Decisions, decisions--decision made! (Update)

Davie813

So I had my RE consult yesterday, and I'm feeling a bit discouraged.  (To be fair, she was very nice and didn't actually say anything discouraging; it's just all real now.)

She definitely didn't proffer a "quick fix": she said that everything looked great and that the likely cause of our problem was simply age and the shortage of normal eggs that comes with it.  Great.

Anyway, these are my options:

1. Complete the three IUIs with clomid my insurance requires before moving on to something more aggressive.  The RE gives these a 6% chance of success each.

2. See if she can convince my insurance company (based on my age and previous FSH of 11) to move directly to IUI with injectibles.  She gives these an 18% chance of success each (and, if successful, a 20% chance of resulting in twins).

3. Move directly (if insurer agrees) to IVF.  She gives this a 40% chance of success each (which seems high to me, but is based on the assumption that we're able to harvest/grow high-quality embryos.  Based on my age, bloodwork, and history, she thinks we will be.)  She gives this the same risk of producing twins, unless we transfer fewer embryos to avoid that--in which case it's obviously less likely to work at all.

I'm not at all sure what to do.  Part of me wants to start with something less invasive than IVF, for a variety of reasons.  Part of me is worried that I'm running out of time and should be as aggressive as possible.  I would also like to start looking for a new job at some point, and I'm obviously limited by insurance until I get pregnant or give up.  Yet another wrinkle is the fact that DH is terrified of the idea of twins and wants to do everything possible to avoid it.  I don't think that would be the most desirable outcome either, but I'm more willing to do whatever it takes to get pregnant. 

I know nobody can make the decision but DH and I, but any thoughts or words of wisdom?  How did those of you receiving fertility treatment decide what course to take?

ETA: nothing against twins (or large families).  We're just concerned about medical complications, and while we could support three kids, it would be very tight for a while!

marijaa333

Could you find out what it is about twins that terrifies him specifically? We tend to have preconceived notions of what something we haven't experienced is like, but they are often wrong. So perhaps pinpointing his exact concern(s) and then reassuring him with some real-world info would help?

lgsdesigner

I have no experience with fertility treatments, but if it was me, I would go with #2…IUI with injectables first. If your RE is telling you that your only issue is “age”, then you may have a higher chance of an IUI pregnancy without having to do the IVF. I used to work for CIGNA Healthcare (a big health insurance company), and we always approved IUI before approving IVF. The nurses that did the medical approval at the insurance company made the customers do IUI first, then if it didn’t work, move on to IVF.

My first step would be to call the insurance company, see what is covered and then go from there. I know some medical reviews can take weeks/months, so you want to find out asap.

As far as the fear of twins goes, that is just the chance you two have to take. If you want a baby, why not have two babies?! I know it might be a lot of work in the beginning, but your main goal now is to just get pregnant, right? Twins or no twins…just having a healthy baby is all that matters. 

marijaa333

PS And being "tight for a while" (as long as all their health and development needs are met, of course) is good for children in the long term, I swear!

Austrogermokee

My RE asked how we felt about twins, the response was, "We only want one child, but two is better than zero." 

How much time do you have to decide?

Davie813

@marijaa333, it's the finances that freak him out--daycare now, and college later (among other things).  And I agree that those numbers are scary, but people in circumstances like ours do have three kids.  All the time.  They make it work, and so would we.

@lgsdesigner, it's all covered.  They typically require the clomid IUIs before approving other things, but they can be flexible if circumstances demand it.  They'll only cover a limited number of both IUIs and IVFs, though.

@Austrogermokee, that's exactly what I say.  DH, on the other hand, feels exactly the opposite.  He does want DD to have a sibling, but he would strongly prefer having one kid to having three.  To be fair, he has said that if we did conceive twins, he would obviously love and welcome them once they were a reality.   He just doesn't want to up the odds.  We need to decide by the end of the week (ack!)

marijaa333

It's great that you have such a thoughtful and concerned hubby. I see his point, but also agree that people make it work. 

Sherby613

Looking at the odds and thinking when DH and I first starting talking with our RE, I wouldn't see any harm in trying the IUI with injectables (if insurance allows) and taking one cycle at a time (and hopefully it works in one!). I get what your saying about worrying about running out of time and wouldn't want to worry that I was starting off with the option that had the lowest rate of success projected for me. 

20% sounds like a lot, but really it's not a guarantee that it will happen.  I think of it as 1 in 5 pregnancies results in twins. My good friend has one year old twins and a four year old. She tells me that it has been a lot of work at times, but has gotten easier as they have learned to walk and no longer need bottles. They also have a great support system to help out. 

Best of luck in your decision!

Lesliem0901

OK, as someone who has done five IUIs with injectables, and had nothing medically wrong with me except for my age (FSH is 8.6), I would recommend option #2 for maybe two tries; three at the most. Because you were able to conceive naturally, I would think you'd have better odds. I wish I could continue IUIs, but time is running out for me. I have a success rate of 20% for IVF at my age (41) and FSH level. My previous doc said 40%, so that is what I'll focus on. Don't worry about multiples. If it happens, it is a double blessing.

Just my two cents for what it is worth...good luck in your decision making.

hooligans4

If the twin thing is a worry for both of you then try and go right for the IVF and only transfer 1at a time. The success rate is higher so I would go that route. I'm sure your RE knows how to navigate the ins co to get it approved.
Whichever you choose good luck.

annalisel

I'm sorry the consult was discouraging.

Based on my unsuccessful experience, I regret not going directly to IVF at age 39, FSH 9.5. Unfortunately, there is no way to know if 6 months will make a difference in response until after the fact. 

You could try one cycle of injectables to see your response. If it's good, try a few IUIs. If it's bad, you can jump to IVF.

URMySunshine77

IFinTN said:

I would go straight to IVF, especially if your insurance covers it. You can do a single embryo transfer and unless it splits (it happens RARELY) you will have reduced the risks of multiples from IUIs with injects. My 2 cents. I wish I had not wasted time with IUIs. Good luck!

I hardly feel qualified to share my perspective, but my initial response is similar to the thoughts of @hooligans4 and @IFinTN.

Mrs.McIrish

Ticker warning-----


I hope you don't mind my responding. Unless your DH has MFI, the insurer is unlikely to waive the IUI requirements. I would 100% say go straight to IVF but I don't think you will get the waiver. FWIW, my FSH started off at 12 at age 37 and went up rather fast during 37-38. Get those eggs before you get higher. You can transfer just one embryo to "mostly" avoid twins (unless it splits but that's not too often). Also, clomid made my FSH jump up so if you can get clomid waived, I'd try that. Just my 2 cents as someone who wasted a very precious 6 months on IUIs....

C_Girlie

Sometimes when you have multiple choices it makes it that much harder of a choice. I would try to do the ivf if I were in your shoes

tlc35

IFinTN said:

I would go straight to IVF, especially if your insurance covers it. You can do a single embryo transfer and unless it splits (it happens RARELY) you will have reduced the risks of multiples from IUIs with injects. My 2 cents. I wish I had not wasted time with IUIs. Good luck!

This.  I would be as aggressive as your insurance will let your be.

LouiseB2001

I agree with several of the PP: I actually regret that I spent 5 cycles trying IUI and didn't go straight to IVF, mainly because of my age. I didn't want anything invasive at first and because I had become pregnant easily 4 years ago I figured it would be the same. Not so. Don't waste too much time, you might still have to do IVF several times. And the twin probability is lowered if you transfer just one egg at a time. However, I was told that when they transfer a blastocyst there is also a higher chance that it will split into two, so the chance of twins is still higher. 

Good luck with the decision, I know it's hard, and even more when insurance has to be dealt with too. 

Davie813

Thank you all so much for your input!

After reading these, I was all set to proceed right to IVF with one embryo (and that's where DH was all along).  So, we sat down and started discussing the finer points of the course we thought we'd agreed on--and talked ourselves right out of it!

Right now, neither he nor I are quite comfortable with IVF (for a lot of reasons, many of which have to do with his being Catholic) although not so uncomfortable that we will hesitate to pursue it in the future if need be.

We decided to try two cycles of IUI with injectibles (ables?  Stupid spelling)--or only one, if I respond badly to the first.  I feel like this is an appropriate level of first intervention for someone who has never had fertility treatment, and while I know I don't have all the time in the world, my FSH does at least seem to be holding steady enough (down from 11 in March to 8.9 in June) that 2 months hopefully won't be the end of the world.

Plus, I have a feeling McIrish is right about the insurance.  DH doesn't have MFI.  His SA was good. We didn't get the most complete report on that available, but we had no trouble at all conceiving DD, and she's only one.  I doubt he's just...developed it...in that time frame!

Anyway, thank you all so much for weighing in.  It was a hard decision, and your support really helps.  You guys are awesome!

ETA:  DH is calmer about the twins thing.  We both still hope it doesn't happen, but we'll deal with it (and be delighted to have them both, obviously) if it does.

kindershlitz

Congrats on deciding! FX for a perfect IUI!

Lesliem0901

Best of luck to you, @Davie813. If you have any questions, please don't hesitate to ask.

FYI - the time I did get pregnant, I had 4 viable follicles. Only one took.

lgsdesigner

Sounds like a wise decision. Best of luck!

marijaa333

Great to hear you've made the decision AND that DH is more comfortable with the potential for twins, as well as having a back-up plan! Well done.

PS What does ETA stand for in this case?

ETA: Thanks!

Davie813

Edited to add

TAT2MAMI

So glad you were able to sit down with your DH and come up with a plan! I wish you the best of luck!! @Davie813

C_Girlie

Glad you and DH was able to talk and come to a decision. Good luck with the iui,

tlc35

So glad you have a plan.  This will also give your RE an idea how your body responds to injectables as well.