What to do after 3rd failed IUI

emilykbw · March 2014

So, I know many docs, including ours, recommend moving on to IVF after 3 failed IUIs. Now, here we are, 3 failed IUIs later. Last cycle, though, my husband's count was much lower than it ever has been before for many reasons. Basically, we just had an off cycle. So, now, I'm feeling like it might be worth trying a 4th IUI given the circumstances of last cycle. We are completely OOP, so obviously that's a factor, too. For those of you who have done more than 3 IUIs or have made the switch to IVF, what factors did you take into consideration? How did you make your decision? We are going to meet with the RE this week for our WTF appointment and I want to have already thought through some of my options because I get flustered just thinking about going to the appt so I'm worried about staying focused during the actual appointment.

JadziaDax · March 2014

I did 6 iui's cause my insurance covered it. I'm moving onto if cause I'm physically exhausted and I'll also be out of pocket. You have to move on when you feel ready. I'm also taking a long break so I can feel more mentally and physically prepared. Good luck with your decision.

marshaleigh · March 2014

After my 2nd IUI, my RE suggested we move onto IVF. My husband has always had it in his head that we would do three IUIs and since we are OOP, I knew he would have trouble moving on ahead of schedule. I just told my RE that we wanted one more IUI before IVF and she was fine with that.

She also told me that she wanted me to try an unmedicated IVF cycle first (which makes no sense to me since I have ovulation issues) and I told her that I didn't have the time to waste an IVF cycle (or the money!). I insisted that we approach this cycle aggressively and she said ok. Maybe it's different overseas, but generally you get what you ask for over here. You just have to be prepared and know what you want to do so that you can advocate for yourself. Good luck!

pmpknbride · March 2014

After 3 failed IUIs we moved onto injects with IUI since that is the path my insurance covers. I have to do 3 rounds of this before moving onto IVF. I could tell my doctor would be prefer ivf since they can control multiples easier and since PCOS patients tend to over respond to injects, but since IUI is covered that made sense for us. I did read somewhere that if your only problem is ovulation issues it doesn't really hurt to try a few more IUIs, but I think if I were you I'd move onto injects as I **think** you are supposed to get better quality eggs.

Milagros315 · March 2014

We are 100% OOP so we didn't do any IUIs. I have endometriosis and the chances of success are 5 times greater with IVF than with IUI. If I had a different diagnosis or some insurance coverage, we would have tried IUI.

What protocol were you on? If it was just clomid/Femara, I would try an injects cycle or two if for no other reason than it could provide your doctor with information about how you might respond to stims during an IVF cycle.

If you've already tried injects then I think most docs would agree that it's time to consider moving on. That said, how you feel is really important and if you're not ready for IVF you shouldn't feel pressured to move on yet. Just take your time to decide what feels right for you. If you need one more IUI to feel like you gave it your best shot, do it.

jencity9 · March 2014

I am working on a 4th IUI because the first one was unmedicated and my RE wants to do three using the medication. Since you are completely OOP, do you feel like you could afford IVF right now or are you going to have to wait? If IVF is plausible I would do that, but if you wouldn't able to do that for a little while I would ask to do another IUI.

ky29 · March 2014

We did 3 injects + IUIs, all BFNs. At that point we had the IVF talk with the RE, but we are a little timid to go that route right now. I decided to start doing acupuncture while trying naturally for a few months, and if that doesn't work we may do acupuncture with one or two more IUIs, just because. If none of that works, we will probably look more seriously into IVF.

When we had the IVF talk with the RE, he totally left it up to us what we wanted to do. I had a good response to injects, DH's sample was decent, so he was fine with us doing a couple more IUIs. He was also fine if we wanted to move onto IVF. He said it was our choice.

Good luck to you!

Twinkie0612 · March 2014

We did 4 IUIs, but the first was with my OB (Clomid w/ no trigger). My first IUI with my RE was thrown in last minute during an unmedicated monitored cycle after he discovered that I have some issues with hostile CM. I did two more IUIs with my RE, but these were clomid + trigger + IUI. After the second clomid + trigger + IUI my RE recommended moving on to IVF.

I don't think it's unreasonable to do another IUI.

wishiwaspreggo · March 2014

100% OOP here. I did 3 IUIs with Clomid and they all failed. I did one unmedicated cycle, and let me tell you what a tremendous waste of money that was!

Anyway, my doctor called me and said she wanted to try a hybrid injects + Femara cycle with me. Doing a hybrid cycle is as effective as all injects, but much less expensive so there's that. I responded well to Clomid but my doctor seems to think there was either an issue with egg quality or lining quality. Now that I think about it, my cycles with Clomid have been lighter than usual without medication so... that could've been my problem.

I think it may be worth your time to try injects (looks like all your cycles were Femara only). As another poster said, if nothing else this will at least demonstrate how well you'd respond to IVF medications! Good luck!!

emilykbw · March 2014

Thank you all for your input/advice/knowledge. I have only been on Femara and trigger with all 3 IUIs. I only had one mature follie with 5mg and 7.5 mg and then this last cycle with 10mg I finally had 2 mature. We did speak briefly with the RE about injects, but he didn't seem to think it increased our chances all that much. He said because of the small increased chance, he thought it made more sense to save our money for an IVF cycle. Although, as @Milagros315 pointed out, it does make sense that a round of injects could give us valuable information for an IVF cycle if we get there.

As far as finances go, we could make IVF work - not without some growing pains, but we could figure it out. My IUI cycles have been less than I expected because it turned out some of my monitoring was covered and thanks to GoodRX, my Femara cost next to nothing. Truthfully, emotionally, I'm just not sure I'm ready for IVF. I'm leaning towards doing a 4th IUI with injects. I do think if that were to fail, I would feel like I did everything I could before moving on.

Thank you all for being so honest about your decisions. There are so many factors - and I so wish $$ wasn't one of them!

BunnyBerry · March 2014

From what I've read, the highest odds are in the first 3 (and about equal odds for each). Then, tries 4-6 still have a chance close to the first 3. But after 6, on average the results drop off. Again, those are averages.

You mentioned sperm analysis wasn't great this time...if I knew something had messed up one of our tries (we only plan 2 to time IVF during a teaching break), I would definitely try IUI again and then hold off IVF until winter break.

Good luck with whatever you choose!

jaytee16 · March 2014

We are in Canada and are OOP for everything except b/w and u/s. We did 3 cycles of Femara + TI and 3 injects + IUI that have all failed. We are in the midst of stimming for IUI#4. Last cycle pretty much ended in a CP but it gave us hope that this might work for us, and our RE is pretty confident as well.

We saw some studies with us that showed good success rates in up to 6 IUI cycles, with injects, for cases similar to ours. The rates dropped off dramatically after that. An inject + IUI cycle runs us about $2K and IVF at our clinic is about $12-13K. For the price of 1 IVF cycle, we get 6 shots at IUI. I should also mention we're unexplained, great SAs, great response to stims, etc so if we have to, we will likely keep rolling the dice with IUIs and end up doing 5 or 6 before moving on to IVF.

Lillovebug79 · April 2014

I have done 6 IUIs and plan to do 1-2 more. The main reason we keep trying IUI is because we are MFI and my DH has been taking meds for almost 4 months now and his numbers have improved. So he and his urologist think we should try a couple more. My RE is willing to do whatever we want but I am personally ready to move on to IVF. I just can't get my DH to agree to starting the IVF process until June as he is convinced his swimmers are will be good enough for IUI before then. I don't want to push him and I want him to feel like we gave it every possible shot before moving on. But emotionally, I'm just done. I'm ready for IVF!
Follow your heart and do what you feel is right for you and your husband. Good luck to you.

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