Deciding on a plan...

AnonymousNurse · September 2014

So our testing last week revealed no issues besides my PCOS. The HSG was fine and I felt no more discomfort than I do during a pap smear, so that was a huge relief.

My RE is recommending IUI with injectables or IVF at this time. We did talk about medicated cycles, and he said that is definitely an option if I'm interested but we discussed success rates and he has me thinking one of the other options are the way to go now. He also said how because we want a big family (we would love 3-4, if it works out that way, but that's another discussion) that it might not be a bad idea to be more aggressive with our first pregnancy and then maybe start with medicated cycles next time and take it from there.

I am fortunate enough to have very good insurance coverage right now so cost is not an issue. I know that IVF is a lot more invasive but the numbers are looking very appealing to me right now. Am I being super impatient? I'm usually a huge advocate of trying less invasive measures first, but I really just want to get this show on the road, you know? Is it irresponsible of me to go right to IVF without trying anything else first? No matter what I do, with my work schedule I'm going to miss some days (I can't miss a couple hours for an appointment... it's all or nothing) and I'd like to keep that to a minimum, so that is also making IVF more attractive because hopefully I'll be successful in only a couple cycles. Although, that's not a given either and I know it.

This stuff is still all so new to me so I apologize if it sounds a little silly. TBH I was expecting them to say "here take a progesterone supplement!" when I went to my first RE appt, now I suddenly have PCOS and we're throwing around all these acronyms and it's a lot to take in all at once! Any input is appreciated!!

TL;DR: I kind of want to go right to IVF because my doctor says I can and my insurance covers it. Is this a bad idea?

RazzyRN · September 2014

I have no experience with treatment yet but me being the impatient person that I am.. I would seriously consider IVF especially because you have coverage. In other words.. I wouldn't blame you if you did choose to go that route.

AnonymousNurse · September 2014

Thank you guys so much for your responses! I knew you would have some good advice.

I agree that starting with the IUI might be prudent... there are a limited number of IVF cycles covered so it might be a good idea to see my response first, like @rainbowbridge14 @iputketchuponketchup suggested. I'm going to call on Monday and discuss this with the RE.

AnonymousNurse · September 2014

LLM100811 said:

I have no advice to give, our insurance covers nothing so I am trying to find things to sell so we can save up money for basic treatment or iui if we get to that point in the near future. Good luck!

@LLM100811 I'm not going to get started on insurance companies right now but I really hate to hear this kind of thing here... IF treatment is something ALL insurance companies should cover. It's such bullshit that some cover everything and others cover nothing. I'm sorry you have this added layer of stress. I recognize that I'm very lucky to have the coverage that I do and that is one of the reasons I'm trying to use it as responsibly as possible.

ritacita · September 2014

My initial reaction was YES jump straight to IVF! However, my RE game us the same choice and we started with IUIs... So take that advice with a grain of salt

I think the biggest, most important thing is to make sure that you feel physically and mentally ready for IVF. If you do, do it! I really wasn't ready yet. Good luck!

BunnyBerry · September 2014

In your situation, I would love to go straight to IVF! We also want 3-4 kids and it's so stressful seeing that we've seen an RE for 6+ months and nothin' doin' yet.

If insurance covered it, knowing that we'd want to transfer any frozen embies and have more kids (since we have ethical qualms with destroying them), I'm sure that's the way we go!

If insurance also covers injects + IUI, it might make sense to do a cycle of that for a couple reasons. One, you might get KU! Two, it gives the doctor a chance to test your body's response to the meds to plan a more ideal IVF cycle.

lebradford · September 2014

You might want to check your insurance coverage closely. I also have great infertility coverage, but my policy does state that IVF is covered only if other reasonable less costly things have been tried. So, IVF would not be covered as an initial treatment, unless the diagnosis required it (no fallopian tubes or something). There could also be a limit to how many cycles of IVF would be covered, which could be an issue if you want multiple children.

With that said, if your insurance will cover it right away and you and your husband are on board, I think you should go for it! The success rates for IVF are so much better and medicated Clomid or injects cycles can bring a lot of heartache with the low success rates.

Good luck deciding!!

theholmanherd · September 2014

Does it cover IUI and meds as well? I agree with PPs about seeing how you respond to the meds first. After that, go for it! I am happy for you that your coverage is so great!

AnonymousNurse · September 2014

Thanks for the advice to double check insurance. I just finished reading all 13 pages of the ART policy and it says nothing about trying cheaper methods first so I think I'm ok from that perspective. The financial dpt at the RE clinic also spoke with my insurance to confirm coverage. We've done a lot of thinking and discussing and will make the final decision after talking with the doc tomorrow morning.

Thanks for all the advice, ladies!

Chasity08 · September 2014

iPutKetchupOnKetchup said:

I agree with Rainbow. I'd go for one IUI with injects to test your response to the meds first before moving on to IVF. That way, your RE will know exactly how you respond and can up/lower your dosage to give you the best shot with IVF. But, that is the only reason I wouldn't go straight to IVF with your coverage.

This. I also have insurance coverage, but we have limits to our coverage, so I am doing 1 round of IUI, and depending on how I respond to that, I may move directly to IVF. My RE said even if I wanted to go directly to IVF it would be helpful to them to do 1 round of IUI to see how my body responds to the injects.

AnonymousNurse · September 2014

Rumbera28 said:

Honestly in your shoes I would go straight to IVF without doing the IUI first. When you go on injects, you get monitoring with ultrasound and bloodwork every day or every other day - so your RE will definitely know what is happening the first time around.

Additionally, because you have PCOS you have a high chance of overstimming, which means you will get cancelled for an IUI or converted to IVF anyway. If you go the IUI route, make sure that your insurance will cover your meds, because injects are really expensive!

@Rumbera28 this is exactly what my RE said when I talked to him today. I spoke with both him and one of the nurses (as well as my husband) and we ultimately decided we were going to go for IVF. I still do feel like I'm skipping ahead a bit, but my RE has assured me that this is a smart decision and I trust him fully with this. My husband and I are both comfortable with the decision and feel ready to get started.

Thank you ladies so much for all of the advice! I'm so glad to have you all to consult with. I'm the first of my friends to TTC so none of them get it at all, as supportive as they try to be, so it's really so awesome to know I have all of you to talk this stuff out with.

They said they were ordering meds for me, and that at this point I just need to wait until my next CD1 and then call to set up a baseline US/bloodwork appt. Then towards the end of next cycle I start the lupron and it's game on! We are very (cautiously) excited to get started.

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