At home insemination - next steps

hlke

I'm not sure if anyone on the board was in this position, but did anyone have to switch from home insemination to medical intervention?  Did you decide to go to a midwife practice or straight to an RE?

Right now we're going to start with the midwife practice.  C is more comfortable there, and she's in favor of waiting until she's met standard definitions of "infertility" before moving up to higher levels of intervention.  But she just turned 35, so now a fertility evaluation is recommended after 6 months rather than 12 months.

Our providers are really leaving the choices up to us.  We've done the basic fertility workup, minus the HSG, and everything looks fine.  I'm just having a hard time with doubting our decisions - that we are being too conservative and will regret it later, or that i am pushing things too hard and not letting C lead.

2brides

yea, we did 2 home home ICIs before pulling the plug and heading to an RE. I am glad we did, because after those 2 ICIs, it still took 7 IUIs and a boatload of meds.

 

Good luck!

2moms2twins

we were told not to even bother with at home if we are using frozen sperm and being older and success rate of 6% with frozen  YIKES! .  So we skipped that and did IUI's and well that led us down a POOR path so our last effort was IVf...

mypalbabs

Insurance coverage (or lack of) would honestly influence the decision for me.  If you have excellent coverage, I'd head to the RE (who has lots of experience in getting women pregnant).  He or she has access to methods and medications that a midwife doesn't.

If the midwife were to do the same basic insemination (with no monitoring) that you're doing at home, I'm not sure it would make a difference.  However, if you were doing IVI at home and the midwife would do ICI or IUI, those generally do have higher success rates.

If you want feedback on your timing, you could link to your chart.  (I'm assuming you're charting via Fertility Friend or similar - I can't remember.)

leapgirl8

Keep in mind that an RE doesn't necessarily mean intervention. They will do unmedicated cycles with monitoring. Many people (including us) work with an RE from the get-go. I know that some people prefer a less "medical" environment, but we just weren't concerned about that and were happy to be in very experienced hands.

hlke

leapgirl8:

Keep in mind that an RE doesn't necessarily mean intervention. They will do unmedicated cycles with monitoring. Many people (including us) work with an RE from the get-go. I know that some people prefer a less "medical" environment, but we just weren't concerned about that and were happy to be in very experienced hands.

This is a very good point, thanks leap.  I think that's what we would want to move to at first.  When you did monitored but unmedicated cycles, did you trigger?

Honestly part of why this decision is hard is because our sperm costs are so low, so the pressure to get pregnant in fewer cycles isn't as strong.  But some of that will change once we move to either the midwife or the RE.

ball.and.chain

hlke:

I'm just having a hard time with doubting our decisions - that we are being too conservative and will regret it later, or that i am pushing things too hard and not letting C lead.

I totally hear you on this.  I constantly doubt myself and the decisions I have made along the way.  I do sometimes wish I'd started meds earlier.  On the other hand, since I responded poorly to Clomid, IVF would have been the next step after that no matter when we did it, and I do not think I would have been ready for IVF after, say, 6 IUIs.

Personally, if I were in your position, I wouldn't bother with the midwives.  I say this as someone who is VERY pro-midwife and absolutely plan to use them for prenatal care and childbirth.  But I don't know that unmedicated IUI has THAT much advantage over IVI/ICI unless the sperm quality isn't good (has your donor had a SA?).  I feel like the stickier issue is timing -- especially if cycles are wonky -- and if your midwives are like my midwives, you'll probably use the same methods (temping/charting, OPKs, CM, etc) you are already using.  One of the things I liked about the RE is that the combination of ultrasounds and blood work and trigger gave me a lot of confidence in timing.

I also think an RE is better than most midwives at interpreting test results relating to fertility.  We did our consult with the RE while we were still technically in the care of the midwives, and she encouraged me to have the midwives order the tests so that if all was fine and I wasn't ready to switch, I could stay with them.  In some ways, I wish I'd just had her handle them because it all got really complicated.  My HSG was a little irregular, and she was able to say, "I don't believe that's a blockage, I believe that's preferential flow," with 20 years of RE experience behind her.  The midwives were a little concerned about my hormone levels on one test; my RE tested me again and declared it fine.

But I see what you're saying about the stakes not being as high because sperm is free.  And of course in the end it's what you and C are comfortable with that's important.  Just wanted to give my 8 cents or so.

CageyMack

Hi!

We went straight to an RE for a couple reasons: I was 34, turned 35 just last month; we didn't want to waste time; we wanted to make sure we were being as "safe" as possible; and, honestly, we didn't want to waste money. 

Our path was a miniscule (25mg of Follistim, compared with the usual 100mg minimum dose) amount of "drugs," a trigger shot, and an IUI. 

And we were exceedingly lucky to get pregnant on the first try, so it feels like it was a good choice for us.  That said, it could still take 5 or 6 tries.  But again, pushing 35? For us, it was better to know we were giving those six months the best chance we could than doing something that might not be the best we could do. 

Again, our RE was perfectly willing to do an unmedicated IUI.  We still would have had great information to help us know we were on the right track (ultrasounds of follicles, expert sperm placement, and great sperm analysis and care in the unfreeze). 

So that was our path.  Good luck on yours!

hlke

I probably should have mentioned that we will have done six at home inseminations by the time we switch, which probably makes the case for the RE stronger.

I also will add that the main reason the midwives are being considered is that C has lots of anxiety about going to gynecological providers. (Thanks unexpected Navy pap smear at 17 with no explanation!)  The midwives are very gentle and allow the process to be very guided by you.  I'm not sure they add any benefit other than getting C her first IUIs in an environment where she is comfortable.

ball.and.chain - we have had a semen analysis.  The results came back right on the border between normal and abnormal.  Donor's morph was 10% strict, it's supposed to be above 14%, but I've read a lot of infertility board and blogs that say "abnormal" morph is extremely common and that morph above 4% is fine.  We're still waiting on the sperm quality info from banking, and that will probably also help guide our decision.  The usual treatment for slightly low morph would be IUI after 6-12 months of trying without success.

Like I've said a million times, we've very committed to the KD process and to low intervention, but sometimes it'd be nice to just go to an RE with anonymous donor sperm and have things be easy.

JoySeattle

Just to share our background/plans, we did two at home IUI cycles (one with two insems, one with one) back in 2009. Then took a three year break. We're getting ready to start ttc again and our plan is to do two more cycles at home, then monitored and unmedicated cycles with an RE, then carefully monitored medicated cycles (we don't want twins if we can avoid it) until pregnancy or IVF (due to RE rec or low vial numbers in storage -- we have a specific donor we're hoping to get pregnant with). For us, based on my age and health, this feels like a good progression.

leapgirl8

We didn't use a trigger - we did two unmedicated cycles and then moved to Clomid + trigger. But if we try again I would want to do just a trigger - the timing is tricky, even if you have no other problems.

hlke

JoySeattle:

Just to share our background/plans, we did two at home IUI cycles (one with two insems, one with one) back in 2009. Then took a three year break. We're getting ready to start ttc again and our plan is to do two more cycles at home, then monitored and unmedicated cycles with an RE, then carefully monitored medicated cycles (we don't want twins if we can avoid it) until pregnancy or IVF (due to RE rec or low vial numbers in storage -- we have a specific donor we're hoping to get pregnant with). For us, based on my age and health, this feels like a good progression.

Joy, so glad you guys are getting ready to TTC again!

Thank you everyone for your posts and input.  C and I discussed it and are going to move to the RE after next cycle.  It simplifies the plan and hopefully increases our chances for success. 

ball.and.chain

hlke:

Thank you everyone for your posts and input.  C and I discussed it and are going to move to the RE after next cycle.  It simplifies the plan and hopefully increases our chances for success. 

FX that you won't make it that far, but I hope the RE brings you quick success if you do.