IF Testing & Treatment w/o 08/08

optimistgardener

@annanbby please do hit us with your questions. so sorry you find yourself posting here.

annanbby

@optimistgardener thank you. It’s certainly turning into a longer journey than we expected, as I’m sure is true for all here.

I had an HSG done on Tuesday, and unfortunately we couldn’t get full results. They had to redo it FIVE times…and every time, the doctor would confirm that the balloon/catheter was snug, and every time it would still just slip out as he was pushing in the contrast. He told me he’s never seen that happen before, so…that’s always great to hear. 🙄

I guess I’m wondering if anyone else has experienced an issue with an HSG like this and where did you go from there?

We confirmed that my left tube is fully open, but he wasn’t able to confirm the right tube because the catheter would come out before he could finish the test…my doctor is supposed to call, so we’ll see what he says. 

anniemarie887

Hiya and sorry you’re here @annanbby weirdly, this was also my experience with my HSG. Tried twice thinking it was all well and inserted… and just contrast *everywhere*, my RE then used a different different diameter catheter and all was well. I’m sorry they didn’t try that in the moment, but that did the trick for me. I would imagine you need to repeat it?

elle-0409

@bumblebee0210 Thank you for the insight!

TW: MC and LC

Without supplementing with progesterone starting on 3 DPO, my luteal phase is 7-8 days. I used progesterone to get pregnant three times, but only one pregnancy resulted in a living child. It's good to know about the fluctuating numbers, though! I'll try not to stress about it.

@acleverusername Wow! Thank you so much for that detailed information.

@mamanbebe You are the sweetest. Thank you so much.

 

annanbby

@anniemarie887 ahh good to know they have other size options (and also that it’s not just me…) They tried to find one with a larger balloon at the end but there was only one size, but they never mentioned a different size catheter. I’ll have to ask about that if my doctor suggests another try. 

abjm0325

I got my confirmed failure of the current cycle this morning, so I'm starting to look ahead. I called my RE's office to ask how long they want me to do medicated cycles before coming back in or moving on, and the nurse pretty much said I can do whatever I want. While I guess that is nice in theory, I'm feeling a little direction-less with that response. When I pressed, she said they usually do at least three cycles of clomid before moving on to IUI or IVF. So, I'm coming for your collective wisdom. I'm leaning toward doing 1-2 more cycles of clomid and then requesting an IUI. Any thoughts? Reasons to speed up the timeline or go a different route all together? I'll be 37 in October if that changes your feelings about anything. 

anniemarie887

@abjm0325 no advice, just sending you a hug 

optimistgardener

@abjm0325 ugh i'm sorry. your circumstances are obvs a little different than mine since you're doing this with a partner, but you're welcome to look at my siggy if you'd like a sense of what i did. i started out when i was 35 with intracervical inseminations, which is basically just like TI but more expensive because you're buying your sperm like it were were precious and rare, instead of one of the world's most common substances. i did a lot of those and they didn't work. i then moved to natural IUIs, which also didn't work. i then had a long detour through surgery-land when it turned out i had uterine fibroids in the way. after that, i shifted to medicated (mostly letrozole and eventually injectable) cycles, and finally shifted to IVF when I was 38.

I can't remember the specifics of what you've done or not done so far, but I would take your age into account as you think about how long you want to spend at any given point along the journey. Lots of clinics default to doing clomid or similar either with TI or IUI, but not for any particularly good reason. they just want to toss a low-stakes option on the table for people who aren't ready to up the ante so they can keep flipping the coin a while longer. for couples that do not have significant male factor sperm quality stuff (and barring any serious problems with the structure of your cervix), my reading of the literature is that there is not a huge difference between an IUI vs TI in terms of outcomes. The IUI gives sperm a taxi ride straight to the uterus, but in couples without male factor issues that sperm will get there anyway. 

If you haven't already done the structural tests (HSG, maybe SIS, a day 3 ultrasound to visualize the ovaries) i would push your doc to do those so you know that everything looks a-ok on that front and so you know what your antral follicle count looks like (a good way to estimate reserve), and also ask for the basic day-3 bloodwork if you haven't done that. i'm sorry if i'm telling you to do things you've already done. i have a terrible memory!

bearmomma1

@abjm0325 I'm in a very similar situation as you. I think it's hard to first admit that you need help getting pregnant. Then it's harder to admit you need extra help getting pregnant. Then it's extremely hard to admit that you need ALL the help getting pregnant. 19 months in here with 1 MC and I've finally admitted we need ALL the help, after failed natural cycle after failed medicated cycle after failed IUI's. I think it's something that you just have to decide for yourself when you want to take a next step and how big of a step you want to take. There's really no wrong or right answer, and unfortunately there's still no guarantee with any of it really. Depending on your financial situation and the timing of where you are should be factored in. and I agree with @optimistgardener that you could at least get any and all testing done to maybe help with your decisions.

abjm0325

@anniemarie887 Thanks, friend ❤️

@optimistgardener Thank you for all of that information! My clinic has all but said they don't think there is anything preventing pregnancy for me and therefore they are just trying to boost my chances each month.

TW - PGs

I've gotten pregnant three times on my own, so they seem to think it's just a numbers game at this point. 

I had an SHG back in June and everything looked okay, but I will definitely ask about the other testing you mentioned when I call them back after the next cycle. I don't have great faith the IUI would result in any different outcome than TI for us, but I might be tempted to try once or twice before IVF because of the cost differential (how terrible that is a factor, but of course it is). 

@bearmomma1 Yes, deciding when to take each next step is such a struggle. I suppose it is rooted in a feeling of failure and denial on my end. Thank you for the solidarity and support! 

kiki047

@anniemarie887 I kept my acupuncture appt this morning, if only because I like the quiet hour in the middle of my workday. Also bought myself a gigantic bouquet of flowers. Tomorrow is a golf day, looking forward to that. Trying to fill my days with things that feed my soul.  

@abjm0325 ugh, I'm so sorry friend. Hugs. Re: your question about when to move on, I echo others' sentiments on that just being a purely personal choice. Like you say, if you've been able to get KU on your own before then maybe a medicated IUI or two would be a good place to start before you bring out the big guns (and the big $$$) moving on to IVF. While the stats for success of IUIs over TI aren't that much higher, there is some benefit to having the sperm washed and bypass the cervix to make sure those swimmers get where they need to go. We've seen plenty of women come through here who haven't had luck with just TI who go on to have success with IUI so I wouldn't write it off completely. But again, that's a very personal choice. 


AFM, confirmed BFN last night on my bHCG test so we're going to take 2 cycles off because our Hawaii trip is right smack in the middle and I don't want to try to cram another transfer in right before we leave. So I'll go, enjoy allllll the mai tais and poke and come back and re-group in September. I just have to decide whether I want to go on BCP in the meantime or let my cycles figure themselves out. On the one hand, I like the control of BCP knowing exactly when my cycle will start/end so I don't get caught with another 8+ week cycle, but there's also that teeeeny tiny voice in my head that's like "but what if you get KU naturally if you weren't on BCP...?", even though it has literally never happened in 5 years of TTC. Andplusalso, that defeats the purpose of "relaxing and not thinking about it" because it's literally ALL I think about. So yeah, that's where I'm at. Also, I don't want AF to show up while we're hiking a volcano in Hawaii because I just know that's what's going to happen, not that BCP is a sure thing either because I bled the entire time I was on it in Vegas so it's really just a crapshoot. Stupid reproductive system, get your shit together woman! 

abjm0325

@kiki047 Thanks for your input! Logically I know it's all personal choice, but it is terrifying to make the "wrong" choice. And I just consider y'all smarter than me, so I appreciate all the extra info. 🙃 I'm so glad you are finding little sparkles of joy. That vacation sounds wonderful! I don't have any insight on the BCP, but I'll shake my fist at your reproductive system for you!

acleverusername

*lurky lurk*

@abjm0325 since you're asking for opinions here... 



Personally, I'd discuss with your clinic about getting you to ovulate 2-3 follicles instead of trying to get YH's sperm a ride into the ute. In your case, I think that's what really would maximize your chances. Of course, both you and your clinic would need to be comfortable with a chance of multiples WHICH IS QUITE LOW AT YOUR AGE given 2-3 follicles. How to do that? Well, starting meds (either Clomid or Letrazole) earlier. For me, Day 2 of my cycle has been the key. Using a higher dose. I.e. 10mg of Letrazole; 150mg of Clomid. Also adding an injectable to the mix a few days after starting the pills. 150IU of Gonal or Menopur. This is called a hybrid cycle. Downsides include but are not limited to: having to do injectables, feeling O pain really badly, low low risk of multiples, cost goes up as do the # of monitoring you'll need to do and - this is a biggie - cycle cancellation. Benefits... increases per cycle chance several percentage points (given that it sounds egg quality is an issue you might be dealing with). 

I highly recommend reading/listening/watching this blog/vlog post from TEW: https://draimee.org/when-should-you-consider-canceling-your-iui-with-guest-dr-blake-evans. In that blog post is the link to the article that Dr. Evans wrote and it it is this nifty heat map: 



I hope this is helpful. I'll get back to studying for the MCATs now. 🤓 👩🏼‍⚕️

abjm0325

@acleverusername Thank you! That is for sure the kind of opinions I am looking for. I feel like my clinic doesn't do (or at least discuss) anything outside the typical TI -- IUI -- IVF, and like you suggest, I'm not sure stepping to IUI really does that much for me. I'm currently slated to take clomid CD 3-7 for this cycle, but you have given me some good other options to bring to the table when I talk to the RE next cycle. Hope you're doing well!

optimistgardener

i second @acleverusername's excellent analysis