New Year's Resolutions
Me (29), DH (30) TTC actively 54 55+ cycles | All BFNs
We are in Canada and are OOP for everything except b/w and u/s. We did 3 cycles of Femara + TI and 3 injects + IUI that have all failed. We are in the midst of stimming for IUI#4. Last cycle pretty much ended in a CP but it gave us hope that this might work for us, and our RE is pretty confident as well.
We saw some studies with us that showed good success rates in up to 6 IUI cycles, with injects, for cases similar to ours. The rates dropped off dramatically after that. An inject + IUI cycle runs us about $2K and IVF at our clinic is about $12-13K. For the price of 1 IVF cycle, we get 6 shots at IUI. I should also mention we're unexplained, great SAs, great response to stims, etc so if we have to, we will likely keep rolling the dice with IUIs and end up doing 5 or 6 before moving on to IVF.
I have done 6 IUIs and plan to do 1-2 more. The main reason we keep trying IUI is because we are MFI and my DH has been taking meds for almost 4 months now and his numbers have improved. So he and his urologist think we should try a couple more. My RE is willing to do whatever we want but I am personally ready to move on to IVF. I just can't get my DH to agree to starting the IVF process until June as he is convinced his swimmers are will be good enough for IUI before then. I don't want to push him and I want him to feel like we gave it every possible shot before moving on. But emotionally, I'm just done. I'm ready for IVF!
Follow your heart and do what you feel is right for you and your husband. Good luck to you.
********Siggy/Ticker Warning***********
Me (35) no known issues DH (37) MFI. TTC 21 months (24 cycles) Dx MFI with low to normal count, low motility, morphology 3% HSG normal, ultrasound and labs on me all normal.
1 cycle of Clomid 50mg and TI, unmonitored by OBGYN= BFN 1 cycle of Clomid 50mg and IUI, unmonitored by OBGYN= BFN Started seeing an RE!! 2 more cycles of clomid 50mg (great response), with IUI and Pregnyl trigger (4.8-8 mil good ones after wash) = all BFN 1 cycle of clomid 50mg (3-7) followed by Follistim 75iu (7-11) + IUI = BFN December 2013 DH saw urologist and is taking Anastrozole, CoQ10, and L-Carnitine IUI #5 natural cycle (needed a med break) = BFN IUI #6 Follistim 75iu (CD3-10) + Pregnyl (CD11) + IUI (final count after wash 300K) = BFN IUI #7 Follistim 75iu (CD3-9) + Pregnyl (CD11) + IUI on 2/20 (post wash count 12.5 million)= BFN IUI cancelled (DH OOT) Clomid 50mg (CD3-7) 1 follicle +(not well timed) TI = BFN IUI #8 and last one!! Clomid 100mg (CD3-7) +OPK before US + IUI 4/17 (post wash 8.5 mil)= BFN
Pre-IVF testing complete! SHG great and measurements taken! Labs for infectious diseases completed, FSH (5.4), TSH (1.6), Prolactin (11), AMH (2.6), Estradiol (40).
Started BCP 5/29 and Lupron 6/11 prep for IVF #1! Started follistim 225u/day on 6/28. Monitoring on 7/2 >15 follicles measuring 11-14, E2 758. Monitoring on 7/5 all ready to go!! Great follicle sizes and lining is at 9. Tigger 7/5, ER 7/7 16R 9M 3F. Stimmed too fast in just 7 days. 7/10 3dt of 2 8-cell grade 2 & 4. 7/14 P4 >60. Holy crap BFP!!! Beta #1 (14dpo) 7/21 112 Beta #2 (16dpo) 7/23 286 a Beta #3 (18dpo) 7/25 761 Beta #4 (21dpo) 2631!!! Hold on tight little embies!!First Ultrasound 8/7- 1 perfect little bean with a beating heart 117bpm!! EDD 3/30.
Second ultrasound 9/2 Little bean measuring a few days ahead with a heart rate of 161!
Re: What to do after 3rd failed IUI
She also told me that she wanted me to try an unmedicated IVF cycle first (which makes no sense to me since I have ovulation issues) and I told her that I didn't have the time to waste an IVF cycle (or the money!). I insisted that we approach this cycle aggressively and she said ok. Maybe it's different overseas, but generally you get what you ask for over here. You just have to be prepared and know what you want to do so that you can advocate for yourself. Good luck!
Me 36 with endometriosis, PCOS, fibroid and ovulation issues, DH 40
TTC #1 since 04/12, BFP 10/12. Missed MC/D&C at 10 weeks 11/12
TTC #2 since 12/12
6 clomid cycles since 7/13, all BFN
IUI #1 (2 b2b) with clomid and trigger shot on 1/20/2014 BFN
IUI #2 with arimidex and trigger, B2B IUI's 2/24 and 2/25, BFN
IUI #3 with menopur injections and trigger, IUI 3/23, BFN
7 month break
Fibroid surgery 10/14
IVF cycle 1 beginning Nov. 1st...cancelled due to follicle issues. On hold for Dec. due to holidays.
IVF cycle 1.2- Gonal F (100) as of 1/12
What protocol were you on? If it was just clomid/Femara, I would try an injects cycle or two if for no other reason than it could provide your doctor with information about how you might respond to stims during an IVF cycle.
If you've already tried injects then I think most docs would agree that it's time to consider moving on. That said, how you feel is really important and if you're not ready for IVF you shouldn't feel pressured to move on yet. Just take your time to decide what feels right for you. If you need one more IUI to feel like you gave it your best shot, do it.
2008: HSG (normal), couple rounds of clomid through gyno
2008 - 2010: dragging my feet out of fear and procrastination
October 2010: first consultation with RE, dx PCOS and fibroids (DH slightly low count/motility)
Oct. 2010 - Dec. 2012: In DENIAL! avoided the issue because I was scared of surgery
January 2013: returned to RE, fibroids grew significantly
February 2013: second HSG, fibroids pushed on tubes which blocked them somewhat
March 2013: MRI to determine what type of surgery may be necessary
July 29, 2013: fibroids (5) removed via robotic laparascopy
August 2013 - Nov 2013 : benched due to recent surgery
IUI #3, Feb. 25, 2014 BFN
IUI #4 canceled due to lack of response to letrozole
IUI #4.1 April 28, 2014, BFN
May 16, 2014: wtf consult, start prepping for IVF in June and add injects for one last IUI in the meantime
IUI #5 started letrozole and bravelle but canceled after HSG led to new diagnosis
May 21, 2014: third HSG, tubes blocked, one at the beginning, one hydrosalpinx??
IVF #1 August 8, 2014 - 3dt of 2 embryos, BFN
September 17, 2014 - 4th HSG, the right tube is very patent (open!!) dye went straight through this time. Weird!
October 2, 2014 - started metformin treatment
November 14, 2014 - blood work, brought A1C down from 5.8 to 5.5
November 26, 2014 - RE finally back from vaca and reviewed my chart, no more IVFs for rest of calendar year
December 1, 2014 - Right after Thanksgiving, I called a new clinic and got in right away! Plan for IVF
December 17, 2014 - ER! 29 retrieved (!!), 16 mature, all 16 fertilized (ICSI)
IVF #2 December 20, 2014 - 3dt of 3 embryos, BFN
We are done with treatment unsuccessfully.
When we had the IVF talk with the RE, he totally left it up to us what we wanted to do. I had a good response to injects, DH's sample was decent, so he was fine with us doing a couple more IUIs. He was also fine if we wanted to move onto IVF. He said it was our choice.
Good luck to you!
TTC since March 2012
DX: MFI (4% motility)
Cycle 13: Natural cycle w/ HSG test = BFP
Identical twins!
Lost my angel boys at 10.5 weeks
Cycle 14-16: Natural Cycles = BFN
Cycle 17: Follistim + Trigger + IUI = BFN
Cycle 18: Natural Cycle = BFN
Cycle 19: Follistim + Trigger +IUI#2
Polyp found: SIS 11/11 - hysteroscopy 11/14
Cycle 20: Follistim + IUI#2 = BFFN
Cycle 21: Follistim (adj. dosage) + IUI#3 TI = BFN
IUI cancelled due to weather
Cycle 22: Follistim + IUI#3.1 = BFN
Cycle 23: treatment break, IVF consult
Cycle 24 - 26: natural cycle w/ acupuncture + Chinese herbs = BFN
Cycle 27: Follistim + IUI#4 = BFFN
Natural Cycles until IVF
Cycle 30: IVF#1 - Starting with Menopur + Follistim + Ganirelix
17 retrieved, 12 fertilized, 5dt w/ 2 blasts, 5 frosties
Betas: #1-156(9dp5dt), #2-1200(13dp5) #3-6112(17dp5)
Ultrasound #1 10/6: 1 bean!
TEAM BLUE!
My Chart
~~ALL WELCOME~~
We did 4 IUIs, but the first was with my OB (Clomid w/ no trigger). My first IUI with my RE was thrown in last minute during an unmedicated monitored cycle after he discovered that I have some issues with hostile CM. I did two more IUIs with my RE, but these were clomid + trigger + IUI. After the second clomid + trigger + IUI my RE recommended moving on to IVF.
I don't think it's unreasonable to do another IUI.
TTC #1 since August 2011
My Blog
September 2012: Start IF testing
DH (32): SA is ok, slightly low morph, normal SCSA Me (32): Slightly low progesterone, hostile CM, carrier for CF, Moderately high NKC, High TNFa, heterozyogous mutated Factor XIII, and +APA
October 2012-May 2014: 4 failed IUIs, 3 failed IVFs, and 1 failed FETw/donor embryos
November 2014: IVF w/ICSI #4 Agonist/Antagonist with EPP and Prednisone, Baby Aspirin, Lovenox, and IVIG for immune issues. Converted to freeze all due to lining issues. 2 blasts frozen on day 6!
January 2015: FET #2 Cancelled due to lining issues
April 2015: FET #2.1
PAIF/SAIF Welcome!
100% OOP here. I did 3 IUIs with Clomid and they all failed. I did one unmedicated cycle, and let me tell you what a tremendous waste of money that was!
Anyway, my doctor called me and said she wanted to try a hybrid injects + Femara cycle with me. Doing a hybrid cycle is as effective as all injects, but much less expensive so there's that. I responded well to Clomid but my doctor seems to think there was either an issue with egg quality or lining quality. Now that I think about it, my cycles with Clomid have been lighter than usual without medication so... that could've been my problem.
I think it may be worth your time to try injects (looks like all your cycles were Femara only). As another poster said, if nothing else this will at least demonstrate how well you'd respond to IVF medications! Good luck!!
Team Purple!!!!
Follow your heart and do what you feel is right for you and your husband. Good luck to you.
********Siggy/Ticker Warning***********
Me (35) no known issues DH (37) MFI. TTC 21 months (24 cycles)
Dx MFI with low to normal count, low motility, morphology 3%
HSG normal, ultrasound and labs on me all normal.
1 cycle of Clomid 50mg and TI, unmonitored by OBGYN= BFN
1 cycle of Clomid 50mg and IUI, unmonitored by OBGYN= BFN
Started seeing an RE!!
2 more cycles of clomid 50mg (great response), with IUI and Pregnyl trigger (4.8-8 mil good ones after wash) = all BFN
1 cycle of clomid 50mg (3-7) followed by Follistim 75iu (7-11) + IUI = BFN
December 2013 DH saw urologist and is taking Anastrozole, CoQ10, and L-Carnitine
IUI #5 natural cycle (needed a med break) = BFN
IUI #6 Follistim 75iu (CD3-10) + Pregnyl (CD11) + IUI (final count after wash 300K) = BFN
IUI #7 Follistim 75iu (CD3-9) + Pregnyl (CD11) + IUI on 2/20 (post wash count 12.5 million)= BFN
IUI cancelled (DH OOT) Clomid 50mg (CD3-7) 1 follicle +(not well timed) TI = BFN
IUI #8 and last one!! Clomid 100mg (CD3-7) +OPK before US + IUI 4/17 (post wash 8.5 mil)= BFN
Pre-IVF testing complete! SHG great and measurements taken! Labs for infectious diseases completed, FSH (5.4), TSH (1.6), Prolactin (11), AMH (2.6), Estradiol (40).
Started BCP 5/29 and Lupron 6/11 prep for IVF #1! Started follistim 225u/day on 6/28. Monitoring on 7/2 >15 follicles measuring 11-14, E2 758. Monitoring on 7/5 all ready to go!! Great follicle sizes and lining is at 9. Tigger 7/5, ER 7/7 16R 9M 3F. Stimmed too fast in just 7 days. 7/10 3dt of 2 8-cell grade 2 & 4. 7/14 P4 >60.
Holy crap BFP!!!
Beta #1 (14dpo) 7/21 112 Beta #2 (16dpo) 7/23 286 a Beta #3 (18dpo) 7/25 761 Beta #4 (21dpo) 2631!!! Hold on tight little embies!! First Ultrasound 8/7- 1 perfect little bean with a beating heart 117bpm!! EDD 3/30.
Second ultrasound 9/2 Little bean measuring a few days ahead with a heart rate of 161!
PAIF/SAIF/All Welcome!
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March 15 Siggy Challenge: You had one job