Infertility

Most Aggressive IUI?

Hi Ladies,
So I had my second unsuccessful IUI in January, and my RE only suggests 3 medicated IUIs before moving to IVF.  Our suggested protocol for the final IUI is 50mg Clomid, Ovidrel and Progesterone during TWW.  This is the exact same as the first 2 cycles, except bumping the Clomid from 25mg to 50.

I explained to my nurse that we really want to be as aggressive as possible with this last cycle (without having a ton of multiples) because we will most likely not move to IVF.  She pretty much just pushed me off and said "well this is what we suggest, and during your TWW for IUI #3, we would have you come in and talk to the RE." I went around her and scheduled an appointment with the RE because this is really our last chance, and honestly her pushing me off really annoyed me.

My question for all of you: how aggressive would you want to go? what is the most aggressive you went for IUIs? any other advice?

Dx: Azoospermia due to chemo

Re: Most Aggressive IUI?

  • I'm sorry you're dealing with this and having to fight for a more aggressive treatment.  My RE went straight to the most aggressive medication for our IUIs as we're also dealing with MFI.  Meaning he put me right on injectables, which he said is twice as effective as oral meds.  I was nervous about doing injectables right off the bat, but I did my research and found that they do have a higher success rate with MFI as primary dx.  If I were you I would request doing injections for your final IUI cycle.  They aren't as bad as they sound!
    ***BFP & Child Warning***

    Me: 34, DH: 38 ~ TTC since 2014
    IUI #1-3 (Nov 2015, Feb 2016, May 2016) = BFNs
    IVF ER (July 2016) = 7 PGS normal embryos
    FET #1 (Sept 2016) = BFP! DD born 5/30/17
    FET #2 (April 2019) = BFN
    FET #3 (July 2019) = BFP! DS born 3/27/20
  • Starlight811Starlight811 member
    edited February 2016
    My RE recommends IVF after 3rd failed IUI as well. I have IUI #2 scheduled this month and we are continuing the same treatment plan of clomid 100mg and trigger shot. My RE says that I responded fine in IUI#1 (2 mature possible 3rd) and injectables could most likely cause much greater risk for multiples (triplets or more) and we agreed that is not something we want to risk or even have to discuss selective reduction. If you responded well before your RE probably won't want to change much since you are responding to your current treatment plan. I asked the same, "can we be more aggressive" and his response was that I am responding as I should and not all woman using injectables will potentially have a higher chance due to possibly not responding. I have DOR and my RE says with most patients like me, he sees best results with clomid and we typically respond better. I would trust what the docs are saying they are the experts but I understand how you want to question the treatment if you feel more can be done. Good luck to u this cycle!
    Me 28 DH 33 | DX: DOR | HSG: Normal | IUI#1: (Clomid/HCG/Progesterone) BFN | IUI#2: (Clomid/HCG/Progesterone) BFN | IUI#3: (Clomid/HCG/Progesterone) BFN | IUI#4: (Menopur/HCG/Progesterone) BFN | IUI#5: (Menopur/Gonal-F/HCG/Progesterone) BETA 7/2
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  • @wifeinraleigh28 Thanks! I get why he didn't put me on injectables right away, but I will definitely ask him about using injectables instead for this cycle.  Good luck on your cycle this month!
  • @Starlight811  I completely agree about trusting the RE, and I do trust him, maybe it was more of the way that the nurse just completely put me off and said to talk to him after a 3rd cycle.  It seems counter-productive to talk to him after if it doesn't work, if we don't plan on doing more cycles after this one. I did respond well to the very small dose of Clomid (1 very mature, possible 2nd) I just want to make sure we are going forward with the best possible option.  Thanks so much for your perspective!
  • I felt very similar to you about wanting to be more aggressive when I was in the TWW after IUI #3 (all w/Clomid and Ovidrel trigger).  I read about injectables and all kinds of things that seemed more aggressive, and I wanted to know why we weren't doing them.  As for background, we have MFI (morphology) issues, and insurance coverage for 6 IUIs and then onto IVF, but we will lose that insurance in August.  My RE, who I like and trust, persuaded us that because I was responding well to the Clomid, there was no reason to change things up when we spoke to him during the TWW post-#3.  He said that studies that show that success rates going down after 3 IUIs does not typically keep the patient on the same meds, even if she responded well.  Also, apparently if you don't have lining issues right away, you're not going to on Clomid (I had been thinking that it was something that happened over time, but RE said that's not true).  I walked out of that appointment feeling quite prepared to do 3 more IUIs with the same protocol.

    BFP & loss discussed
    The third IUI did end up being successful for us, but unfortunately we had a loss (mmc discovered at 11w).  It's still pretty fresh, and we have not seen the RE again yet.  I think it is likely we will start back up with the Clomid IUIs, as long as the RE does not think that the morphology issue contributed to the genetic abnormality that caused our loss, in which case we would probably look at going straight to IVF when we are ready to go again.
    About me:
    /loss mentioned/
    TTC#1 July 2014
    dx: MFI (morphology)
    IUI #1 w/Clomid + Ovidrel Sept. 2015 ~ BFN
    IUI #2 w/Clomid + Ovidrel Halloween 2015 ~ BFN
    IUI #3 w/Clomid + Ovidrel Thanksgiving 2015 ~ BFP!!
    hb 146 bpm at 7w5d
    1/28/16 ~ began to say goodbye to our beautiful baby at 11w 
    d&c, followed by cytotec
    TTCAL April 2016
    IUI #4 w/Clomid + Ovidrel Apr. 2016 ~ BFN
    IUI #5 w/Clomid + Ovidrel ~ CP
    IUI#6 w/Clomid + Ovidrel ~ BFN
  • @BrightenMySky - Wow, I didn't know you had a loss recently.  I'm so so sorry and can't imagine what you must be going through!! :cry: 
    ***BFP & Child Warning***

    Me: 34, DH: 38 ~ TTC since 2014
    IUI #1-3 (Nov 2015, Feb 2016, May 2016) = BFNs
    IVF ER (July 2016) = 7 PGS normal embryos
    FET #1 (Sept 2016) = BFP! DD born 5/30/17
    FET #2 (April 2019) = BFN
    FET #3 (July 2019) = BFP! DS born 3/27/20
  • @wifeinraleigh28 thanks.  I have been off the boards for the past 2 weeks and just decided to come back today, so I will see you around.  FX for your upcoming IUI!
    About me:
    /loss mentioned/
    TTC#1 July 2014
    dx: MFI (morphology)
    IUI #1 w/Clomid + Ovidrel Sept. 2015 ~ BFN
    IUI #2 w/Clomid + Ovidrel Halloween 2015 ~ BFN
    IUI #3 w/Clomid + Ovidrel Thanksgiving 2015 ~ BFP!!
    hb 146 bpm at 7w5d
    1/28/16 ~ began to say goodbye to our beautiful baby at 11w 
    d&c, followed by cytotec
    TTCAL April 2016
    IUI #4 w/Clomid + Ovidrel Apr. 2016 ~ BFN
    IUI #5 w/Clomid + Ovidrel ~ CP
    IUI#6 w/Clomid + Ovidrel ~ BFN
  • edited February 2016
    @BrightenMySky Thank you!  It's good to see you around though not under these circumstances.  Praying for your future cycles!!
    ***BFP & Child Warning***

    Me: 34, DH: 38 ~ TTC since 2014
    IUI #1-3 (Nov 2015, Feb 2016, May 2016) = BFNs
    IVF ER (July 2016) = 7 PGS normal embryos
    FET #1 (Sept 2016) = BFP! DD born 5/30/17
    FET #2 (April 2019) = BFN
    FET #3 (July 2019) = BFP! DS born 3/27/20
  • I think others have kind of alluded to this but there really is not such thing as the MOST aggressive IUI. It is 100% dependent on how you respond to medication. The goal of an IUI is to produces 1-2 follicles (definitely no more than 3-4) and have good lining. If you are responding this way with clomid there is ABSOLUTELY no reason to move to injectables. Injectables are specifically for individuals who are not getting mature follicles with oral medications. Honestly if your RE moved you to injectables now, knowing that you responded well on even a LOW dose of clomid, you would probably over produce and not be able to do a cycle at all period. Most RE will flat out cancel your IUI if you have 4 or more follicles (with some exception of MFI). I know it is so tempting to want to jump to the big guns but it sounds like your body doesn't need it. Which is REALLY a blessing because the price of injectables super sucks. 
  • *bfp mentionned*
    After the laparoscopy I had last July, we asked our RE to be more aggressive with treatments. Up to then, we had done Femara and TI. He therefore agreed to have us try IUI, even though all was good on DH's end and a PCT done a few months prior revealed everything was fine. I just wasn't ready to make the jump to IVF without having tried IUI. To my surprise, our RE decided to be really aggressive and got menon a Femara and Follistim combo (5mg of Femara days 3-7, 75iU of Follistim starting day 6). I always had around 3 mature follies with Femara, and so I was sort of scared about how that would go. His reasoning was to produce better quality egg, not increase the number. Turns out that by the time I started ovulating on my own, I only had one mature follie, with possibly 2-3 that could make it in time (they had grown 3mm overnight and were at 15mm; I had the trigger that night, and the IUI the next morning). I was actually kind of disappointed in how many follies I had produced, especially considering all the money I had spent (OOP) on the injectibles. But... This was our successful cycle.

    From everything I've read here, it seems that people with PCOS have to be super careful with injectibles as they'll tend to produce more follies to begin with. In your case, I wouldn't be as worried. However, keep in mind that MFI will reduce your chances, and that maybe IVF will be the way to go if this doesn't work out. Best of luck to you! 
  • @BrightenMySky I'm so sorry for your loss!  I can't imagine :(
    @PCOSat25 I definitely get what you are saying, and I don't want to over produce, but we are using frozen donor sperm, and his counts have been fantastic, and we still haven't gotten pregnant, so it's just frustrating.
    @KidShrink Thanks for the info!  I get the better quality egg, not the number, and I'm wondering if that would work for us.  We have already decided if we aren't successful with this last cycle we most likely wouldn't move to IVF, so I'm really hoping the RE can set my mind at ease.
  • PCOSat25 said:
    I think others have kind of alluded to this but there really is not such thing as the MOST aggressive IUI. It is 100% dependent on how you respond to medication. The goal of an IUI is to produces 1-2 follicles (definitely no more than 3-4) and have good lining. If you are responding this way with clomid there is ABSOLUTELY no reason to move to injectables. Injectables are specifically for individuals who are not getting mature follicles with oral medications. Honestly if your RE moved you to injectables now, knowing that you responded well on even a LOW dose of clomid, you would probably over produce and not be able to do a cycle at all period. Most RE will flat out cancel your IUI if you have 4 or more follicles (with some exception of MFI). I know it is so tempting to want to jump to the big guns but it sounds like your body doesn't need it. Which is REALLY a blessing because the price of injectables super sucks. 
    This actually isn't entirely true, especially with MFI.  Statistics show that injectable meds result in more pregnancies when you are dealing with a sperm issue.  In our case, oral meds have less than a 10% chance of resulting in pregnancy, and injectable meds have a 12-15% chance.  They monitor you with injectables just like they do with oral meds to make sure you don't over-produce, and a lot of REs will want to be more aggressive when it is male factor.  My RE doesn't even use orals when it is only male factor.  You do however have to be careful with injectables if you have PCOS.
    ***BFP & Child Warning***

    Me: 34, DH: 38 ~ TTC since 2014
    IUI #1-3 (Nov 2015, Feb 2016, May 2016) = BFNs
    IVF ER (July 2016) = 7 PGS normal embryos
    FET #1 (Sept 2016) = BFP! DD born 5/30/17
    FET #2 (April 2019) = BFN
    FET #3 (July 2019) = BFP! DS born 3/27/20
  • @wifeinraleigh28 i totally did not see the diagnosis at the bottom of the original post. I didn't realize the poster is dealing with MFI. My bad! Thanks for the feedback!
  • Can anyone tell me what the benefit to progesterone during TWW is? I had my first IUI February 12.
    Me:  29  DH:  32
    Together since January 23, 2013
    Married March 22, 2014
    TTC #1 since August 2015
    First RE meeting February 2, 2016; tests normal for both of us
    Clomid round #4 of 150 mg followed by
    First Ovidrel trigger shot February 10, 2016
    First IUI February 12, 2016 Negative
    Started Letrozole 5mg round #1 February 23
    Began additional Letrozole 5mg + Dexamethasone 1 mg March 8
    Ovidrel trigger shot March 16
    IUI #2 March 18 with progesterone suppositories beginning March 19
    Positive HPT April 2 Praise God!!! :)
    Estimated Due Date: December 8

    <a href="http://www.thebump.com/?utm_source=ticker&utm_medium=HTML&utm_campaign=tickers" title="Parenting Advice"><img 

    Faith is the confidence that what we hope for will actually happen; it gives us assurance about things we cannot see. Hebrews 11:1
  • @bbkidz to make sure your lining is nice and plush and remains that way if implantation occurs. Progesterone is produced naturally from ovulation to sustain a pregnancy, but progesterone supplements increase the chance of a pregnancy remaining if it occurs...just giving your body an extra support until the placenta takes over (around 10 weeks). 
  • @KidShrink Thanks! I am going to call my RE tomorrow and ask about it!
    Me:  29  DH:  32
    Together since January 23, 2013
    Married March 22, 2014
    TTC #1 since August 2015
    First RE meeting February 2, 2016; tests normal for both of us
    Clomid round #4 of 150 mg followed by
    First Ovidrel trigger shot February 10, 2016
    First IUI February 12, 2016 Negative
    Started Letrozole 5mg round #1 February 23
    Began additional Letrozole 5mg + Dexamethasone 1 mg March 8
    Ovidrel trigger shot March 16
    IUI #2 March 18 with progesterone suppositories beginning March 19
    Positive HPT April 2 Praise God!!! :)
    Estimated Due Date: December 8

    <a href="http://www.thebump.com/?utm_source=ticker&utm_medium=HTML&utm_campaign=tickers" title="Parenting Advice"><img 

    Faith is the confidence that what we hope for will actually happen; it gives us assurance about things we cannot see. Hebrews 11:1
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