what might you do?

HopeSprings2012 · November 2012

Hi ladies,

I know this is ultimately a personal decision, but I'm wondering what you think...

So I've done every blood test you could think of, and have had ultrasounds. I am ovulating, my cycles are like clockwork, and seem to be in fine shape. I have not had an HSG or SIS yet - because there was a chance my RE would suggest we go straight to IVF so I wouldn't need them.

My DH seems to be source of the problem. He's had three semen analysis - one 1% and two 2% morphology. The RE is saying since his other numbers are good we should consider trying a couple unmedicated inseminations first. If they don't work, we'd move on to IVF from there.

So we only have $10,000 covered for infertility under insurance. I'm wondering what the chances are with 2% morphology - of an IUI working? Will the IUI's be wastes? I always thought the problem with poor morphology was that they couldn't penetrate the egg.

And if we do IUI's - I still need the HSG and SIS done then right? I just feel like we're going to go through all our insurance $$ for nothing... The RE's argument is that I am ovulating and everything looks OK with me so doing some natural inseminatons are much less invasive than IVF.

Thoughts?? Any information, opinions or experiences would be greatly appreciated!!

brookelynpaisley · November 2012

I would go with your RE's recommendation, personally. They're the expert and I'm sure they wouldn't recommend wasting time with IUI if they didn't think you could be successful. Can you afford to pay for IUIs OOP so you don't have to touch insurance money and keep it for IVFs?

I don't know about an SIS, but you'd definitely want an HSG. No point in putting the sperm in a prime spot if the egg can't get to them.

HopeSprings2012 · November 2012

SweetC80:
If it were me and I had $10,000 from insurance, and I knew I could cover the rest I would do IVF. Especially with a morph that low. Nobody wants to do IVF, but since everything is so expensive I would hate to spend half of that on 3 rounds of IUI if I didn't have better odds. Since the RE was suggesting IUI was his count really high?

Thank you for the response. To be honest - I haven't seen the numbers. The RE just called because the numbers came in and said his count was good, his concentration, everything.. Just still not his morphology - which has been consistently very bad.

HopeSprings2012 · November 2012

brookelynpaisley:

I would go with your RE's recommendation, personally. They're the expert and I'm sure they wouldn't recommend wasting time with IUI if they didn't think you could be successful. Can you afford to pay for IUIs OOP so you don't have to touch insurance money and keep it for IVFs?

I don't know about an SIS, but you'd definitely want an HSG. No point in putting the sperm in a prime spot if the egg can't get to them.

Thank you! This RE is highly recommended - a top doctor with great success rate, etc. so I do feel good about her opinion. But I'll have to ask about the HSG.. She oddly didn't mention that if we did the insemination then I'd have to still do that first before DH and I discuss our options...

HopeSprings2012 · November 2012

juleskeim:

I had an unmedicated insemination (ovidrel only) last cycle, and my husband has wonderful sperm. Our chances of success were less than 10 percent per the nurse at the RE's office. 10,000 goes by really fast when talking IF.

Good luck to you.

Thank you... So it sounds like you feel it was just a waste..? My RE said if we felt we wanted to push right on to IVF she would be fine with that, but thought it was worth trying unmedicated insemination. That success rate seems quite low though. The cynic in me thinks it's just a way for the doctors to make more money...

brookelynpaisley · November 2012

HopeSprings2012:
juleskeim:

I had an unmedicated insemination (ovidrel only) last cycle, and my husband has wonderful sperm. Our chances of success were less than 10 percent per the nurse at the RE's office. 10,000 goes by really fast when talking IF.

Good luck to you.

Thank you... So it sounds like you feel it was just a waste..? My RE said if we felt we wanted to push right on to IVF she would be fine with that, but thought it was worth trying unmedicated insemination. That success rate seems quite low though. The cynic in me thinks it's just a way for the doctors to make more money...

Most IUI patients have between a 5 and 20% chance, depending on the circumstances. IUIs in themselves don't have a particularly high success rate because you're dealing with IF factors. Putting the sperm in the uterus helps, but you may have egg, lining, or sperm issues to still contend with.

IUIs aren't particularly expensive - clinics probably don't stand to make that much money off of them.

katib77 · November 2012

With our mild MFI, we decided to go with our RE's rec of 4 IUI's first. Then we'll do IVF if needed. But we're totally OOP after testing. I would def. Say get the HSG. And get yh on CoQ10 to improve his motility if you can.

new+tothis · November 2012

SweetC80:
If it were me and I had $10,000 from insurance, and I knew I could cover the rest I would do IVF. Especially with a morph that low. Nobody wants to do IVF, but since everything is so expensive I would hate to spend half of that on 3 rounds of IUI if I didn't have better odds. Since the RE was suggesting IUI was his count really high?

I'd do this too. I've done 3 IUIs now and I've probably spent 10 grand. I'd say one medicated cycle is about $2,000 for me which includes blood work, semen analyses, ultrasounds, monitoring appts, IUI, meds, etc (2,000x3 attempts= $6,000). Plus the HSG and all pretreatment testing was at least $4,000 - heck our sperm dna fragmentation test was over a grand by itself. If I had $10,000 in insurance coverage I would go for IVF right off the bat with morph at that rate - at most I would have done 1 IUI. It's really a personal decision though and you have to do what feels right for you.

jfb29 · November 2012

My DH has 2% morph as well, with other numbers being great. Both RE and uro didn't seem too concerned about it and doing IUI, as they said they have seen success with "worse than that". We actually haven't gotten to an IUI cycle yet due to me not responding properly to clomid and TI isn't an option for us bc of delayed ejaculation problem. We are completely OOP for any fertility stuff (diagnostic is covered at least and some of the meds). It is really up to you though as to what you feel comfortable doing - I am not sure about IVF and if I will ever do it (damn Catholic guilt complex). If you have concerns, I'd discuss them with your RE or their nurse to see if they have thoughts since they all know cost is a problem....

htn1763 · November 2012

We are in the same boat exactly. 2% morph (which is only slightly low) and all else coming back ok. I also have 10k in lifetime insurance.

One thing you might not realize is that while an IUI costs around 2k (or whatever it is for you) that isn't what the insurance pays. I was worried at first until I realized that the insurance paid about $300 for the IUI instead of 2k. For $300 I am having 3 IUIs and then moving on to IVF...which will also be less than you think for the insurance rate.

vpine · November 2012

In your case, I would do IVF since it's the highest success rate. Good luck to you

monkandnut · November 2012

Hi there
I did 2 unmedicated IUI cycles and I also ovulate each month and have clockwork cycles, but we don't really have any MF issues. That said obviously they didn't work and honestly, I wished we had moved on right away to at least medicated IUI. I think if it were me and you have a max, I would be more aggressive. When I asked my RE about statistics with IUI she told me she wouldn't even consider the unmedicated cycles in the realm of stats which frustrated me. At the end of the day though, I think you should do what you are most comfortable with! Good luck with everything, I know these are tough decisions to make!

HopeSprings2012 · December 2012

Thank you all! I think I have a few follow up questions for my RE before we can really make a decision. I think also have to accept that there is no "best" or "right" decision.. best of luck to you all!

what might you do?

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