WWYD? Need opinions.

10-4LilBuddy · September 2012

I had a meeting with my RE today and we are weighing our options. Since you have all been there or at least thought of it, I thought I'd get your take on the options in front of us.

Background: After years of BC pills, I had an IUD put in after our wedding. IUD was removed February 2010 to start TTC. Lots of annovatory and long cycles until October 2010 when we saw RE. Took forever to get a cycle to do our bloodwork and HSG. Started Femara plus TI in Jan 2011. Did Femara and TI Feb 2011 - Aug 2011. Started Femara + IUI in February of this year. Have been doing that since then. We had 2 cycles of really low counts from him, so my RE wasn't counting that in the totals. These last two cycles were supposed to have Ovidrel but I ovulated early and missed the trigger. We did manage to do an IUI but think it may have been late. I think we have a timing issue because I just don't think we are capturing the actual ovulation.

Today, my RE told me we can only do two more IUI cycles with Ovidrel. There are two options for us.

1) Do more IUIs after doing laproscopic surgery to make sure I don't have endometriosis. I don't have any symptoms (heavy or painful periods), but some people don't have symptoms. Insurance would cover 80%.

2) Do IVF. We were thinking we'd do this in February or March after the year starts. We'll put as much money as we can in our FSA and pay the rest. They are estimating $10K. Our main concern with this option is having an excess of fertilized embryos. RE said that is not likely given my age (39). Of course, the cost is very high and would be a significant, but doable, hardship.

What do you think? Should I do the laproscopic surgery or go straight for IVF? Of course, I'm still hoping these last two IUI cycles do it or we have a Hail Mary cycle before February or March. I just like to plan ahead.

Thanks in advance for your feedback. I really appreciate you ladies. My head is swimming right now and I need some rational thoughts.

Mrs.McIrish · September 2012

I am going to be honest here. It is out of love, ok?? I would not do the lap since you have no symptoms and it will delay what I think is the inevitable=IVF. I would go with IVF as soon as you can so you can see your eggs and how they fertilize. You have no idea what is happening in there with an IUI. While women can get pg. at 39, the lucky ones usually do fairly soon. After 2.5 yrs, it probably is not really a timing issue. Those particular eggs released just may have not been good. Something like 7 eggs out of 10 are aneuploid at 40. Or the sperm that got in wasn't good and growth stopped before you would even be able to test. You need more egg production to increase your chance of finding a good one. This is why it is hard for a DOR lady like me----you can't make enough eggs to find a good one. You have a good shot to find success if you can grow a bunch. Wishing you luck.

MrsNukem · September 2012

Mrs.McIrish:
I am going to be honest here. It is out of love, ok?? I would not do the lap since you have no symptoms and it will delay what I think is the inevitable=IVF. I would go with IVF as soon as you can so you can see your eggs and how they fertilize. You have no idea what is happening in there with an IUI. While women can get pg. at 39, the lucky ones usually do fairly soon. After 2.5 yrs, it probably is not really a timing issue. Those particular eggs released just may have not been good. Something like 7 eggs out of 10 are aneuploid at 40. Or the sperm that got in wasn't good and growth stopped before you would even be able to test. You need more egg production to increase your chance of finding a good one. This is why it is hard for a DOR lady like me----you can't make enough eggs to find a good one. You have a good shot to find success if you can grow a bunch. Wishing you luck.

I agree 100% with all of this. I wanted to skip IUI and go straight to IVF, and I'm glad I did, now that I know I only produce 3-4 mature eggs for retrieval. It really is a numbers game trying to find that one golden egg.

chucktgirl · September 2012

Mrs.McIrish:
I would go with IVF as soon as you can so you can see your eggs and how they fertilize.

Mrs.McIrish, you sound like you know what you're talking about and I have been considering what you've said. May I please briefly tell you my situation to see if your answer is the same? I'm 41, been TTC for 2yrs 9mos. Had one pregnancy that ended in miscarriage this January. I'm starting IVF, but first RE wants to do a hysteroscopy to see what a small unidentifiable mass is in my uterus. This will delay my IVF start by two months. He also gave me the option of ignoring the 5mm mass and proceeding with IVF. What would you do? I feel like every month is precious! (Feel free to PM me if you want; I don't want to hi-jack her post!)

To the original poster: It's such a personal decision, particularly when you are considering your finances. I certainly hope that you get lucky before the decision needs to be made, but I think I would go right for the IVF, if you can afford it and can tolerate the stress, just to give yourself the best possible chance of conceiving. Whatever path you take, I'm wishing you much baby luck!

amandaleigh1 · September 2012

I am a lurking grad of this board, hopefully you don't mind my butting in. I would also recommend skipping the lap if I were you. I had a lap to remove endometriosis and adhesions that I already knew that I had. Removing signs of visible endo did not ultimately help get me ku. I am still glad I had my surgery since it alleviated symptoms that I had. But if you happen to have silent endo that us making you less fertile, removing it does not necessarily restore fertility.

In your case, it could amount to unnecessary surgery for which you get to pay 20.

I was ultimately successful with my first ivf. I am glad I did not mess around with iui before doing ivf.

Best of luck to you!

Mayzie15 · September 2012

I have to agree with other posts we have MFI and with MH low count IUI was going to be a long shot for us we had a much better success rate with IVF. I have a lot of respect for the ladies that have done IUIs because they are trying to get pregnant and every time it doesn't work that's hard to deal with. My failed IVF was tough and I'm OOP too but I want to give myself the best chances. I think you've been reasonable time wise and I think it would be in your best interest to move on to IVF. Good Luck with your decision.

owlprof · September 2012

I'm in a very similar situation, so I'm glad that you posted the question! (Not that I have much input, but I'm glad to see what other ladies have to say). I think the ladies -- esp McIrish -- make a good point. I'm OOP, but I am starting to get antsy and if this next cycle (Femara + Ovidrel + IUI) doesn't work for us, I'm going to get serious about IVF. I do wish that my RE would tell me that I needed to do IVF now, as I think it would make it easier for me to make the financial commitment.

PS: I wouldn't do the lap.

Good luck with your decision!

jadwedd · September 2012

I do not understand why your re wants to do surgery if there is no evididence that you have endo. Did they do the HSG test and did it show something? If you trust your re then do whatever he/she tells you. If you do not, then get a second opinion.

Mrs.McIrish · September 2012

chucktgirl:

Mrs.McIrish:
I would go with IVF as soon as you can so you can see your eggs and how they fertilize.

Mrs.McIrish, you sound like you know what you're talking about and I have been considering what you've said. May I please briefly tell you my situation to see if your answer is the same? I'm 41, been TTC for 2yrs 9mos. Had one pregnancy that ended in miscarriage this January. I'm starting IVF, but first RE wants to do a hysteroscopy to see what a small unidentifiable mass is in my uterus. This will delay my IVF start by two months. He also gave me the option of ignoring the 5mm mass and proceeding with IVF. What would you do? I feel like every month is precious! (Feel free to PM me if you want; I don't want to hi-jack her post!)

Yes, I would do the hysteroscopy before IVF. You don't want to get good embryos and have them not be able to implant because of the mass. I think it is worth the 2 month delay. I had a hysteroscopy in April to remove some polyps. It was a little bigger than yours (9mm) and perhaps not in the way of anything implanting but I wasn't taking any chances. Turns out when she got in there, there were some other small polyps too. I thought the hysteroscopy was pretty easy. There is no cutting to get into you so recovery was easy (some cramping and bleeding). Mine was done in the ambulatory wing and I was home by the afternoon.

happywifemomofone · September 2012

Mrs.McIrish:
I am going to be honest here. It is out of love, ok?? I would not do the lap since you have no symptoms and it will delay what I think is the inevitable=IVF. I would go with IVF as soon as you can so you can see your eggs and how they fertilize. You have no idea what is happening in there with an IUI. While women can get pg. at 39, the lucky ones usually do fairly soon. After 2.5 yrs, it probably is not really a timing issue. Those particular eggs released just may have not been good. Something like 7 eggs out of 10 are aneuploid at 40. Or the sperm that got in wasn't good and growth stopped before you would even be able to test. You need more egg production to increase your chance of finding a good one. This is why it is hard for a DOR lady like me----you can't make enough eggs to find a good one. You have a good shot to find success if you can grow a bunch. Wishing you luck.

I totally agree with McIrish, and wouldn't hesitate to move on to IVF. Also need to take into account the emotional toll of likely additional cycles resulting in BFN. We did alot of IVF cycles with our OE, and the emotional toll is much worse than the financials. There's also the toll of time going by much too rapidly as we age. Each IUI is an additional month of having no idea if those eggs are capable of resulting in a successful pregancy. Embries always looked good for us, but looks can be deceiving when it comes to ability to make a baby.

chucktgirl · September 2012

Mrs.McIrish:
chucktgirl:

Mrs.McIrish:
I would go with IVF as soon as you can so you can see your eggs and how they fertilize.

Mrs.McIrish, you sound like you know what you're talking about and I have been considering what you've said. May I please briefly tell you my situation to see if your answer is the same? I'm 41, been TTC for 2yrs 9mos. Had one pregnancy that ended in miscarriage this January. I'm starting IVF, but first RE wants to do a hysteroscopy to see what a small unidentifiable mass is in my uterus. This will delay my IVF start by two months. He also gave me the option of ignoring the 5mm mass and proceeding with IVF. What would you do? I feel like every month is precious! (Feel free to PM me if you want; I don't want to hi-jack her post!)

Yes, I would do the hysteroscopy before IVF. You don't want to get good embryos and have them not be able to implant because of the mass. I think it is worth the 2 month delay. I had a hysteroscopy in April to remove some polyps. It was a little bigger than yours (9mm) and perhaps not in the way of anything implanting but I wasn't taking any chances. Turns out when she got in there, there were some other small polyps too. I thought the hysteroscopy was pretty easy. There is no cutting to get into you so recovery was easy (some cramping and bleeding). Mine was done in the ambulatory wing and I was home by the afternoon.

Mrs.McIrish, thanks so much for your opinion! I hate the delay, but I feel remiss if I don't do everything by the docs recommendations.

darby17 · September 2012

Hi Ladies,

I am new to the boards, but unfortunately not new to fetrility struggles. I am 38 years old and been trying for over 2 years. I just wanted to give Lilbuddy some input or offer a different opinion.

Have you tried other drugs with your IUI (Clomid, or injectibles?) How many follicles have you gotten duirng the IUIs with Femara? I have done IUIs with all three, but actually responded best to Clomid. This month I am on 100mg of Clomid and I have 3-4 mature follicles. I am going in for an IUI tomorrow. So we'll see if this change in meds does the trick. Maybe before you move on to IVF your RE can try some different protocols? If you decide to have the HSG or Lap, you should still be able to do an IUI the same month. So at least you wouldn't have to sit it out a month.

I did about 5 IUIs in 2011 that were all BFNs. I was eager to move on to IVF. I did two IVFs this year (Jan and Mar). Both resulted in Chemical Pregnancies. My RE actually suggested that I go back to IUI. The reason he gave is that each IVF only produced about 6 mature eggs. Of those, I had 3 embryos the first time, 2 embryos for the 2nd. He said the benefit of IVF is to have many eggs to work with. I wasn't getting a whole lot to work with, so he said he thought we should try IUIs again. I wouldn't discourage you from IVF, but I'd be curious about how you respond to the other meds.

Best of luck with your decision. I know it is never easy!

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