When to move to Ivf

Kelsey Rose 24 · August 2014

Hello everyone! I am looking for opinions here. I will give you a little background of my situation first. I started seeing the infertility specialist (ob/gyn) at my local clinic October 2013 because I was not getting my period after quitting birth control in June 2013. I have been diagnosed with pcos and I am anovulatory. We tried 3 cycles of clomid no follicles grew and I ended up with cysts 2 cycles (which ended in cancelled cycles for the next cycle) I then moved to letrozole and follistim combination cycle. First cycle I had 1 mature follicle and 2 almost mature and a lot of 10-11mm follicles. That cycle I used ovidrel To force ovulation and we did timed intercourse. Was not successful. Ended up having a cyst again so one cycle off. This last cycle we did letrozole and follistim again doing smaller doses of follistim with the hope of not so many follicles coming up. Everything was going good until today's ultrasound when I ended up having 7 mature follicles. The original plan was to do iui this weekend but we ended up canceling this cycle due to too many mature follicles. My dr. Is now recommending Ivf. My question is what is your opinion on if it is time to move on to Ivf or if we should get a second opinion from a different dr and see if they will do injections and iui again. Anyone else have a similar situation and what did you do.

CMH25 · August 2014

If I was in your situation, I would focus on three things:

Are you seeing an RE or your ob/gyn? You only mention your ob/gyn. If considering IVF, and even IUI for that matter, I would suggest seeking out an RE (reproductive endocrinologist). This is their specialty and your time and money is best spent with them.

What type of testing have you completed? There are a number of tests usually completed prior to IVF. You should discuss with your doctor if you had those tests (and your partner) and what the impact could be if you move forward without them.

And what is your financial situation? If paying out of pocket, I would consider the above pieces even more carefully. IVF is expensive.

Good luck!

Sigh202 · August 2014

You definitely should be seeing an RE, not an OB. They don't have the same level of training and often do not do adequate monitoring. Good luck!

gnl42 · August 2014

I don't have PCOS, so others likely have more similar experiences... But like many ladies on this board, had to decide whether to pursue IUI or IVF. There are many factors to consider and it is a very personal decision.

Finances definitely come into play depending on what your insurance may or may not cover and what you feel comfortable with paying out of pocket. IVF is obviously a bigger financial commitment and many people don't get coverage. The risk of multiples with IUI is also a factor (you can choose to do only single embryo transfer with IVF if you have good quality embryos). IUI is clearly less invasive, but it is harder to control your body's response to medications and can lead to cancelled cycles as you have experienced. Then again, that can happen with IVF as well. Some people get lucky and their first cycle goes smoothly and everything works out. Other times it is a bit of a learning experience to see how your body responds to the meds. Since you have already been exposed to stims, your doctor may already have helpful information for what to expect from an IVF cycle. I agree with the ladies above, that you should definitely see an RE (if you aren't already). If you are really unsure, then getting a second opinion from an expert never hurts.

I chose to skip IUI and go straight to IVF because I was worried that I would over respond to stims and have cancelled IUIs. I also appreciated the much higher success rates with IVF as well as the control over how many embryos to transfer.

Good luck with whatever you decide!

daydreamernyc · August 2014

To echo PP, it's a personal decision that comes down to a number of factors. IVF has a much higher success rate than IUIs. I'm not sure of your age and how much time you want to take to become pregnant (of course we all want it in the next cycle, but some people may be willing to go through a less invasive procedure and spend more time and vice versa).

I echo the comments on finances. If you are willing to take on the cost, then it might be the right step for you. Also consider whether this process is putting stress on your marriage. If it is and the additional finances will not add to that stress, you might want to consider IVF now. IF is a hard, stressful process and you want to ensure you are continuing down this path not to the detriment of other things that you value in your life. For that reason, a faster route might be a better option.

again, very personal decision and I struggled with it. My first IUI started in dec 2013 and I went through 6 before moving on to IVF this month.

Good luck with your decision.

Mrs.Ess · August 2014

Others have given good advice so I sill basically echo that.

First see an RE if you're not already. You really need to have an HSG and a semen analysis if you haven't already. Those two things will have great impact on what options will work best for you. If your tubes are blocked or there is male factor, depending on the severity, You may be better off with IVF. If those things check out ok I would think IUI would be a good option. On a side note, I wonder if you wouldn't respond to a high dose of letrozole on its own. Many ladies who don't respond to clomid do respond to letrozole. Plus it's super affordable if your OOP. But again, make sure you see an RE who can point you In The best direction.

Good luck!

Kelsey Rose 24 · September 2014

Thanks for all the advise. My current ob wants to send us to an re. So I think we might take off this next cycle just to recover from all the treatments and then visit with the re the following cycle and see what they recommend. I have had an hsg test and my husband has had a seman analysis. All came back good. I've also had lots of blood work done to check hormone levels.

Kelsey Rose 24 · September 2014

Did you have success with Ivf ? How many cycles did you do of it? Also do you need all the money up front or are their options to pay for it

siempre595 · September 2014

You need to move to the RE before doing anything else. OBs are not trained for this. I would move on to IVF if I were you. But I'm impatient and the finances are lower on the list of concerns for me. To me, yes you pay more, but the success rate is A LOT higher.

Also, I also have a cyst problem, and just got an IVF cycle cancelled because of it. So be prepared that if you are cyst-maker, like me, you may get delays in IVF also.

When to move to Ivf

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