When to move toward IUI/IVF

Irisheyes81 · March 2017

Happy Monday everyone. I am super new to the forum and would love some advice. When did you make the decision to move forward to IUI and IVF? I'm 35 and we have been trying for a year. I have PCOS. My ER wanted to start metformin alone and see if I could ovulate. She always seems to take the least amount of intervention approach. I think it might be due to the expense and because she went through infertility herself. When that failed, we progressed to Letrozole at 2.5. Then Letrozole with a trigger shot. Then an additional trigger 7 dpo because progesterone was lower than 15. Here we are with a BFN. This month, I'm on Letrozole at 5.0. The nurse wants to know if we want to do IUI this month or try with the bigger dose. I wanted to draw from the experiences of when you guys decided to move to IUI. Did you try a few medicated months or just try IUI to give the best chance? We have to decide by my ultrasound on the 14th and I don't have a clue...

KLake42 · March 2017

Have you tested your partner's sperm? Sperm that's weak but not terrible will benefit from IUI over TI, since there's less swimming. But terrible sperm, not so much.

mtpbadger · March 2017

Hello! I'm sorry you find yourself here but welcome! Has your DH had a sperm analysis done? I have PCOS (or at least PCOS tendencies though not a lot of symptoms) and my husband's sperm analysis came back "borderline average" so we went straight to IUI as recommended both by my OBGYN and RE as they wanted to be sure sperm was getting to the correct place for fertilization. I'm glad we did as we tried three IUIs and then moved onto IVF.

How are you responding to the medication? How many mature follicles are you getting each cycle? What's your AFC? At this point, you've done 4 cycles (at least medicated if I'm counting right) with no success doing what you are currently doing. If I were in your position, I would probably want to move onto the IUI. You have to do what you feel most comfortable doing.

Another thing to consider is if you are paying out of pocket or what insurance covers. If you are paying 100% out of pocket, it might be more cost effective to move to IUIs since the success rates could increase. Or you may want to stick with TI while you save for future treatments (which hopefully you won't need!)

fresh76 · March 2017

agreed with @mtpbadger totally - how did you respond to letrozole on 2.5?

I am actually on my first medicated cycle, and if this doesn't work out, we had planned to do a second medicated (letrozole 5mg from cd3-7, trigger if needed, and TI).. and then I'm probably moving towards IUI. Although, these days, we are thinking about being a little more aggressive and might reach out to our RE about going straight to IUI if this medicated cycle doesn't work.

funkykey · March 2017

Hello, happy monday

I had one medicated month before starting IUI, but it's because my clinic was closed over Christmas, and I ovulated about a day earlier than I'd expected. (Darn.) Because clomid shouldn't be taken more than a few times, my doctor wanted me to increase my odds of success with IUIs - he thought it would be better to skip right to IUI and not do any medicated cycles, that our year of TI TTC had been enough. I don't know if the same is true for letrozole, though - if it works like clomid. I don't know if, with PCOS, clomid is an option for you.

Truthfully, I am relieved that our RE has decided to be so aggressive. This journey has been draining: I want it to be over as soon as possible. For me as well, in the back of my mind (the hopeful part of me) would like to have more than one child, so I keep thinking: "what if we have to do this again? how old will I be?"

PP have given good advice - you'll want to think about all of these factors when making your decision. In addition, your AMH level may be instructive: if I'd had a level that was cause for concern, my RE said he would have wanted us to move to IVF faster, instead of doing the 3-4 IUI cycles he'd recommended.

Good luck with your decision!

Irisheyes81 · March 2017

Thank you everyone for your responses! That is really helpful.

@klake42 DH's SA came back with good count and motility. However, morphology is 2%. The RE said that because his count and motility is high that morphology is not as big of a deal. Having less than 4% is not good according to what I've read though. I love how you said "less swimming" hahaha. It's true. My DH doesn't clean the house very often so I wouldn't be surprised if his sperm take lots of breaks to relax. I laugh every time I see your signature line that your wife has low sperm count hahaha

@mtbadger What kinds of symptoms do you have that is tendencies of PCOS? How was IUI for you? Is it scary/painful? I have had one dominant follicle with the 2.5 letrozole both times. I've only had two medicated cycles. There were a few follicles that were like 10 mm (and then a bunch of little ones). They said that is "responding" to the meds but increased it to get more follicles this time. My AFC was normal. My AMH is 36 because I have insane PCOS. I guess ovarian reserve is good for my age because of PCOS.

@fresh76 Did you do letrozole 5.0 last time too or start with 2.5 and get three follicles? Have you had any side effects from it? I feel totally fine but just started last night. I also started day 3 but have seen people start on day 5. What day did you start both times? 3 is great!!

@funkykey That is such a bummer about Christmas! I bet you were so frustrated. I totally agree that we have all done enough TI through this process. I heard about not taking clomid for multiple months in a row but I honestly don't know if famera is the same way. I would guess it is? They haven't said anything. Clomid isn't an option because my progesterone is already low so apparently implantation would be difficult. I totally agree about the multiple children and doing it all again thing. The struggle is real just getting through one and time keeps going and so does age! I would be so thankful for one but man having two would be so awesome.

Thanks again for all your responses. I should have joined this forum a year ago.

Lin&say · March 2017

I honestly wish I hadn't wasted my time with timed intercourse cycles. This is an emotionally and financially draining process that can drag on for months and years. I'd say spend the extra couple hundred bucks and give yourself a better shot. Best of luck to you! ❤️

mtpbadger · March 2017

I have the polycystic ovaries and my hormones come back as PCOS (it's been so long I can't recall what was high/low) but no other symptoms (not insulin resistant, overweight, facial hair, etc) that can be caused by PCOS. My RE said she calls it "skinny/lean PCOS" and that for some reason women that fall into that category tend to have a harder time getting pregnant than the stereotypical PCOS patient. If that makes sense.

IUI wasn't painful, a little uncomfortable since they put a catheter in to get the sperm into the uterus but it only lasted a few minutes. I had done enough research and was on these boards so I knew mostly what to expect going in it wasn't too scary.

wifeinraleigh28 · March 2017

We went straight into IUI when we started with our RE due to MFI diagnosis. Our insurance covered 3 of those (and no IVF coverage), otherwise we would have moved to IVF sooner since our chances with IUI weren't that great either. **TW** Our first transfer (IVF freeze all then FET) was successful, and my RE told me from the get go that this would be our best chance at getting pregnant. He was right!

This is such a case by case kind of thing and depends so heavily on your diagnosis. It seems like your RE is pretty optimistic that you can get pregnant with less invasive means (mine wasn't) so it's probably not a bad idea to try other things first. But I can also understand getting a little impatient and just wanting things to work, since that's how I am! Good luck to you in whatever you decide!

Irisheyes81 · March 2017

Congrats on your baby girl! That is so exciting! The first try even. I love those stories. Is there a reason you had a few months between IUI's?

@mtpbadger I have lean PCOS too! I don't have symptoms either. I didn't know it was even harder for this type. Makes sense because insulin resistance is easy to treat. Thanks for the info about what to expect. What was the day like for you? Did you take the day off work and relax or is it a pretty easy procedure?

fresh76 · March 2017

@Knottie1454621357 we started with 5mg of letrozole - the only symptoms i had was really strong ovulation pains (I generally get ovulation pain, but it's totally manageable - this time around, because there were 3 follicles, i was doubled over for a few hours). I have a fairly short cycle (24-28 days), so I was probably put on letrozole so early in my cycle because i ovulate early (i am totally speculating though).

Are you leaning towards IUI vs TI this round?

mtpbadger · March 2017

My RE said there's no scientific proof that lean PCOS is more difficult but the majority of women she sees in her office fall into that category if they do have PCOS.

For the IUIs, I usually went to work in the morning and then took the rest of the day off after, only because most of mine were late morning or early afternoon so it didn't make sense for me to go back to work. DH went about 1-2 hours before I was scheduled to do his part so they could "wash" the sperm (basically all the good sperm get left behind to use during the procedure) so he actually had to take more time off that I did.

wifeinraleigh28 · March 2017

@Knottie1456269879 Thank you! We ended up taking some time off in between IUIs because DH was seeing a urologist who started him on clomid to improve his counts. The urologist was optimistic that the meds would work but said that it could take awhile for us to see improvement (like up to 6 months). So we thought if we were going to give the IUIs the best chance, we should give his meds some time to kick in first. His post wash count improved slightly from IUI #1 to IUI #2 with 3 months in between, so we gave it another 3 months before the next one. But then we hit kind of a plateau and weren't seeing anymore improvement, sadly, which really justified our decision to do IVF!

Irisheyes81 · March 2017

@fresh76 It's great you had 3 follicles! Do you remember what size they were? Were they on the same side?? I had horrible ovulation pain and only had one follicle last month with less letrozole. I'm glad you said something about the pain because I'm sure I would have thought that I was having a reaction or something. I talked about it with DH last night and we decided to go ahead with IUI. I got really good advice on this forum that helped me decide.

@mtpbadger Thanks for the info on the process. I had no idea DH did his sample ahead of time and that it takes a couple of hours. So you weren't in there at the same time? Did you get your Fallopian tubes checked? My OB recommended it but the RE said it wasn't necessary since I've never had a surgery or std. Did you ovulate pretty regularly with PCOS?

@wifeinraleigh28 You must have been so excited to have such successful IVF and of course the successful FET. Do you regret not jumping right to IVF? I'm sure you don't because of your cute little rutabaga

pawcall · March 2017

@Knottie1456269879 - When we IUI, my FI comes with me with his sample. To give you an idea of timing, it seems to be about 2h total from the time FI produces his sample (which he does at home) and the time it's being injected into me. Part of that time is driving to the clinic and waiting in the waiting room - wash (at our clinic) takes about an hour.

Polythene Pam · March 2017

Trust your doctor but also your gut! My diagnosis is different (blocked tube with apparently the ovary on the "good" side rarely jumping in) and my RE wanted clomid, IUI, try opening the tube. The thing is we'd TRIED all those things (besides IUI but it didn't make sense to me) with my OB and those were terribly stressful months for us, I hope to never see another ovulation kit and forced sex haha. Everything is out of pocket for us, so every time our RE wanted a sit down I knew we'd get another bill. We ignored our RE, trusted what my OB said months before and jumped straight to IVF. Not saying that's right as our diagnosis is different but I'd never felt such relief. Even my husband was in the room for transfer day and teared up, saying he was so happy the last few years were behind us.

So my roundabout way of saying listen to your doctor but also look at stress levels and if making a more aggressive move would be stressful or if it might actually help. Best of luck!! ❤

Irisheyes81 · March 2017

@pawcall I had no idea he could do it at home! I'm sure he will be happy about that. Apparently the inside of a clinic isn't sexy. That really eased my mind. I had this vision of a long procedure and then not being able to return to regular activity after.

@polythenePam I was so frustrated when we went to the RE and she wanted to start with metformin. I knew it wasn't going to work considering I don't have an insulin issue. I wanted to get going because of my age and diagnosis. I totally agree about the ovulation kits and timing and all of that. I get a sick feeling in my stomach every time I look at them. You give really good perspective that seems similar to a lot of people on this forum. I think we are all tired of waiting.

mtpbadger · March 2017

My DH usually went about 1-2 hours ahead of me and then would find somewhere to work remotely or get something to eat and then would meet me there once it was my turn (I work 1 block away from our clinic so I would just walk there and didn't make sense for me to take the whole morning off with him). He also had the choice of doing it at home but hasn't had an issue doing it at the clinic. I did get my tubes checked with an HSG which my OBGYN ordered and they were all clear. I have never ovulated on my own since high school when I went on birth control, which I went on because my cycles were irregular. I went off of BC for a year right out of college since I didn't have a doctor yet and didn't renew my pills and didn't have a period that whole time. So once I met DH and we got married, I knew we would most likely have issues and thankfully my OBGYN is awesome and didn't make us wait the standard "1 year" of trying before she started running tests and referring us to the RE.

Aera11 · March 2017

@Knottie1456269879 I did many rounds of clomid with *TW* two losses and moved onto IUI - we did just the one IUI and I felt like it was a waste of our time and money since we're out of pocket. I've done one round of IVF since and I'm glad we made that decision to move in that direction. I thought maybe it would be more difficult to accept IVF as our next step but now I wish I would've just skipped the IUI completely. Goodn luck with whatever you decide!

Irisheyes81 · March 2017

@mtpbadger I never ovulated either! I went to an OB when I was off BC in college and they told me I was too stressed and too skinny. Um first of all I'm not stressed and for sure wasn't in college. It would have made more sense if they said I was drinking too many beers, not stressed. Skinny, um also no. I've never been underweight. They just don't know about PCOS or other fertility issues and don't care until it's an issue conceding. So the "washing" sounds like it takes about 2 hours? I scheduled my ultrasound for March 14th to see what size of follicle(s). I feel good about the decision to move toward IUI. TI feels like a waste. Thanks for your great advice.

@Aera11 So sorry for your losses! You are so kick @ss for going through all this. If it wasn't so darn expensive, I would move right to IVF too. Money is the only thing really holding me back honestly. The only reason I'm willing to explore is because the issue I know I have is lack of ovulation.

Aera11 · March 2017

Ovulation is my issue too @Knottie1456269879. My ob diagnosed me with 'mild pcos' 3 years ago because I wasn't ovulating or getting periods but I have no other pcos symptoms. My RE just considers me anovulatory. IVF costs are no joke but hopefully you'll have time to prepare for that. I ultimately knew that's where we'd end up and started saving but it blows my mind how much it is. I hope more sites start popping up for couples going through infertility/IVF who need financial support. Insurance really should cover it as it is s medical condition.

BecauseLove · March 2017

Do you get mature folicles when you take Let?

If yes, I would go for a few rounds of iui.

Tw. We got pregnant at 36 with pcos, on letrozole with trigger and monitoring on our 2nd iui (it ended up being a chemical pregnancy) but it took me almost a year of attempts to get mature folicles to have completed iui attempts. If we had success creating mature follicles I would have tried a few more rounds of iuis because they are easy and pretty low cost.

We ended up going onto ivf...and our currently 11 weeks pregnant with our ivf/fet kiddo. Glad we finally pulled the trigger on ivf because of my age and follicle issues. We ended up spending roughly 33k between iui attempt or prep and then ivf/fet.

Irisheyes81 · March 2017

@BecauseLove congratulations! I hear what you're saying about the age thing and love success stories. I had a 17.6 mm follicle with 2.5 of let. There were two more that were like 10. I have an appointment on the 14th to see how I respond to 5.0. I sucked at ovulation before so I was so excited for that one follicle.

@Aera11 I totally agree about the insurance! My insurance doesn't cover anything. Well, they cover what can be coded as PCOS but nothing else. The IUI is $450 where Ivf starts at 14k. We can't wait long based on my age. I guess I'm just in denial and hoping above all hope that IUI will work for us. A friend of mine did a go fund me and got a bunch of money for her IVF. It's just money and I want a baby. My RE seemed like we would be fine with IUI. I feel like you did though, realizing what the reality likely is. Makes me so mad/sad

BecauseLove · March 2017

Knottie1456269879 For sure don't waste time trying to ovulate naturally...trigger shots are not that expensive and are easy to do. If your using them then I would for sure do IUI's and even at your age...I mean if you get 1 mature follicle that is all you need per cycle...so you could do 1 IUI and have success or 2 or 3 and get your success. (that should only take you roughly a little over 4 months to give that a try and see where you are at that point and I think that would have likely cost me like 800 per IUI (ultrasounds, meds, trigger shot and IUI)...which might even be on the high end...it has more to do with how many times you have Ultrasounds).

If after 4 months or hey 6 months of giving IUI's a try then I would say get your but to a IVF clinic (after you have done your research on what facility would be the best choice and best bang for your buck).

35-36 won't change much>>>>>Unless! The IVF clinic you are looking at has discounts before you turn 36. I know some of the ones I looked at increasesed in cost depending on age. The clinic I ended up going with doesn't do that though.

wifeinraleigh28 · March 2017

@Knottie1456269879 Part of me does regret not going straight to IVF since it was my RE's recommendation all along, but at the same time he didn't say that IUIs were out. I know everything looks different in hindsight, but it was hard for us to justify not using our 3 covered IUIs first. We did almost move to IVF after IUI #2 though, and I do wish that we would've just done that because the BFN from IUI #3 for some reason hurt so much more than any of the other ones and DH and I were hot messes for a long time after that. I'm not sure why though, as you'd think we would've gotten used to the disappointment by that point!

Irisheyes81 · March 2017

@wifeinraleigh28 isn't it so strange what 'gets' us? I was the biggest hot mess on the planet over Christmas and wasn't even medicated. This past cycle, I was on a whole pharmacy, got a bfn and just called the clinic to get my prescription. So this might be a personal question you DON'T have to answer but: did you guys choose a girl embryo?

Irisheyes81 · March 2017

@BecauseLove after I read what you wrote, I called immediately to see if the prices change with age. They said that they can offer discounts past the second failed transfer unless you are over 38. So it looks like there isn't much of a difference. I struggle because we have two of the best IVF clinics in the country here but they are insanely expensive. Their success rates are great though.
I did a trigger shot last month because I hadn't surged CD 15 when my follicle was at 17.6 on CD13. Now, I'm not fooling around with any of that and just going right to trigger. My clinic uses HCG to increase progesterone on 7dpo and haven't heard of anyone else doing that... Thanks for the great advice. My clinic was like "you heard on a forum?" haha

thothscribe81 · March 2017

We ended up doing IUI right away - started with clomid (no injections ) but the package we paid for included the iui so we figured it was worth it to try. I've been lucky I think that my doc has been pretty progressively more agressive each cycle. I'm curious as to when he will suggest ivf- though our problem isn't with motility it's more with getting the timing of my ovulation right so I think once we figure that out im hopeful fertilization won't be a problem!

Are ypu comfortable enough talking to your doc about trying different approaches? Or even one of the nurses? Ive found that when I'm g e tying my blood drawn it's a great opportunity to pick the nurses brains a bit about my treatment - anything they can't answer they make sure to pass on to the doctor so he can answer it when he does my us :-)

wifeinraleigh28 · March 2017

@Knottie1456269879 We did choose to use a girl embryo. Even though I've always pictured myself with a daughter, when it came down to it I really had no preference. DH, however, really wanted a girl so I let him have his way

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