XP from TTC: Too many options - need some direction

sliz

So we just had our 4th failed cycle since the m/c (1 spontaneous, 1 clomid, 2 femara (one with 2 follies)....my saline sono and hsg did not show anything wrong with my tubes or uterus. Dh's SA is excellent (as good or better than last year when we conceived twins on the first clomid cycle)....

We met with our RE this morning and I am confused about the options. I am starting to question why none of the last 5 eggs fertilized and implanted given that we hit two for two a year ago with a less than ideal lining. She gave us a lot of options.

1) Try another femara/TI cycle

2) Try IUIs (we would be out of pocket for the IUI and all associated costs which I think would be about $600-$800 not including any meds). Also, last year she told us that an IUI wouldn't really help if we had such a good SA. This time she said that an IUI might work better than TI? Plus TI worked once - did my ute/cervix anatomy or chemistry change that much in a year or from the pg?

3) Try gonadotropins/TI. They didn't seem confident about doing a rescue IVF if I overstimmed. Since we did have multiples with 2 follies on clomid, the potential of having even 3 follies is scary. But then I didn't get pg on femara with 2 follies so who knows.

4) Move on to IVF (we are completely OOP)

5) Try a natural cycle and see if I am ovulating and what my lining is on my own (we suggested this). This would at least give us an option to avoid meds if we are trying IUI.

6) Do a hysteroscopy to double check for scar tissue in the ute (I would definitely do this before IVF)

7) Do a laparotomy to remove some paratubal cysts and check for endo. I have had 2-3 paratubals for over 2 years and they don't seem to be growing. I clearly got pg once with them AND last year the RE told me that they would not impact ability to get pg. This year when I specifically asked, she told me they could weigh down the fallopian tubes. She also mentioned that the laps were good for those not wanting to do IVF but may be unecessary if we decide to move to IVF.

We decided to do a natural, monitored cycle this month to give us time to think and also see what my body is doing (I can't believe that with the weight loss and metformin, I am not back to ovulating on my own)...This gives us a chance to get the insurance paperwork in line for the follistim.

 Do you have any suggestions? We have been TTC#1 for about 1.5 years already (though we did get pg). DH is an asst. professor trying to get tenure and he has 3.5 years to go - he is going insane and going to drop dead from the all the work they pile on. I feel like his tenure clock is racing my biological one and the failed cycles are adding more stress. Plus we have some money saved now - I don't want to fritter it away on cycles with a low chance but also don't want to make a rash decision about IVF....

if you made it this far you are trooper . I didn't think we would have to go down this path given our success last year....

desabean

Have you been given a reason for losing the twins? I'm with you that i'm not sure you need significant interventions to get pregnant and would probably try clomid or follistim with ti or iui (I figure the iui is better at getting the washed sperm where it needs to be) as long as I felt confident there wasn't an unresolved issue that caused the m/c. Good luck, hope to see you back here for good, soon.

elliek05

As long as the monitoring on your natural cycle shows all is ok and you're producing follies, have a clear hsg, and good sperm, I think it's only a matter of waiting for it to happen, and possibly clomid or gonadotropins would help speed things along.

Paying OOP for IVF at this point seems like a fairly big step to me if everything's in working order and should theoretically produce a pregnancy. If something shows up to be off, then I'd see about moving on, but would definitely try IUI at least once as it's cheaper and has a decent success rate for otherwise unexplained IF.

rispergirl

I just wanted to say that I think a lot of us are too upset over what is happening with poor sweet Annaleigh and Brooke (Million$$baby) tonight to really focus on anything else.  I'm sorry for your struggles and if you don't get a good response, I'd try reposting again maybe tomorrow or in a few days.   Best of luck.

sliz

the reason for losing the twins is iffy- i started bleeding at 13 wks went on bedrest, developed a hematoma at 15 weeks, the hematoma resolved by 16 weeks and then I had a premature membrane rupture at 16.5 weeks and lost them both - the babies grew on track and their heartbeats were perfect the entire time....

after the m/c, my ob told me that their placenta's tested positive for e. coli and it was the bleeding that created an ideal environment for infection....the rupture/contractions were my body's way of saving me over the babies...i suspect the infection was caused because they were checking me with a speculum every 3 days - i didn't know this was bad until after the loss and I worry everyday that I could have saved them by just refusing those exams...

i know happytracy who got pg the same time as me had bleeding that resolved and she carried her pg fine...she had a thin lining like I did...i thought that was too much of a coincidence and asked my ob - she said that implantation issues cause much earlier losses and by 12 weeks that isn't an issue (the placentas did look very nice and attached)

my peri told me that the problem was likely poor placentation (due to the thin lining) that was complicated by twins - he indicated that if it were a singleton that the outcome might have been better...

so I don't know what to believe...i think i can rule out clotting and mthfr (because those cause early losses I think) and I got tested for a lot of the rpl stuff....i don't think it was incompetent cervix because the week before I lost them my cervix was 4 cm and the night before the rupture i had contractions...

SkypekWithoutAC

I agree with the pp who said you probably don't need more drastic interventions. If you feel like you do want to do something more, I would go the injects route...injects give better quality eggs and would lessen any lining issues.  I think that's what I would do next...injects and TI.

Mrs.Greenie

I wouldn't move on to IVF just yet. Maybe IUI, most likely I would try the TI. For me IVF was a last resort. But it was our only chance they said since we have severe MFI. I know lots of successes with IUI's with unexplained IF, Good luck to you and sorry for your loss.

EmptyOven25

I am a big proponent of follistim, trigger, IUI cycles, since it only took 1 of those to finally work for me.  I don't know about all the other procedures you mentioned, though.  If I were in your shoes, I would feel better having all the tests run that could be run to make sure your not spending money needlessly--especially since you're OOP for IUI and IVF. 

Definitely take this next cycle to think about everything, and choose to do what you are comfortable with.  Best of luck to you.

dtwmco

rispergirl:

I just wanted to say that I think a lot of us are too upset over what is happening with poor sweet Annaleigh and Brooke (Million$$baby) tonight to really focus on anything else.  I'm sorry for your struggles and if you don't get a good response, I'd try reposting again maybe tomorrow or in a few days.   Best of luck.

..This.. Ugh, it's all I can think about...