XP: Need Help with Next Steps

chicagobride_07 · May 2012

Just had IUI # 3 last week. The nurse called with 7 DPO results today and progesterone was low. I do not have a good feeling about this cycle and just know in my heart it is a BFN. Beta is scheduled for 5/11. I need help with next steps. RE wants to do IUI # 4 next month with injectibles, but I don't see the point. I am 42 and my stats are in my siggy. We have 80/20 insurance coverage for IUI, but no coverage for injectible fertility meds, so IUI cycles are running us $1,000-$1,500 a month.

We have no insurance coverage for IVF; nada, zilch. I want to move on to IVF, but for a variety of reasons, we only have one shot. I am scared to use my OE. RE thinks I have a shot and my second opinion RE concurred. However, second opinion RE mentioned that the risks of "nothing to transfer" are very high.

I am starting to think I should just move onto DE as my next step. My RE seems resistant that I won't try with OE first- but I can't seem to get him to understand we have only one shot. If OE IVF doesn't work- we are child free.

DH has questions about DE- but supports me in whatever decision I make. I think he is looking for me to make the decision (no pressure here).

So, given my stats would you: 1.) go for IUI # 4? 2.) go for IVF with OE as a once and only attempt or 3.) move onto DE?

If your answer is DE- any suggestions on discussing this with the RE when he is resistant?

Thanks!

danieleandwayne · May 2012

I am not familiar with all the ins and outs of IUI with vs without injectibles and IVF with OE vs DE, so forgive me if this question seems totally whacky, but could you not move forward with IVF with the idea that if you cannot produce OE to transfer that you could have a DE on back-up/stand-by?

As for moving forward with IUI #4, I guess for me the question would be-- what would make #4 different from the previous 3 cycles? Is the RE getting a better idea of how to make your body more receptive to implantation? Is your body adjusting to the process in a positive way? If it's just going to be the same and you feel like IUI isn't working, then I'd move forward with the IVF. But I would personally feel better moving forward with the IVF if I could do the "OE with DE backup/standby" option.

But again-- I am not familiar with these options and I have my own personal feelings about DE which may not jive with yours...

None of this is an easy decision. Good luck with whatever path you end up pursuing!

dhreczuck · May 2012

Well I hope IUI #3 ends up working out for you and you don't have to move to next steps. Ultimately what you end up deciding is up to you and DH and RE needs to accept that or I'd move on

It's a really tough gamble. Have you been responding well to the injectibles? Id be tempted to do just one more IUI if I were you. As to what comes after that, I've grappled with the same decision. We're OOP for IVF so I'm in a similar situation. It's such a personal choice, if IVF is going to exhaust all your funds for the foreseeable future, I would probably go directly to DE

MrsNukem · May 2012

danieleandwayne:

I am not familiar with all the ins and outs of IUI with vs without injectibles and IVF with OE vs DE, so forgive me if this question seems totally whacky, but could you not move forward with IVF with the idea that if you cannot produce OE to transfer that you could have a DE on back-up/stand-by?

Not a whacky question but here's the jist: DE cycle is not as easy as having it on "stand by" unfortunately like you can with donor sperm. If you are doing a fresh DE cycle, you have to go through the whole process of finding a donor and syncing up with the donor's cycle while they go through the whole stim/retrieval process, you are committing to using that donor. And most clinics don't have frozen DE that you can have on hand as "stand by" (I know RBA in Atlanta has a frozen DE bank, which is what I'm researching, but still it is not to be used as a stand by), it is a whole long process to be approved for the DE process, go through to select the donor, thaw the sample, go through fert, etc. Just FYI.

MrsNukem · May 2012

To answer your question, after 3 IUI's I would not do another. So then the option is either IVF with OE or DE. Unfortunately, since you only have 1 shot and you have no insurance coverage, I would be tempted to move on to DE to increase my chances of a successful pregnancy. If money was not an issue, I think I would at least give my OE a shot at least once. Would you regret never trying with your OE? I'm surprised your RE is resistant to you going to DE if that is what you want for the variety of reasons, but perhaps he just wants to make sure you will have no regrets at not trying with your OE.

It is such a difficult decision and very personal choice, one that we can't make for you. It is definitely a lot to think about, and you and your DH need to be on the same page before moving forward. I wish the best for you in your decision.

MrsNukem · May 2012

PetraStonegirl:

If you want to move to DE IVF and your RE doesn't want you to because you 'might' succeed with your OE, then you need to find another RE. Straight up, they need to respect your financial situation, in addition to your body.

As for talking with them, I would be that blunt. If you feel that the math doesn't support OE IVF, they need to support your decision. Period.

Ditto Petra. Well said.

chicagobride_07 · May 2012

I've done two cycles of femara with gonal-f; my last cycle was gonal-f only. 150 iu of the gonal-f. The RE's goal was to produce 1-2 follicles, and I always did-although one was bigger than the other.

happywifemomofone · May 2012

PetraStonegirl:
Doing an injectable IUI will give them a better idea of how you react to injectables, and a better idea of what you might be able to produce in an IVF cycle. However, it's no guarantee. At 42 with one financial shot at IVF, I'd go for DE IVF hands down. Better to have 15 20-yr old eggs to work with a 65% chance at a live birth with that money, than 5 42-yr old eggs and a only 10% chance.
But, you need to ask yourself... if the goal to have a child, or is the goal to have a genetically-related child?
If you want to move to DE IVF and your RE doesn't want you to because you 'might' succeed with your OE, then you need to find another RE. Straight up, they need to respect your financial situation, in addition to your body.
As for talking with them, I would be that blunt. If you feel that the math doesn't support OE IVF, they need to support your decision. Period.

I also agree with Petra. Typing PM for you now.

happywifemomofone · May 2012

You may also want to consider Mini/Micro IVF. It's less expensive than traditional

IVF because it doesn't use high stims and works with your natural cycle. McIrish has experience with this.....you may want to ask her. At least it would allow you to have your eggs evaluated for quality, prior to moving on to DE. There is also donor embryos.....which is less expensive than donor egg. Good luck.....these are tough decisions!

mtlaurel · May 2012

Your chances for success with DE will be much higher. So, if you're comfortable with DE and all it means, and that includes your H being totally comfortable with it, too, then I'd say move onto DE. If your RE pushes back, then it might be time to find a new RE (which you may want to do anyway, if moving onto DE).

Our stats are somewhat similar (see my siggy), except I'm 36. We didn't do IUIs because of MFI, but we only got one decent quality embryo that didn't stick out of two IVF cycles.

Good luck.

dhreczuck · May 2012

chicagobride_07:
I've done two cycles of femara with gonal-f; my last cycle was gonal-f only. 150 iu of the gonal-f. The RE's goal was to produce 1-2 follicles, and I always did-although one was bigger than the other.

Well I know every RE has different opinions but mine has said the goal w/ injectibles is to have between 2-4 follies each cycle, if your only cycling w/ one follicle your chances aren't really any better than a natural non IUI cycle. 150 seems like a bit of a low dosage for ama ladies... You might want to ask your RE about it.

BeckyP005 · May 2012

mtlaurel:

Your chances for success with DE will be much higher. So, if you're comfortable with DE and all it means, and that includes your H being totally comfortable with it, too, then I'd say move onto DE. If your RE pushes back, then it might be time to find a new RE (which you may want to do anyway, if moving onto DE).

Our stats are somewhat similar (see my siggy), except I'm 36. We didn't do IUIs because of MFI, but we only got one decent quality embryo that didn't stick out of two IVF cycles.

Good luck.

Agree with this and Petra. I did 2 IUI's last year and now that I will be 44 this month DE is the only way I'm going since I only have one shot of being a mom. If I was younger and had more $ I would try w/OE but that's not happening. Some pp have a hard time with using DE but for me and MH it wasn't.

It is a long process...for me anyway. It will be a whole year before I probably get PG if it all goes my way. Good luck!! I'm sure the ladies who are in the process or got PG by DE will be more then happy to answer any questions!

BeckyP005 · May 2012

Oh and DE is not foolprooff if I might add. That is also something you have to consider. My friend had to do a fresh and then a FET before she got her bfp but I think she just had to pay an additional $2000. This all stinks

Mrs.McIrish · May 2012

happywifemomofone:

You may also want to consider Mini/Micro IVF. It's less expensive than traditional

IVF because it doesn't use high stims and works with your natural cycle. McIrish has experience with this.....you may want to ask her. At least it would allow you to have your eggs evaluated for quality, prior to moving on to DE. There is also donor embryos.....which is less expensive than donor egg. Good luck.....these are tough decisions!

Yes, I am doing low stim IVF. We are just trying to get one good egg. But the odds are terrible as it is just a fact of nature that with a "crop" of only 1 or 2 eggs, they are likely to be aneuploid (especially at 42). I hate to say it but I feel it is true. You need to be able to try it multiple times I think to try to find that 1 good egg (needle in a haystack)

I agree with Petra 100%. What is your goal? If it is a live baby, any live baby, hands down DE IVF is your best shot if you have only 1 attempt at it.

chicagobride_07 · May 2012

Thanks, ladies for all the feedback. I spoke again with DH about it and we are leaning more towards DE.

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