IVF: did you or your RE decide that was the next step?

Aera11

I don't know if it's because I am feeling down about this medicated cycle, but I am CD14 and only have follicles measuring 12mm.  I know they can still grow and I'll O late like last cycle, but we're trying to avoid that because of egg quality.  On my drive back this morning I started thinking about IVF.  My question is... did you decide on your own you were ready or did your Dr./RE encourage you to move in that direction?  Initially, my RE said we'd do two cycles with injectables + TI, then two cycles with injectables + IUI, and then we'd discuss moving towards IVF... but I am getting antsy and impatient.  I feel like if I am reacting so poorly this time, what is the point of three more cycles of this?  Driving 30 minutes there and back every other day is starting to wear on me too.  I know the TTTC board could have more IVF people, but I never went back there after my second loss and there doesn't seem to be much posting going on there.  I know ultimately DH and I will do whatever our RE thinks is best, but I will see her again in two weeks and I am thinking of asking if we can just skip ahead to IVF.

JDW0325

i'm interested in this as well. best of luck to you @Aera11

roxgibbons

@Aera11 after a 2-3 failed IUIs at my RE office, they start discussing to think about moving on or start thinking about IVF but it's up to the individual to make the appointment for the IVF consult. At mine he suggested we try injectables first but he said we could go ahead an skip that get on the IVF list. He said ultimately it was up to us and some people just don't want to mess around with anything else. He makes suggestions but the decision is up to the couple. I'm sorry you are having such a dissapointing result with the injectables. What are you taking if you don't mine me asking. 

chloe97

@Aera11 I've not even been given the medicated cycle option, so it's naturally or IVF+PGS for us. That being said, we get pregnant easily since my body seemingly accepts all embryos. We made the decision to try one last time naturally and then go on to IVF +PGS. Maybe we'd give another shot if we had a CP.

 My FSH is good, but my AMH is VERY high which gives me pause about IVF. Anyway, I'm probably not a good test case for you since my issue is not getting pregnant, but getting pregnant with a healthy embryo.

RiverSong15

@Aera11 - I'm so sorry you're not responding to your meds as well as you'd like. I don't have any experience with this, but I wanted to encourage you to have a discussion with your doctor. Maybe there's a different medication protocol your RE plans to use next time? What does he think your chances of success are with TI, IUI, or IVF with different meds? I think it's great that you are asking these questions, so don't be afraid to advocate for yourself and ask your doctor the same questions. Ideally, the decision to do IVF should be yours, in consultation with your doctor.  

BornReady

-----Lurking-----triggers mentioned

I hope you don't mind my responding here, @Aera11. In my case I went into treatment with the goal of finding the quickest route to a healthy pregnancy, whatever that was. At our initial consult the RE was looking towards clomid/IUI after seeing my husband's SA results which indicated a motility issue. She went ahead with getting the IUI authorization, but also requested another SA in the mean time to get a better grasp on it. When we were just about to start the IUI cycle she called and said that her new clinical recommendation after seeing the second SA was IVF. Not being aware of the statistics, we decided to go ahead with the IUI cycle which resulted in BFN. After the fact she said that for us, our chance of success with IUI was something dismally low, like 5-8% or something. Super depressing.

We moved directly to IVF/ICSI/PGS after that, which was about a 3 month process, but offered us a much higher rate of pregnancy chance statistically. Our RE told us average IVF success is 65%, but with my history of past live birth and PGS testing she said closer to 80-85%. In retrospect I wish I had just skipped the IUI all together. But to be fair, we live in a mandatory IF insurance coverage state, so the financial piece has not been a part of our decision making journey.

Are you on the IF board at all? There are some monthly IUI/IVF support groups that might be able to offer you some guidance in this area. Unfortunately, the success rate for IUI is poor. Often times there will be only 1 BFP on the monthly IUI board, if any.  All in all, if you feel like you're spinning your wheels doing this, definitely talk to your RE. And as always, feel free to PM me anytime with questions etc. Best of luck to you!

Aera11

Thank you @JDW0325!

@roxgibbons yeah, I am sure I can be proactive and my next appointment and ask my RE if I can discuss IVF so I have all the facts.  I am on Gonal F and then I'll trigger with Ovidrel if my follicles ever mature... The nurse mentioned a second Ovidrel shot to help thicken lining, I've never heard of that though.

@chloe97 we are in similar, yet different boats my body just won't ovulate on it's own, but when it finally does...I don't seem to have trouble getting pregnant,  t's just whether or not it's a healthy embryo...which is why IVF is intriguing to me.

@RiverSong15 I did so much Clomid and was ready for something new, but now I am impatient and hoping maybe she'll have another option for me since I don't seem to be reacting well to the Gonal F.  I'd be willing to consider another cycle like this with IUI but I feel like I am emotionally/mentally ready to move on.  The last year or so has really tested my patience.

@BornReady I will ALWAYS take input from anyone who has actually traveled the IVF road.  And, side note, but I miss your Thankful Thursdays!  DH did two SA and met with a urologist and checked out fine, so I think that is why IVF wasn't the first thought for any of us.  Especially since I was able to get pregnant twice off of just Clomid + TI.  I feel like the success of IUI's is low too and would rather invest our time and money into IVF, because my heart tells me that is where we will inevitable end up if the injections don't work.  I used to post in the IF boards but stepped away when I get pregnant the second time and never went back there or TTTC.  I almost felt like I had no right being there when some of these women/families were going through far worse/harder times.  Thank you for your insight and I will for sure message you with any questions!

NewMommyCoop

@BornReady I really know nothing about IVF, I thought I did, but I now realize that I don't. With this being my third loss, I am looking for answers. What I am reading in this thread is others who, like me, seem to get pregnant easily but don't have healthy embryos (maybe? My OB said that it is more than likely a chromosome issue, is that the same thing?).  Would IVF be a more successful option because they test the embryos first? Any information you can give me is much appreciated. Just trying to figure out what makes the most sense for our next step. My DH thinks we should try one more time and call it good.

BornReady

The process of IVF itself tends to weed out the unhealthy embryos. In the lab setting embryos that have issues tend to Die out and not make it to day 5 when they can be tested or transferred.  In my case we had 11 eggs and only 2 made it to blast stage. 1 did it in 5 days and the other took 6. Of those 2 we did pgs testing and only one embryo that was normal, the one that made it to blast in 5 days. The 6 day blast was chromosomal abnormal in a few ways despite looking technically good.  

My doctor thinks PGS will be standard in the future  because it saves so much time testing which embryos have the best chance.

definitely ask away!

mjacks16

@Aera11  My RE let us make the decision. We did three IUI's with different medications and after I never got more than one egg, my RE asked if we wanted to try again with a different protocol or go ahead with IVF. We went straight into IVF the next cycle. I'm glad we did not try more IUIs as I just felt they were not going to work for us. On our IVF we had 25 eggs retrieved and only 2 made it to day 5. I don't know if I am completely on board with PGS testing. We had both of ours tested and they both came back normal and I still ended up with a M/C. My RE actually suggested that we don't do PGS testing again if we do another retrieval since it seems my eggs got rid of the bad ones themselves. I'm transferring the second embryo next week, so we will see if that has a different outcome. 

Aera11

@BornReady & @mjacks16 what does PGS testing involve? 

roxgibbons

@aera11 I too was disappointed with my injectable response. I only made one egg. On femara/letrolzole, I always usually ended up with 3-4. Oddly enough when we did conceive it was totally on our own on a break. This next cycle will be a pill/ injectable cycle for a better response, hopefully. If we could do it I would have moved to IVF a while ago but, it came down to finances as it's completely OOP for us and we were quoted about 30K because we would want to do ICSI and PGS so that's why we've been sticking to IUI as it's half covered under our insurance.

Aera11

@roxgibbons hopefully this pill/injectable cycle is the one!!  FX for you lady  
I still can't believe IVF or really any fertility treatment costs as much as it does, well I know it costs that much, but I can't believe more of it isn't covered by our insurances.  It sucks that costs/insurance can be the determining factor for so many of us.  I had been relatively lucky until we started injectables and they are not covered, so they are over $1000/for a 900unit pen and I am already on my second one and it's only CD14.  Serious woof.  We do get 25% off for comp care which is better than nothing, but still....  I've said it a hundred times, but IF we ever do have a successful pregnancy/birth, I will give back to those struggling.  None of us should be denied having a family because of cost.  

mjacks16

For PGS testing, they take a small biopsy from your day 3 or day 5 embryos and send it to a lab to screen for chromosomal abnormalities. The ones that come back normal without abnormalities have a better chance of implanting and a lesser change of miscarriage.  PGD testing will screen for a specific disease.

The only problem is that it is usually expensive. At my clinic I paid $1,900 for them to biopsy the embryos then it was $2,250 to get up to 8 embryos tested. 

A lot of clinics will only test on a day 5 embryo which forces you to then freeze the embryos and do a FET once you know the results which then leads to more costs. 

DungeonTrollMel

@aera11 my RE has said 3 rounds of clomid and then IVF with PGS. We are only doing clomid with  the hopes of healthy eggs so if 3 rounds doesn't do it then we need to move to fully testing things since I already have 3 loss and one was confirmed severe chromosomal issues. 

I don't think it hurts to talk to your RE and start looking into coverage to make sure your insurance doesn't require so many medicated cycles before hand 

KarenBeth714

I decided to try ivf but only because we are genetic carriers, so a bit of a different circumstance but with added stress of genetic testing for embyros before implantation - extra money, time and stress. Definitely talk to them and go over possible options. They should have a financial counselor to help you navigate through it all.

Aera11

@mjacks16 I had no idea!  Thank you for that info/insight.  I am taking in all IVF info because I know it will be overwhelming and I want to get a better understanding of it so I can ask good questions when I sit down with my RE.  I still can't believe everything costs as much as it does. Mind. Blown.  Also, I am assuming a fresh transfer is better but there is still a good success rate with FET?  And that is me just 'assuming'....I really have no clue.

@DungeonTrollMel hopefully the clomid will work for you  

@KarenBeth714 will you do PGS or PGD testing?  Depending on costs for us, I don't know if I will since neither of us are carriers, my recent loss was most chromosome related most likely due to a bad egg.  So many decisions..

*edited for typos

BornReady

@Aera11 Actually my clinic has a higher success rate with a FET than a fresh transfer. They've found that the body is more receptive to accepting an embryo for FET as opposed to right after a stim cycle when your body is in such a chaotic state hormone wise. They prefer to do FET because they can control the "environment" much more.

Aera11

Really?! That actually gives me great relief.  And it makes so much sense. Thank you again for your help @BornReady! I really am in the dark and am starting to wrap my brain around all the details.

DungeonTrollMel

@aera11 my RE only does FET as well since they prefer at least day 5 embryos instead of 3 and they do their own in house PGS testing 

jwg9101

Hi there! Thank you for posting this! I've learned so much in this thread! For me, it boils down to cost and my RE was 100% on board with letting me make the decision. I've met my out of pocket max for this year so we decided to skip the IUI process and jump straight to IVF. Since my insurance will cover any procedure at 100% through the end of the year, it seemed like a no-brainer to skip to the most expensive and most successful method. 

If if not for that factor, we would still be stuck going through 3-4 IUI cycles before moving to IVF in hopes that the least expensive method worked for us. I think you should follow your heart and do what's best for you and your family!

NewMommyCoop

I too appreciate all of the information from you ladies. I did a little research yesterday and found I am basically on my own cost wise. I am a federal employee and federal health care does not cover any testing, IUI, IVF, anything to do with infertility, except 65% of your office visit to a specialist. No infertility benefits and no maternity leave, at all. Gotta love the government.

KarenBeth714

Even with the 75 percent coverage, it's a lot. We just found out we will be testing for two diseases, increasing our cost. I have emails to write, calls to make, paper work to fill out and get notarized and financial forms to go over. We have decisions to make. We are totally avoiding it all. Wish we could just go ahead naturally. I hate this all so much.

NewMommyCoop

@KarenBeth714 I am sorry you have to deal with all of that. It is ridiculous how much money the IVF (or any infertility process) costs. I am making an assumption that DH is not a carrier because he has a healthy DD. (I know my assumption may be wrong, but I am going with it.) I have no idea about myself. After finding out about having zero coverage, we have decided that we are going to try again and see what happens. I am ready for the miscarriage process to be over so my body can do its thing and we can start again.