AW: Need some TTCAL advice

MrsG80inTN

Hello lovelies.  I need your advice.

First, let me apologize for not being around as much as I'd like to lately.  Work has been NUTS (my boss is out for two weeks) and I'm preparing to go on vacay to the beach in FL next week and hiring a new person at the office.  That and basically all of the programs I work on had catastrophic failures in the last two weeks that caused me some serious stress and extra hours.  UGH.  So, @rmpar29 and @holdingouthope plus my Bible study and healthy-living ladies... this is why I've been quiet.

So, back to my AW... many of you are aware that I started seeing an RE 3 cycles ago after our third loss.  I've seen the doctor once and ever since it's either been techs or nurses and that's it.  We've done two cycles of clomid + HCG and one cycle of just clomid (this last cycle because I was traveling when I should have been monitored so they just had me do clomid).  I'm on CD1 today (dang biatch) so obviously not successful again.

I called the RE's office to ask about next steps (they don't do CD3 bloodwork or u/s or WTF appointments).  The nurse called back and said that they think I should do clomid + HCG shot again with monitoring and IUI.  My DH doesn't really want to move to IUI because he doesn't understand how this helps in cases where people have had multiple early losses...DH's concern is we seem to be able to get pregnant, we just can't stay that way.  He's also concerned because my cycles with the HCG shot have shown no temp shifts and he thinks maybe they screw with my system in a not so positive way... DH doesn't want to proceed without talking to a doctor and I'm not sure I can get in before our vacay (we leave for a week tomorrow afternoon) and we basically come back to my monitoring appt on CD14... 

So, what would TTCAL do... do any of you have any thoughts on why IUI might be a good plan for people with recurrent early losses?

To complicate matters, the initial ultrasound back at my initial appt the tech thought my endometriosis had returned and I keep wondering if that is a further cause for concern... Should I press for more answers before moving to IUI/IVF or is this normal practice?

Thanks in advance ladies - I'm so thankful for you and for your insight.  

[Deleted User]

Hello,
   I'll address the endometriosis bit.   If your doctor thinks you might have it back again you may want to get it checked.  If you do indeed have it, it could cause you to not be able to become pregnant normally or with IUI.   Many people with endo go right on to IVF. 

I'm also not sure why you would need to go to IUI if you are able to get pregnant on your own, but you have recurrent losses.  IUI is to help you get pregnant, not to help you stay pregnant.

Has your doctor tired putting you on progesterone after you are pregnant to try and keep you pregnant?

Km380

Hi MrsG! I hope things seriously slow down for you soon. At least you have vaca coming! I have no advice on endometriosis, sorry. But as a recurrent loss lady, I get where YH is coming from about IUIs. My RE explained at the beginning after all our tests showed no problems, that the only way to decrease chance of mc is genetic testing with IVF. Huge jump from trying on our own. The main reason we tried IUIs this summer was emotional. My RE wants his patients to include emotional and financial implications in their decisions. Basically how much more of this can we handle. We weren't ready for IVF so we tried IUI. It didn't work but now I feel like IVF is the next step not some huge leap from nothing to everything.

Are you happy with your RE? I only ask bc it sounds like maybe you're not completely satisfied with the attention you get.

I don't know if any of that helped...

MSU_Girl1202

Hi lady,
Sorry you're going through such a rough time. While I understand your Dr not wanting to try clomid again, I really don't get not monitoring. If it were me (which this was a few years ago), I'd ask for femara and monitoring. Is your husband's sperm good? If so, and if you don't have a hard time getting pregnant, rather staying pregnant, I'm really not sure how much more IUI would help. With monitoring though, they could check your lining and make sure its adequate to support a pregnancy. Also, are they checking your progesterone 7dpo? It might be a progesterone issue, which could be resolved with supplements? Just my two cents...

MrsG80inTN

@26summer – I’m on progesterone every cycle as a precaution… for my endo, I had it removed in April 2013 and my 3 pregnancies have been after the removal, but they thought it might be back… I’m just not sure I’m comfortable giving them money for IUI without knowing for sure… of course I don’t really want to have surgery either as my MIL is going to be having surgery and staying at my house in November…

@km380 – not happy at all with the RE because I haven’t frickin seen the guy since June… haven’t talked to him, nothing… my OB was just the best and even called two weeks ago just to check in on us so this is a stark change, but the only doc in my area that does IVF… So I feel a little tied… I thought about doing IUI a couple times as it’s easier to stomach $500 than $9800, but still don’t feel I fully understand, ya know?

@MSU_Girl1202 – The not monitoring this last cycle was because of my work travel… I would be monitored this current cycle if I did it.  DH’s sperm is supposedly fine.  Lining was fine at my August monitoring apt and while they haven’t checked my progesterone since going to the RE I am on a Progesterone supplement… 

Km380

Snip

@km380 – not happy at all with the RE because I haven’t
frickin seen the guy since June… haven’t talked to him, nothing… my OB was just
the best and even called two weeks ago just to check in on us so this is a
stark change, but the only doc in my area that does IVF… So I feel a little
tied… I thought about doing IUI a couple times as it’s easier to stomach $500
than $9800, but still don’t feel I fully understand, ya know?

______________________________
Oh ok, I'm sorry you don't have another option. Yes IUI cost a lot less. Bc of some other factors (my age and irregular pap) I think the RE decided we needed to get a move on. And we're at that point that I'm not going to disagree with him. But mh and I also discussed the possibility that it could work and I could lose it since it does not reduce mc risk. We agreed to try and if it didn't work or I had a loss we would do IVF. It wasn't a simple decision. I'm sorry you're faced with this


Eta weird mobile quote

buggirl72

Before moving to IUI, I would push for a consult with the RE. You and your husband need to understand why the RE feels this is the best course to not only get you pregnant but to also keep you pregnant. If the practice refuses to set that up, then I would look at finding a different practice (is there anyone else you can see within a few hours drive if need be?) that has a more hands on doctor. I know it is common for some REs to farm everything out to their techs but it is also pretty common to find REs that are hands on and do everything - including all monitoring U/S. 

As far as your endo goes - from what I read, endo releases antibodies that can attack a perfectly healthy egg and damage it. I read an article from an RE that said he no longer does IUIs with endo patients because of this. Instead, he moves directly to IVF.  When you factor in the cost of 3 IUIs (the typically before moving to IVF), it makes sense to skip it if you have a condition that greatly reduces the odds of you being able to get pregnant.

If you do not want to do surgery, you might ask the doctor about Lupron suppression. You might also reach out to @snegde. I believe her endo was one of the factors that came into play when she and her husband decided to move to IVF before doing more IUIs.

DenaMaree

I actually just had this discussion with my RE today! The thing with a IUI is they do a fresh retrieval and a full wash of the sperm which is ensuring that the fastest and best quality make their way to the egg(s). They will do the monitoring to make sure your lining is a minimum of 7MM and you have at least one follie that is at least 16mm. If anything isn't where it needs to be they won't/shouldn't proceed!! You've now ensured you have a healthy lining, good quality eggs, and great quality sperm!! I don't know if quality was a concern for you My DH is on the same page as yours per the extra expense of $500 if we don't "need it". I bluntly told him that if we don't conceive this month the stress is only making things harder/working more against us so moving forward with the clomid, trigger and IUI will take some of the pressure off of us. It's totally per choice. I'm more concerned if we didn't proceed with going with the IUI we will be benched for a couple of months due to thinning lining so if we get to fourth round of clomid we are pulling out all the  stops

MrsG80inTN

Thank you all.  @buggirl72 - you are very wise and I greatly appreciate the insight as well as the @snegde call out - I'll see if she can give me some insight (she has before) :-)  

@sarcaztic10 - Hi sweets :-)  I plan to vaginally temp this cycle (I'm a little freaked out by this, but what the heck!).

@DenaMaree - thanks for imparting your wisdom.  Glad you had the same discussion with your RE today.

@km380 - thanks for your insight!  You're a gem.

MrsG80inTN

buggirl72 said:

Before moving to IUI, I would push for a consult with the RE. You and your husband need to understand why the RE feels this is the best course to not only get you pregnant but to also keep you pregnant. If the practice refuses to set that up, then I would look at finding a different practice (is there anyone else you can see within a few hours drive if need be?) that has a more hands on doctor. I know it is common for some REs to farm everything out to their techs but it is also pretty common to find REs that are hands on and do everything - including all monitoring U/S. 

As far as your endo goes - from what I read, endo releases antibodies that can attack a perfectly healthy egg and damage it. I read an article from an RE that said he no longer does IUIs with endo patients because of this. Instead, he moves directly to IVF.  When you factor in the cost of 3 IUIs (the typically before moving to IVF), it makes sense to skip it if you have a condition that greatly reduces the odds of you being able to get pregnant.

If you do not want to do surgery, you might ask the doctor about Lupron suppression. You might also reach out to @snegde. I believe her endo was one of the factors that came into play when she and her husband decided to move to IVF before doing more IUIs.

Tried tagging you in my above post, but apparently TB doesn't like me.  Any possibility you remember where you saw that RE / endo article?  I've always heard with endo that it's not diagnosable without surgery so I was surprised when the u/s tech even made the suggestion that it might be back.  

[Deleted User]

MrsG80inTN  since you aren't happy with your RE is there another somewhat nearby?  My RE is 2 hours away but they are great.  I don't always see my RE at appointments because it's a big office but I can always get ahold of him.  In contrast, for my monitoring I go to a small office with one RE and I see him EVERY visit.   Maybe you should check around and see if there is anyone within a decent distance if you aren't happy with your current RE.

Frenchteachermama

I second everything that @snegde said above. We never thought we would move to IVF but know it was our best shot. Your old RE sounds like my old one that I switched from. I wanted more contact with doctors. I do think though that in most practices it is the nurses who handle the IUIs. The doctors focus more on the women doing IVF. I would have a serious sit down with DH and I would also ask to speak to your RE. Maybe you need an HSG? I'm sorry you are going through this. ((Hugs))