WWTBGD?

clairmeij · August 2012

Hi Ladies!

I'm looking for opinions on the decision I have to make. I thought I'd made up my mind, but my RE has got me wondering...

I've had 3 unmedicated IUIs. I've had perfect cycles for the last year (and I'm pretty sure before then too, but I wasn't tracking). The only 'blip' was in my second IUI month, which I am concerned was stress related.

Our plan was to use drugs in this cycle, but my RE has said that in his opinion, I don't have to.

He's saying that I am still well within the statistically 'normal' range, and that I could comfortably do one more round with no drugs. The other option he's given is to use Femara (letrazole) and a pre IUI ultrasound. He definitely said that there was a choice, but he seemed to be leaning towards another unmedicated cycle, saying he has no doubt that I am ovulating.

What would the bump girls do?

ctbride08 · August 2012

I think the answer depends a lot on your feelings about and preparedness for multiples.

I dont think its crazy (given the cost of sperm and REs) to ramp up to femara/clomid following 3 unmedicated IUIs, but your doc is right that you don't necessarily *need* it.

2moms2b · August 2012

When we first started our journey we tried for a year at home (mid-wife). After a year of no success we met with an RE. It took a year to get on top of my fertility issues, so when we started again we decided on using medicated cycle heavily monitored. It was a hard decision for me as I originally thought meds = failure on my part but after looking at our options I was just ready to maximize every attempt. Our RE also agreed that as we had been trying for more than a year with no result and my sever insulin issues he recommended meds so we could better control my cycle. We also looked at our finances and sperm samples are not cheap!

Only you can make that decision so just go with your gut and what your pocket book will allow. Ultimately the goal is to get that bfp, stickey pregnancy and bring home baby so go with what you feel.

pixie76 · August 2012

We were also one of those people that did about 8 insems at home before moving on to clomid (another 3 cycles) then moved onto injectables (menopur)

Is it possible to do a monitored unmedicated cycle with a trigger? That way you can measure the growing follie and time your insem according to size and uterine lining?

The multiples thing is always a huge factor. We had 3 great follicles with my DS. We had 1 great follicle with our twins so there really is rhyme or reason here=)

I would be more inclined to do the unmedicated this early on since you have "text book" cycles.

Good Luck!!

leapgirl8 · August 2012

Since in retrospect I feel that our doctor recommended going to meds faster than we needed to, my inclination would be to wait and do another one, and inseminate twice if you haven't been doing that.

ball.and.chain · August 2012

The short answer is, your RE is right -- you don't *have* to use drugs. There's no medical need for it since the drugs technically are prescribed to treat infertility and 3 unsuccessful IUIs do not equal infertility. Straight women under 35 typically do not take fertility meds until they've been trying unsuccessfully for a year.

That said, there's a big difference (emotionally, financially, stress-wise) between 3 IUI cycles and 3 months of sex with your husband -- which is why we didn't wait 12 cycles to start meds.

Things we considered:

Age. I'm 34, and want a second child (through a second pregnancy), so I started to worry that if I didn't move the process along on #1, it would be that much later when I started TTC #2.
Comfort with risk of multiples. For us, it would be extremely difficult financially to have twins. We live in an area with a high cost of living and the most expensive childcare in the country, our mortgage payments are big, and I worry a lot about making ends meet with two infants in daycare. Obviously having two babies is harder than one beyond just the financial burden, it's a higher risk pregnancy or birth than with one baby, etc. I spent a lot of time thinking about all of that and wasn't ready to try meds until I had made peace with the possibility.
Cost. My testing, IUIs and monitoring are covered in full by insurance, so our only cost is sperm. We realized at some point that a few more vials of sperm cost a lot less than what raising twins vs. a single child would cost us.
RE's opinion. Remember, they are experts! In my case, I ovulate on my own and all testing seemed fine, so she did not think we needed to rush into medicating.

Obviously it's a very personal decision and something you and your SO need to be comfortable with. Good luck with the decision and with your next cycle!

hlke · August 2012

I like the idea of a monitored unmedicated cycle, if that's a possibility. It's slightly higher intervention without bringing in the big guns yet.

It's a really personal decision, and I do think your age, your feelings on multiples, and how IUIs affect you are huge factors. For us each cycle has been pretty stressful and so we're thinking about trying some intervention earlier than we had originally planned.

clairmeij · August 2012

Thanks ladies - we talked last night, and I read your posts out loud to V. Each post raised something that we hadn't thought of before, so thank you all very much for your input and opinions

We've decided to go with the Letrazole based on a few things:-

1. Someone made the point that the end result is a sticky bfp - and that brought me back to my last negative result, and my feeling that I didn't use all the available options to me.

2. We're OK with having twins if that happens - We've been toying with the question of having either one or two children, so if this happened, it would answer our question. Financially we are in a situation right now where we don't want to have to spend $1,000 plus a month on this, although in a few months we'll be back to normal and would be comfortable supporting two babies if that happened. If its more than twins, we're not comfortable 'reducing' so that raises a tough one since I have no desire to be octomom. Knowing that if multiples does happen, typically it is twins, and on occasion triplets, we'll take the risk.

3. I am 34, and I'd like to maximize my chances while I'm still under 35.

Fingers crossed for round 4 ladies.

Thanks again for your input

jeannkerricotober09 · August 2012

I don't know if you are still looking for thoughts but I'll add mine anyhow You sound like you're living my life, 2 years ago I was 34, had 3 unmedicated, back-to-back, IUI's and nothing to show for it. I was ovulating fine on my own but I decided enough was enough and up'd the ante. My wife had been trying for nearly a year and I we needed *something* to happen so I went for it, even though my RE said it wasn't necessary, but it was worth a try. I did 2 round of 50 clomid and nothing. Then I up'd to 100 and BAM-O. Baby N was born 9 months later.

Was it a coincidence? Maybe. I was still under AMA, ovulating fine and got pregnant within the first 6 months.

Will I go directly to clomid next time?

You betcha.

good luck!

AMA = Advanced Maternal Age, which they are going to call you the second you hit 35 - be ready. It's awesome.

clairmeij · August 2012

Hahah.....AMA - looking forward to it. I appreciate the warning, it'll stop me from giving the medical person who refers to me as AMA stinkeye.

Thanks for the input regarding your journey - crazy how our timing matches up!

hlke · August 2012

Thanks for everyone's thoughts, it's helpful for us too. Clair, we are in almost the same boat too. C turns 35 this month, and we'll do our fourth unmedicated insemination this month, and her cycles are also (mostly) regular. We're not ready for intervention yet, but we're getting there faster than we thought. Fingers crossed for you!

clairmeij · August 2012

Thanks so much hike! I hope that this next cycle is the one that ends your ttc journey!

All the best of luck! I'll keep an eye out for your progress!

ball.and.chain · August 2012

clairmeij:
Hahah.....AMA - looking forward to it. I appreciate the warning, it'll stop me from giving the medical person who refers to me as AMA stinkeye.
Thanks for the input regarding your journey - crazy how our timing matches up!

Did I imagine that AMA is based on your age at delivery rather than age at conception? (maybe got this from hlke?) If so, I am about 3 weeks away from AMA if this cycle works; otherwise...

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