Where to Start: Meds w/Timed Intercourse vs. IUI update

Steph1673 · June 2014

I'm meeting with my RE on Tuesday and aside from DH's SA which we should have the results of by then all other testing (bloodwork, AMH, HSG) has come back "essentially normal" according to my doc. So basically, unless DH shows signs of MFI, we are dealing with an unexplained IF.

RE's nurse, when scheduling me, mentioned starting Letrozole and IUI as the next step; HOWEVER, I'm not sure how I feel about it yet. I know that with an unexplained diagnosis you need to start somewhere with trying things, but I have regular cycles and positive OPKs each month so what will the Letrozole really do? And if SA is normal do we need to start with IUI or DH suggested maybe we discuss starting the meds and time intercourse before we jump to IUI. Of course, I trust my RE to guide us in the right direction, but I was interested in input about where most people start.

GraceyandTroy · June 2014

I would have to consider your husband's SA results, your budget and your urgency. If you feel like you want to do everything you possibly can afford as soon as possible and don't want to waste any time, then doing an IUI will be more aggressive. If you feel a little less urgency and want to be less invasive and are willing to slow down, then medicated with TI could be a good option (assuming the SA comes back good/normal). Even if you're ovulating, the meds could help give you a stronger ovulation or could cause to you release more than one egg, increasing your chances.

I totally understand your dilemma in that our dx has to do with my not ovulating. It's clear in my case that I need the meds to ovulate, but IUI vs TI is hard to decide.

See what your RE says and then think about how aggressive you want to be.

designer303 · June 2014

So @GraceyandTroy‌ said all the right things, but I thought I would share my experience since it might be helpful. We were completely unexplained the first time around once we started meds and cycling we found I had lining thickness issues and different meds helped that. My RE says that taking drugs even tho I ovulate on my own just creates a better environment as all my hormone levels are normally better during a medicated cycle. With no real dx the first time around it took an injectable cycle with an IUI and had 3-4 good follies to get one singleton pregnancy.

So I guess what I'm trying to say is even tho you are unexplained it could still require you throwing everything you have available to you at it to get results. Best of luck and let me know if you have any other questions!

Frenchteachermama · June 2014

PP said some really great things. I think you and DH need to think a lot about how fast you want to take things. With my diagnosis, extremely low AMH and two miscarriages this year, my RE doesn't want me to waste too much time with IUIs and move soon to IVF. Although he's been very forward about saying all of this is our decision and we could do many IUI rounds if we wanted to. Talk to DH, my husband has been great so far about performing under pressure (i.e. telling him a day or two before that he has to have the sperm sample ready at X time), but a lot of men are nervous about that part. TI definitely takes some of the pressure off. This cycle we were worried I would miss my IUI based on travel plans for memorial day weekend and the NP said that even thought IUI does have a better success rate, for someone without MFI TI does work very well. I think it's going to be your personal decision.

Steph1673 · June 2014

Thank you everyone! I appreciate your insights. I think we'll see what the SA reads and the RE says in the morning and talk about how aggressive we want to be there from there. Budget, while I don't want to throw money away, is not the main concern, it's more of a desire to be as successful as we can with as few interventions and interruptions to our daily life as we can help (A girl can dream). We'll see! That might go right out the window tomorrow, or in a few months.

GraceyandTroy · June 2014

I look forward to hearing how it goes.

sailorgal · June 2014

Good luck tomorrow!

The girls have given excellent advice.

Steph1673 · June 2014

UPDATE: I met with my RE today to discuss next steps. DH's SA came back normal, which was our last test we were waiting on, so moving forward with our unexplained IF diagnosis. Today I got a positive OPK CD15 so we are crossing our fingers for a miracle this natural cycle with TI alone, but at least after today we do have a plan in place. Herein lies my question...

I have read all of the horror stories of unmonitored Chlomid cycles; however, my RE is suggesting for my next cycle 5mg Letrozole CD3-CD7 and coming in for an IUI 1-2 days after positive OPK with no trigger... and no pre-monitoring. When I asked about the monitoring leading up to IUI he said that for my case I do not need the monitoring and that it has not been proven to reduce the risk of multiples so he said it was unnecessary in my case since I seem to ovulate on my own and am not using a trigger.

I know he monitors sometimes because it's on his IUI instructions checklist, but he crossed it out on mine. We spoke for a long time about it and he put me at ease, explained the off-label use of letrozole, said that monitored or unmonitored I have about the same 8% chance of twins and 1% chance of triplets. I have to be honest, the idea of not leaving work for constant monitoring is appealing if he says its safe...He did say if appropriate they may order a blood test after the LH surge or an office visit to evaluate the ovaries. So I may not be completely unmonitored... aka I won't take it cycle after cycle with out testing and knowing if I'm pregnant, but there doesn't look like there will be monitoring leading up to IUI. I feel pretty comfortable with this so I think I am ok proceeding this way at least for the first IUI, but has anyone else proceeded essentially unmonitored (no ultrasounds) on letrozole for their first medicated cycle with an RE?

iheartsippycups · June 2014

Never been not monitored by RE, but I did 2 rounds of clomid w/iui's my first pregnancy, and what got me pregnant was my 3rd round with letrozole instead of clomid, and just ti. I went to an RE specifically for the monitoring, but if you feel comfortable, that's all that matters. I however, do not ovulate on my own though...

Good luck this cycle!

lazfam1120 · June 2014

Hi, I too am unexplained, all my (and DH) tests are normal and healthy. I have a 2.5 year old son who took 2 months to conceive. Now I've been trying for #2 since May 2013. I recently started seeing an RE, and she started me on Clomid. I have had regular ovulation and regular cycles for the past year. I asked a lot of the same questions you did. It was explained to me that even though I regularly ovulate, the Clomid (and other meds for ovulation) can help the eggs to be more "ripe" I guess is the word you could say!

My first two cycles of Clomid have been unsuccessful. I just started round 3. My follicles are being regularly monitored via ultrasound by my RE and when they look to be a good size, I will do a trigger shot (Ovidrel) which causes ovulation 36 hours later. We have the option of doing timed sex or IUI, and we are going to try timed sex on our own first. If that doesn't work, then we will consider IUI.

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