Probably flameworthy...

firsttogo

** I am talking about this situation only... I know that there are others who have different circumstances.

 

I have two friends currently who received their IF diagnosis, and jumped right to IVF (one tried ONE IUI before determining it "wouldn't work" and she did not have the patients) The liklihood of getting pregnant after one month for average couples is not super high, so why would you expect it to take only one iui?

Both of these girls had full IF benefits, which I know because we have the same insurance policy. The RE of course will let you do IVF if you chose, but why would you chose that as a first round?

I know that there could be variables of which I am unaware. but both were given the option of IVF, or IUI first (I have used their RE) I just wonder why you would select IVF before you have tried other things barring a lack or tubes, age , ect. 

krissyh21

I am suprised with coverage that their insurance would allow them to go right to IVF without IUI first, unless it was medically necisary. I needed to do at least 3 IUIs before my insurance would approve me for IVF (my dx is DOR, but I was not dx'd that until after my first IVF).

schmoodle

I would hesitate to judge regardless of the circumstances.

For one thing, IUI has much lower success rates than IVF, and depending on their diagnoses, it could be that the RE offered IUI as a less invasive first step but gave them extremely low chances of success. With our MFI, our RE advised we go immediately to IVF within about a month of our first appt with him (and only 8 months after we first started TTC). I'm sure other REs may have recommended IUI first just to give it a shot but I'm glad we didn't waste our time.

There's also less risk of a cancelled cycle due to having too many follicles and lower risk for HOM with IVF - maybe for whatever reason they are very concerned about this.

LCB34

I totally agree - I think a lot of women rush into IVF simply b/c the want a baby right now and just look at the success rates.

I personally was no where close to ready to do IVF after just one IUI cycle.  We did three for my peace of mind (knowing that we tried less invasive, less expensive treatment) and so my DH had time to get on the IVF train.

I also hate when people say they jump to IVF just b/c they are 100% OOP - um, that makes no sense.  Spend $1-2K on an IUI cycle and see if it works before throwing out $15-20K on IVF.

I think a lot of people forget that IUIs do actually work (too bad they didn't work for me)!

I also agree that some situations warrant an immediate move to IVF but, no where near all cases, IMO.

 

susanc07

just speaking from my experience here, but my first IUI was converted to an IVF cycle due to overstimulation.  after that, partially due to MFI, we decided just to stick with the IVFs. 

maybe i am a little impatient too, though. 

mrsolsenk12

I think only 1 IUI with no other reasons and going to IVF is a big jump. If I had the coverage, I would do mulitple IUI's before moving to IVF. IVF is so much harder than IUI.

firsttogo

I do agree that jumping to judge is not kind of me, but I happen to know a little more about these girl's situations than others.

firsttogo

susanc07:

just speaking from my experience here, but my first IUI was converted to an IVF cycle due to overstimulation.  after that, partially due to MFI, we decided just to stick with the IVFs. 

maybe i am a little impatient too, though. 

That is different! Totally understandable, and nothing to do with being impatient. 

Cajun_gal

I'm hoping we'll be able to go right into IVF with #2, but we did 6 IUIs for DS and none worked.  I do have insurance coverage, so they'll probably require me to do 3 IUIs first though.  While trying to conceive DS, I desperately wanted IUI to work and not to do IVF so we kept trying that first.  I can't imagine being so quick to jump to IVF without the IVF history and without trying multiple IUIs.

ETA: This is under the assumption the diagnosis is not there to go straight to IVF and there is no overstimulation, etc.

LVBlvd

I only did 1 IUI before IVF.  I had several failed cycles of TI and we have no MF, so IUI wouldn't help.  It was a money thing for me too.  Why keep spending 4K on an injectable IUI cycle when that money could be better put to IVF.

I try not to judge people and their fertility choices.  You just can't know what is going on if you aren't them. 

OrangeSmoke

We did 2 rounds of clomid with absolutely no response and jumped straight to IVF.

I think for me, I always had it in my head that I would need IVF to get pregnant (I've had the PCOs diagnosis since I was about 15) so the mind game was much less for me.  DH and I talked about how we would probably need medical intervention to have kids before we got married, so I think on some level he was prepared too.

I had full IF coverage but it maxed out at $20k.  My gut feeling told me to go staight to IVF and to not "waste" any time/coverage on IUIs.  Luckily my coverage did not require us to do IUIs before IVFs.

Looking back, I think I made the right decision since it took me 4 fresh cycles to get pregnant.  I think I would have been a horrible IUI candidate, tons of AFCs, limited number of good eggs.

That being said tho, I do think I'm the exception, not the rule.

 

jmkatz

We are 100% oop so our situation was a little different, but my RE gave me the choice of doing 1 or 2 IUIs, and then IVF, or starting with IVF right away.  

He explained that my chances of having one healthy baby were much higher with IVF (b/c of my age he was super concerned with overstimming and the chance for HOM).  My RE's office also shared some of the cost breakdowns given our circumstances, and honestly, had we needed to do 3 or 4 IUIs, it would have been comparable to one IVF.  

I was super impatient and wanted a baby NOW - however, I was not mentally ready to tackle IVF.  Luckily, IUI worked for us, but we are already discussing what route we might take next time if that is the course we have to go down. 

LALASEPT05

My coverage counted IUI's and IVF the same. They covered 80% of IF treatments up to 20k. So each IUI was eating into my coverage for IVF. I did do IUI's but looking back for me it was a waste. Also the success rates are just so much higher with IVF. I think any ART procedure takes a heavy emotional toll and some times that emotional outlay is not worth the 10 -12% success rate with IUI. Also you know IF is hard and it's difficult to walk in anyone else's shoes who is going through it. What might be best for you may not be best for them. Just like those who don't have to use ART think they never would.

GypsyEsq

I don't think it's flameworthy per se but I would also caution against judgment.  One of the first things my RE said to DH and I when looking at our history was that I hadn't had a period since I went off birth control in 2004 without the use of Provera and that that fact alone meant that after 4 years of no pregnancies we couldn't eliminate any factors.  Structurally, after the HSG, we knew the "highway" was fine.  But with zero conceptions as far as we knew we have no idea if we made good embryos and it was my RE's recommendation to do one IUI, because the "highway" and "swimmers" (his words...) were ok but to not waste too much time there because the critical issue from his perspective was discovering whether or not there were any good eggs left. 

DD was conceived on that one IUI cycle that was actually a bust medically speaking.  I had such a poor response to the follistim that I was canceled and given the option of triggering and TI "just in case."  But there were no visible follies on my u/s the day of trigger.  And we were prepared to move to IVF for the next cycle.

LuckySunshineBaby

Our insurance allowed us (as did our RE) to do what we felt most comfortable with.  We did 4 cycles (first one was a bust, 3 on clomid) with IUI's that we're all BFN.  We did our first round of inject., over responded, changed it to an IVF and BFP.   We will go straight to IVF the next time.  Honestly, DH only ever wanted to do IVF.  He felt we had better control over the chances of multiples and we triggered each IUI with 2-5 follies, so it was always a concern. 

 At my ET, the RE made the point that based on the response, egg quality/sperm quality (known donor sperm) we could go back to IUI's (as there was no apparent reason they hadn't worked).  I was so frustrated with that.  I hated knowing it didn't work for no apparent reason. 

IUI's and IVF's have very different success rates.  I wish we would have moved straight to IVF and not have had the BFN cycles we did.  

 I know I had it easy compared to a lot of SAIF.  Between having full insurance coverage, knowing we would face ART prior to ever marrying or starting TTC and getting pregnant on IVF #1, I'm not going to whine here.  But, my BFN IUI's sucked.  And I don't wish that on anyone.  Why not go for the procedure that has the highest success rates?  If you IF diagnosis, IVF doesn't pose a medical risk for you, go for what your gut says.   Do what works best for you and your spouse.

kittylove

I see where you are coming from but this choice is very personal and I don't see our right to 2nd guess them. We are 100% OOP (at least with DS) and our Dr was fine with us doing 3 IUI and then moving on to IVF. For us it was a matter of money, when our clinic had great IVF stats and had a reduced payment for multi IVF cycles.

howleyshell

1.  My insurance required 2-3 IUI's prior to authorizing IVF.  Even then I had to fight tooth and nail as they looked for any excuse not to cover it.

It was agonizing doing IUI's when we had been told it was highly improbable they would work (sucky ovaries).

2.  When making the decision to move to IVF what it came down to was numbers.  Long term IF treatments are exhausting.  I'm not trying to play "my situation was worse than anyone else's" but really.... a full year of diagnostics and treatment really has a bad effect on you as a person and can eat away at your marriage.

DH's reasoning for moving to IVF was "I'm exhausted with this and I'll do just about anything to get my wife back."

 

So....  when you say you don't have the full picture you're probably right.

It's not always about impatience.  IF sucks.  If someone has the ability to get the hell out of the trenches as fast as possible I'm not going to judge them for doing everything they can to maximize their chances as fast as possible. 

GypsyEsq

Also, I am not sure why being impatient to have a baby isn't, in and of itself, a good enough reason to move straight to the procedure with the highest success rate.

PeachyKate

We also only did one IUI before moving to IVF and our insurance was fine with it.  Since we had and still have no idea what the problem was our RE didn't see the point of doing more IUIs when my previous clomid cycles and the 20 plus cycles on our own didn't work.  They wanted to see what my embryos looked like under the microscope to see if that gave us any more valuable information.  The IUIs just seemed like a waste of time since we didn't have a huge MFI issue.  The other thing we were worried about was my reponse to injectibles if we went that route with IUIs since I had such a good response to clomid.

PhillySue

schmoodle:

I would hesitate to judge regardless of the circumstances.

For one thing, IUI has much lower success rates than IVF, and depending on their diagnoses, it could be that the RE offered IUI as a less invasive first step but gave them extremely low chances of success. With our MFI, our RE advised we go immediately to IVF within about a month of our first appt with him (and only 8 months after we first started TTC). I'm sure other REs may have recommended IUI first just to give it a shot but I'm glad we didn't waste our time.

There's also less risk of a cancelled cycle due to having too many follicles and lower risk for HOM with IVF - maybe for whatever reason they are very concerned about this.

These are my feelings exactly and we were in a very similar situtation.

kimarino13

We went right to IVF without Clomid, IUI or anything like that.  I have PCOS and MH has MFI and we have insurance coverage that allows 4 lifetime IUI *or* IVF cycles.

smilee

I don't think it is flameworthy, per se, as you are privy to more info about these girls than we are. But I will say this- sometimes, a lot of times, IVFs don't work either. Just look at IF- there are so many girls on there that have had 2, 3, 4, etc. IVFs.  Perhaps they are keeping that in mind as well. 

But I will say this:  I wish we had skipped IUIs altogether.  At the time, I needed to do them simply because IVF was just "so big" and I did not want to believe we would ever need it. So, we did 3.  And honestly, wasted many precious months.   

Of course, money and age play a factor for us.  In the time I messed around with IUIs, my FSH skyrocketed.  All I know is that in a few short weeks, I will be 36.  It took a total of 14 embyos to get us one baby.  While we have 4 frosties, I do not really have faith that these will ever lead to another pregnancy and given age, DX and money- I won't ever do another fresh IVF. So, there is a part of me that thinks if we started the IVF process sooner, perhaps we would have a shot at another child.  And this makes me really sad. 

Alas... hindsight is always 20/20. 

JGirl2005

It's hard to know the full idea as if someone iUI was converted and maybe they didn't tell you.

I had 2 IUIs when they told me TO STOP as no more would work for me due to a bad sperm count.  I would have tried more.

My coworker is the opposite.  She wants to do IUIs but is not on board to do IVF if it comes to that.

LCB34

GypsyEsq:

Also, I am not sure why being impatient to have a baby isn't, in and of itself, a good enough reason to move straight to the procedure with the highest success rate.

I guess my statement about impatience is coming from a few of my IRL friends that jumped straight to IVF after one SA that came back borderline or borderline day 3 results.  That just seems impatient to me.  They never went on any meds, never tried anything else, just ran to IVF.

I also think the way we personally felt while doing treatment influences how we feel about others treatment - right or wrong.  I was sure as hell not ready to go straight to IVF so that is why I scratch my head when I see situations like my friends' that I listed.  It is simply not understanding.

 

 

AlissaCell701

I also had full IVF/IF coverage with a high deductable.  .Didn't do ANY IUI's due to MFI, there wouldn't be any point and quite frankly went right into IVF. I also did 3 back to back cycles..

I am no offend by your statement but I don't think that you can judge your friends. They might not be disclosing all of there medical info to you and quite frankly it's not really any of your business what they do and how they do it.

keg

I think it could depend on a lot of factors that you may not know about.  After a lap where they diagnosed/removed endo, I got pg on a non-treatment cycle.  However, it turned out to be ectopic.  We were planning on starting IUI after that cycle, but decided to skip them and go straight to IVF.  Why?  To minimize the chance of another ectopic happening.  Plus, although HSG and such came out clean, I think my tubes are pretty crappy due to the endo. 

BelleBaby

We had to go straight from clomid to IVF.  My RE said that I was not a good IUI candidate since I only ovulated once out of 5 cycles on clomid.  Maybe that's why?

I was hoping that we could avoid IVF and do IUI because I had insurance coverage for IUI, but she thought it would be a waste of time and money for us.

weemodin

Were I in their shoes, I'd go straight to IVF, too.  It works much better, and you risk of HOM is much, much lower.  Plus, even if the first round does not work, you may have "back up" tries from a single IVF cycle if you have frozen embryos.  You don't get that with IUI.

I did not find the IVF process to be *that* much more physically difficult than an IUI w/injects cycle -- in fact, one of my IUI cycles was so ridiculous and protracted that it easily wins out as worst cycle ever...

Also, studies and articles have indicated that going straight to IVF is often more cost effective.

https://www.medicalnewstoday.com/articles/45801.php

https://theafa.typepad.com/theafablog/2010/03/iui-vrs-ivf-a-patient-guide.html

Kim777

We did several Clomid IUIs with the OB, but only one IUI with the RE. He told us from the beginning that IUI was not likely to work for us due to our MFI so why throw money down the drain? Plus I was concerned about the higher risk for HOMs with injectable IUI. Every situationn is different.

nicolita14w

I wonder if they read the book "How to Get Pregnant." It recommends IVF highly over other procedures because of the increased success rates. It especially recommends it for older couples who have less time to waste trying other things.

I had to do 3 IUI's before I would have been allowed to move to IVF under our insurance plan. (I got pg on IUI#3). 

Don't know their particular circumstances, so I can't judge their decision. 

Waiting4baby08

Considering how much higher the chances are for IVF given a diagnosis, if it is about money I would rather the 5,000 bucks from a few failed IUIs go to an IVF.  And I don't know if I consider it about "patience" because by the time I got to the point of discussing IUI vs IVF I was freaking READY.  Every month made such a difference!

I was fortunate enough to get pg via IUI, but if we ended up going to IVF I might have been mad that we spent all that money on IUIs knowing the chances were so much lower of success.

Ali212

OrangeSmoke:

We did 2 rounds of clomid with absolutely no response and jumped straight to IVF.

I think for me, I always had it in my head that I would need IVF to get pregnant (I've had the PCOs diagnosis since I was about 15) so the mind game was much less for me.  DH and I talked about how we would probably need medical intervention to have kids before we got married, so I think on some level he was prepared too.

I had full IF coverage but it maxed out at $20k.  My gut feeling told me to go staight to IVF and to not "waste" any time/coverage on IUIs.  Luckily my coverage did not require us to do IUIs before IVFs.

Looking back, I think I made the right decision since it took me 4 fresh cycles to get pregnant.  I think I would have been a horrible IUI candidate, tons of AFCs, limited number of good eggs.

That being said tho, I do think I'm the exception, not the rule.

 

I could've written this (with a few slight differences).  After having IUI cycles cancelled multiple times, I did one IUI before moving to IVF....for me, it was partly b/c we switched REs (2nd RE felt IUI probably wouldn't work for us given MH low morph while 1st RE thought it would) and as I looked at my full IF coverage (not really full though - the lifetime limit of $15K was coming up quickly), I opted to go down the route to maximize my dollars.  After 3 fresh IVF cycles (have basically been OOP for all 3 since I hit my IF max before starting my first), I'm glad I didn't waste more time with IUIs.  The meds, etc....it's a good $4k around me.,...nothing compared to IVF but not insignificant. 

I wouldn't judge others on the IF road...we all have our own stories, issues, challenges.

AvaLikeLava

We did IVF right away. I have no regrets over this decision. I would do it again in a heart-beat.

We were diagnosed w/ MFI, so I had no blocked tubes, and I was 28 at the time.

Our ins. company gives you a 15000K lifetime limit on IF treatment. Given the cost of IVF (~12K) vs. an IUI (~3K), and the fact that we had a higher success rate with an IVF, HELL YEAH, that decision was easy to make. We could've done multiple IUIs, not succeeded, and eated into the money for an ultimate IVF we would need.
Our RE said we needed IVF+ICSI given DH's morphology, so given that I didn't see how IUI would work.

In regards to patience, by the time you accept that you need treatment, your patience is already depleted. You waited months/years to get pregnant, why wait months and face disappointment AND financial hardship on treatment that is less likely to work.

I have no regrets over our choice to go straight to IVF, and would do it again in a heart-beat.

eyenerd

We didn't have an option.......and honestly, after all was said and done, i was glad that we didn't.

I think everybody views treatments in a different light, and i agree if they can get out of the trenches, the quicker, the better!

 

Quizzle

I think it can definitely depend on circumstance. The only treatment I did before we did IVF was 4 clomid + TI cycles with my OB. We skipped the SA because I'd gotten pregnant right off the bat originally but m/c, so we thought the problem was all on my end when my body decided ovulation was optional.

Once we got the SA done (and a repeat to confirm; my RE wouldn't send us straight to IVF without confirmation) we jumped straight to IVF.   A big part of the decision was that we were 100% OOP. But also, 1% morph and low to borderline motility plus being 36 were big factors as well. We just didn't have time to mess around.

 

If we'd had insurance coverage, we might have tried a cycle or two of IUI to see how I responded, but our RE thought it would be a complete waste of time and money for very little potential reward. He'd have done it if we wanted, though. 

njdcgirl

I, too, took a "quicker" route to IVF.  After a year TTC, I was dx with PCOS, did 3 Clomid + TI cycles with my OB, moved onto the RE, tried one IUI, which was cancelled with no reponse, and decided to move to IVF for my next cycle.

I had insurance that covered both IUI and IVF, but knowing time wasn't on my side (36 at the time) I was ready to get pregnant.  Comparing a 15% chance with IUI to almost 50% chance with IVF was a no-brainer for me.

I'm glad I did - it took me another year, and 3 IVF cycles to get this BFP.  I'll be 38 next month, and given the poor egg quality found during my cycles, I'm pretty sure IUI wouldn't have worked - it took 39 retrieved eggs to get 24 embroys, which only led to 6 blasts, no frosties, and 1 BFP. 

cmw&tdm

Ha!  I was just going to post about this soon.  I'm considering going back to IVF.  I only have one tube and it's always a crapshoot whether I am going to ovulate on the "correct" side.  And even if I do get pg, I may m/c like I did the one time I got pg without meds. 

I did one IUI with Clomid and injectibles.  Didn't work.  I also did one inj only cycle and I got one follie ... on the wrong side.

I don't like IUI + Inj cycles because of the uncertainty of how many follies with fert and implant.  

alison43

i replied to the other post (s/o this one) and i'll repost here. 

we were planning on IUI before we knew about MFI.  at that point--RE said our chances were less than 10% with IUI (not sure if he meant over 6 months or per cycle, thinking over 6 months as those were the rates we talked abouot) or 60-70% with one IVF.

our insurance paid for IVF and we didn't see the point in doing something that had such a low chance of working when IVF at the time seemed like more of a sure thing.  granted not a sure thing but you know what i mean.

also we had done two clomid/unmonitored rounds with ob.