IUI/IVF consult tomorrow. ?'s I should axe?

LoveActually55

Hi all. We have our RE consult tomorrow (2nd time around) we tried monitored clomid last year. 5 cycles all BFFN. Would you A. Do 1-2 IUI with Femara, Trigger B. IUI and request injectables C. Go straight to IVF I'm 34, with thin PCOS I ovulate late or usually not at all. I ovulated on clomid. I think my eggs just can't release. They "sputter" out as my OBgyn so eloquently put it. DH sperm is good not great just a lil low. Nothing that really worries my RE. Thanks for the input! :x

LindseyM2012

I've got a couple questions for you if you don't mind:

1) Is this your first RE consult, a second-opinion with a different RE or a WTF consult with your current RE?

2) Did you do trigger with Clomid? If no, how do you know you ovulated (based on E2 levels possibly?). I only ask because if you think your eggs don't release that makes me think you're not ovulating. But you clearly stated you ovulated on Clomid. Those are conflicting statements that need some clarification. 

3) You either ovulate or you don't. I have no idea what your ob would have meant by "sputter". To my knowledge, that's not a thing. Did he/she clarify what "sputtering" meant?

4) How many follicles would you normally develop on Clomid?

5) What does "good not great" sperm mean? 

All those answers are probably going to dictate your treatment. Studies seem to support that Femara creates a better response for us PCOSers. And since you've had so many Clomid cycles (I think studies recommend a max of 6 so it might be worth asking about switching to Femara. If you had a decent number of follicles on Clomid, there might not be a reason to switch to injectables yet. I don't think too many PCOSers who respond to oral meds move to injectables due to a risk of overstimming. 

I wonder if you'll leave this consult with a Femara/Trigger/IUI protocol to start and vague your response. You can definitely advocate for what you're comfortable as far as treatment goes, but your RE is going to recommend what he/she feels is medically appropriate. 

ETA: it would be helpful if you added your treatment history to a signature so we could have some frame of reference and don't give unhelpful suggestions.

Remylove1011

Agree with PP"s that it would be helpful to have more information to give a more informed answer. I don't understand the "sputtering" comment. Did you use a trigger while on the Clomid? 

LoveActually55

I've added my current Dx and treatments to my signature it just does not show up. I'm on my iPad. I'll try agin tomorrow from my desk top at work. Ok here goes... 1. 2nd RE. We used a different doctor in 2013. He moved to an office about 45 min away so he referred us to this new dr which is more convient. I have an appointment with the old RE 1/29 just in case we don't click with this RE. 2. I always had 1-2 follies at my CD14-16 ultrasound. And BW confirmed strong to moderate O. We are going back almost 2 years so I'm sorry my memory is shakey. We took a break after our last clomid & TI cycle and put all this baby making on the back burner. I never took a trigger shot. 3. My OBGYN is a great guy before I was medicated he thought I would gear up to O and then stop or sputter as he put it. Bless his heart he sent me to an RE after 12 months trying. 4. 1 or 2 max. 5. DH most recent SA was 17.4 million with everything else in normal range.

LoveActually55

My iPad doesn't do paragraphs I apolgize. Ugh

LindseyM2012

LoveActually55 said:

I've added my current Dx and treatments to my signature it just does not show up. I'm on my iPad. I'll try agin tomorrow from my desk top at work. Ok here goes... 1. 2nd RE. We used a different doctor in 2013. He moved to an office about 45 min away so he referred us to this new dr which is more convient. I have an appointment with the old RE 1/29 just in case we don't click with this RE. 2. I always had 1-2 follies at my CD14-16 ultrasound. And BW confirmed strong to moderate O. We are going back almost 2 years so I'm sorry my memory is shakey. We took a break after our last clomid & TI cycle and put all this baby making on the back burner. I never took a trigger shot. 3. My OBGYN is a great guy before I was medicated he thought I would gear up to O and then stop or sputter as he put it. Bless his heart he sent me to an RE after 12 months trying. 4. 1 or 2 max. 5. DH most recent SA was 17.4 million with everything else in normal range.

This is all really helpful! So this is my opinion (of course non-RE speaking here):

I would say you sound like a good candidate for Femara/Trigger/IUI. My thinking: You responded with a couple follicles on Clomid and will likely have a similar response to Femara, which is probably what you want if you go IUI route because PCOSers are likely to over-respond to injects. You indicate moderate to strong ovulation on your own so a trigger will likely bump you into the strong ovulation category consistently. It makes timing so much easier. You'll probably want to do IUI because the count was borderline low (from Resolve website: "Counts below 10 million are considered poor; counts of 20 million or more may be fine if motility and morphology are normal." You in the middle of these).

This is all said based on test results and your responses to meds from quite a while ago. I'm sure they'll re-run all tests. ESPECIALLY the SA. 

LoveActually55

Thank you so much. We just did a SA Tuesday and I had CD21 BW (0.5prog) repeat HSG 1/26 (thank god for insurance). I just want to ask for the right treatments normally I freeze and forget to ask questions.

LindseyM2012

I hear you! I'm the same way with freezing in overwhelming situations.

It certainly can't hurt to write down the treatment options as you see them, try to list the pros and cons as you see them and address them with the RE tomorrow. Write every question you have down and take notes as you go. Do you have a preference about what treatment you do? Would you prefer going straight to IVF or would you prefer staying with IUI right now? Figuring that out for yourself before the consult may help you direct the conversation and advocate for yourself.

LoveActually55

We agreed we would try 2 IUI's then move to IVF. I'm optimistic to hear what the new doc says. We could potentially start a IUI cycle in February. P.S when is your test date?

LindseyM2012

LoveActually55 said:

We agreed we would try 2 IUI's then move to IVF. I'm optimistic to hear what the new doc says. We could potentially start a IUI cycle in February. P.S when is your test date?

I think (again, non-RE here) that plan sounds quite reasonable. Good, good luck tomorrow. Definitely update us with how it goes and what the RE says. February is right around the corner  

Sadly my test date is on Friday. I say sadly because our TI timing was awful because I was having REALLY bad IF sadness for a couple weeks. I think we're out and have a WTF consult on the 29th. I have a feeling my RE is going to suggest IUI at this consult and I'm just not ready for that so I have to advocate for keeping TI (we have no MFI factors so IUI won't increase our chances much at all anyway). I'm just not mentally ready to move to IUI.  sorry.... /rant

LoveActually55

I hear you. That's why we did the Clomid & TI. I wasn't ready. My wondeful (side eye) MIL bought me f*cking crib for Xmas as "incentive" so as of now I have a crib and an empty ute. FML!!!

LindseyM2012

LoveActually55 said:

I hear you. That's why we did the Clomid & TI. I wasn't ready. My wondeful (side eye) MIL bought me f*cking crib for Xmas as "incentive" so as of now I have a crib and an empty ute. FML!!!

Oh. My. Gosh!!! That's horrible!!! I have no idea what I'd do if that happened! I'm in grad school so everyone assumes we're not going to start trying until I finish my degree. The most I get is my MIL (I love her to pieces) asking, "So are you thinking of motherhood after you finish grad school?" You definitely win.

jerseymack23

A CRIB!?!?!??!?!?! That is AWFUL!

LoveActually55

Yep! It's in our guest room mocking me. I didn't react to her. (Best way to deal with her) I did however bawl my eyes out when DH and I were alone.

LoveActually55

Hey! Hey! So we love love love the new RE.  She spent over 2 hours just talking things out with us before the ultrasound and exam.  She thinks I DO NOT have thin PCOS!  I have the acne and irregular ovulation but she says my ovaries DO NOT show PCOS.  Holy hell WTF. We also have a plan!  Going to start Femara with Trigger and IUI as soon as AF shows.  I have to call on CD1 and we will get everything rolling!  She gave us so much hope (the 1st RE we saw said IVF was our only hope) she didn't seem to agree.  We are beyond excited and hopeful! Now come on AF!!

LindseyM2012

LoveActually55 said:

Hey! Hey! So we love love love the new RE.  She spent over 2 hours just talking things out with us before the ultrasound and exam.  She thinks I DO NOT have thin PCOS!  I have the acne and irregular ovulation but she says my ovaries DO NOT show PCOS.  Holy hell WTF. We also have a plan!  Going to start Femara with Trigger and IUI as soon as AF shows.  I have to call on CD1 and we will get everything rolling!  She gave us so much hope (the 1st RE we saw said IVF was our only hope) she didn't seem to agree.  We are beyond excited and hopeful! Now come on AF!!

SOOO glad you're feeling more positive! Sounds like it was a change for the better. Hopefully CD1 gets here soon so you can get going