You ladies are the most knowledgable, can I ask a PCOS question? Siggy warning

SnowflakeBride06 · July 2013

I am a lurker,

I defer to you ladies as you are the most knowledgeable.

I lost my right tube 1 month after starting our TTC journey. I was able to conceive without meds the first time though my cycles were 45-60 days long (6 months later) and I got dx with PCOS in the mean time.

We started TTC (charting) 2 years ago when my PP AF returned.

One miscarriage and a dx of Lupus.

I got sent to an RE and after seeing 3 of them. I had the testing. My b/w (Estradiol, AMH and FSH) was normal and my HSG showed an open tube. S/A was normal too. But my antral follie count was 50 so its PCOS.

RE said we should proceed to IVF as that would give us the best chances. He said on our own we have a 2% chance every month but we would be allowed 4 IUI/clomid cycles. The clomid would be 50 mg/5 days and monitoring to make sure because I would be prone to overstim.

Is this pretty standard for a person with PCOS to have such a low chance on their own? I thought normally it was 20% for a couple without problems.

He also did not do testosterone or other PCOS hormonal tests. He seemed not worried about that.

Is it just that most RE's think IVF gives the best chance for success?

ETA clarity

Twinkie0612 · July 2013

IVF does give you the best odds of success, but that usually isn't the only factor to deciding the treatment plan.

My RE was upfront and said that if money was no issue, he would recommend IVF as treatment, because the success rates are so much higher. Since so many patients are OOP, he usually starts with much less aggresive treatments. We did 4 IUIs (one clomid + IUI with my OB/GYN, 1 unmedicated IUI with RE, and 2 Clomid + Trigger + IUI cycles with RE) before moving on to IVF.

SnowflakeBride06 · July 2013

talon1226 said:

IVF definitely gives you the best chance of success, but most people don't start there since it's so expensive. Plenty of women with PCOS conceive on their own or with less invasive treatments such as Clomid with TI or IUI. Unless there is something I'm missing, it seems odd that he would suggest starting with IVF. Do you have insurance coverage for IF treatments. You should also get your glucose and insulin levels tested to find out if you are insulin resistant since you have PCOS. Testosterone and LH are usually tested too. Your RE can give recommendations but it's ultimately your choice how to proceed.

We have insurance coverage with some out of pocket co-pay. I did just look at the b/w list and I did have my glucose, insulin tested and I am not IR.

It just feels like a big leap.

He said we could do IUI/clomid first and that would be what I am inclined to do.

chickyclg · August 2013

Did your RE recommend IVF just because of your PCOS, or a combination of only having one tube. I don't have PCOS but I do only have 1 working tube, and had 2 canceled IUI's before my completed one because I kept ovulating on the blocked side.

Alicia_R1 · August 2013

When I was diagnosed with PCOS I was given similar options. I have long and irregular mostly anovulatory cycles. I did 2 clomid cycles, no trigger or IUI, but it wasn't working and like you I had an very high antral follicle count (over 27 on each ovary). Our RE laid out the costs and chances of success for each round of IUI vs IVM. He would do IVF if that is what we wanted but he's one of what seems like very few RE's that does IVM. For the cost and # of trips down to the office it made more sense for us to just go to the IVM instead of another clomid cycle and IUI.

We have some male factor issues as well, DH doesn't have optimal morphology, so he had said that was something that could also make it take longer for us to get pregnant. It took me quite a few months to be ok with the jump. For some reason I was ok with medicated cycles/ovulation induction, but the thought of IUI or IVM was too much for me.

I think it all depends on your comfort level. I was deterred at first by cost and the fact that you spend so much (in our case to do the IVM it will be 7K) for a 27- 35% chance of pregnancy or the IUI which was a lot lower but still cost around $2500. If our insurance covered IUI, I might have considered it, but I was also against wasting more time on clomid because of poor response previously and the RE I go to won't stair step or modify the ovulation induction if you aren't responding, the cycle is basicallly just a bust. And I kept seeing on here and other boards where people were going through so many IUI cycles and they weren't working, that I felt like it was going to cost us more in time, money, emotional pain to do a bunch of those.

It was and still is a hard decision because there is an emotional cost that comes with it that is impossible to put a value on. It helped me to talk with some of the ladies I worked with and knew in my personal life who did IVF. But it was definately a blow to hear the words IVM and even IUI on our first visit to the RE. But he and this clinic tend to be a bit more aggressive in order to achieve pregnancy more quickly since that is what most of their patients want and also part of the reason I chose to go to them.

I'd say go with what ever you are most comfortable with, if that means doing a few clomid + IUI and then reevaluating do that.

sarah_beth2005 · August 2013

I would ask your RE whether his recommendation is based on the PCOS diagnosis, the one tube, or the combination of those. My guess is it's because of the combination.

My RE diagnosed me with PCOS (no other known issues at this point), and told us we had about a 2% chance of conceiving naturally on our own, 5% with just Clomid or Femara and TI, 20-25% chance with IUI with injectables, and 60-65% chance with IVF. My RE said that a couple with no IF issues has about a 15% chance of conceiving in a given month. For us, the decision to do injectable IUIs was an easy one, since insurance covers it, and we wanted an aggressive approach. I think for most people IVF definitely has the best odds, but it's so expensive, so you want to make sure you've tried less aggressive and less expensive approaches first. I would have a follow-up conversation with your RE and ask him to lay out all your options, based on your diagnosis, and their relative probabilities of success, and their costs, so that you can make an informed decision on what is the best path to take for now. What your RE is recommending sounds like a cost-effective plan, so it might be worth trying for a few cycles to see whether it works, before moving on to something more aggressive (like injectables). Good luck!

nicole336 · August 2013

hey there- I also have Lupus and wanted to make sure you've been checked for Lupus Anitcoagulant and Antiphospholipid anitbodies. Those can both causes issues with ttc and staying pregnant.

SnowflakeBride06 · August 2013

nicole33647 said:

hey there- I also have Lupus and wanted to make sure you've been checked for Lupus Anitcoagulant and Antiphospholipid anitbodies. Those can both causes issues with ttc and staying pregnant.

Thank you for mentioning that, I have been tested and both are negative.

nicole336 · August 2013

SnowflakeBride06 said:

nicole33647 said:

hey there- I also have Lupus and wanted to make sure you've been checked for Lupus Anitcoagulant and Antiphospholipid anitbodies. Those can both causes issues with ttc and staying pregnant.

Thank you for mentioning that, I have been tested and both are negative.

glad to hear they were negative!

You ladies are the most knowledgable, can I ask a PCOS question? Siggy warning

Re: You ladies are the most knowledgable, can I ask a PCOS question? Siggy warning

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