How to know what treatment option is best.

libellula28 · January 2018

I am currently 41 with secondary infertility. I have had all of the testing done, and the only issue I have is a lower AMH. The first time I was tested it was .29, so I took DHEA, Vitamin D, and Ubiqinol and the number raised to .628, which is promising. However, I am AMA, and really feeling the pressure. We have tried to clomid cycles, which didn't end in a BFP. I have talked with my doctor and discussed IUI and IVF. He said IUI will only increase my chances of pregnancy to 5-6% a month, whereas IVF will increase my chances (of a live birth) to around 50% at 4 treatments. My partner and I are not a rich couple, and a 4 round cycle is around $30,000. While I see the benefit of IVF, I don't know how to make this choice. I think my biggest fear is trying IVF and being let down. We've been trying for almost a year with no success and it is emotionally the hardest thing I've ever been through. I don't really have anyone I can talk with, so I am curious how all of you all made the decision as to which treatment option to try. Thank you all SO much!!!

tosh24 · January 2018

So sorry you find yourself here but there is a really great group of ladies on this board and tons of information you can learn so I think you've come to the right place! I am also struggling with secondary infertility.

I understand the frustration since things seemed to work fine on your own before, so why all the trouble now with no explanation?!? When we started with the RE, we went straight to medicated IUI since we had been trying so long already and I felt like I was on a time crunch. I am <35 so that's probably why my RE was OK to start with IUI first, although he did say given how long we were trying (4.5 years at that point) IVF was still our best option. I wish we had looked into IVF sooner. I can't be too hard on myself because I guess I needed to figure out that nothing else was going to work first, but in hindsight, I potentially could have avoided a year of treatments and appointments and stress (and money down the tubes). I think at 41, I would be seriously looking at IVF as my best and only option if I knew I could swing at least one cycle financially. Is there a reason you have to do 4 cycles (is it a shared risk program he's offering?)? Or is your RE just anticipating that's how many it will take? I don't think you have to commit to 4 cycles and stress yourselves out financially. You can do whatever number of cycles you can realistically afford and in the end know that you did everything you could and gave yourselves the best chance at TTC. GL with whatever you decide to do moving forward!

Edit* formatting

libellula28 · January 2018

My RE said at 4 cycles, my chances are about 50% for a live birth, and that's why he suggested it. I am leaning to IVF, just because it makes sense to go more aggressive. It's frustrating because I'm ovulating, my partner's sperm is great, everything is working, but I cannot get pregnant and I don't know why...

I appreciate your message and positivity. It's so easy to get caught up in feeling sorry for yourself. So, thank you!

kiwi2628 · January 2018

Honestly, I am a bit surprised with your RE. At 41, a lot of REs skip IUI and go right to IVF, so I am surprised they even botherd with TI cycles with you and with an AMH that low. I in no way want to be a debbie downer, but I would do some research on IVF success for your age. While I am not AMA, I am huge into research, so while I never focused on the AMA stuff, I read quite a bit pertaining to it. Most of the stuff I have read shows much lower stats than 50% for over 40...a lot of what I have said said maybe 20% success, unless you use donor eggs, and I have seen much lower stats than 20%. I would seriously research a lot more so you have the more realistic expectations possible, but I would jump right to IVF at your age and AMH.

cseley321 · January 2018

I agree with previous posters. I would not waste my time and money with IUI. Prepaying for 4 cycles though seems like a bit much to me though.

libellula28 · January 2018

I have the option to purchase fewer and freeze any embryos that are not used, has anyone done that?

cseley321 · January 2018

@libellula28 yes, what normally happens is you do an egg retrieval, they fertilize the eggs and see how many embryos make it to 5 days. If you are able to do so, they will fresh transfer 1 or 2 embryos and freeze the rest.

If the fresh transfer fails, they will thaw 1 or 2 embryos next cycle and try again. This continues until you run out or become pregnant.

ndz2018 · January 2018

@libellula28 I am also AMA at 37. Our Re said she finds one thing wrong with us and it’s straight to IVF, she knows we don’t have time on our side when it comes to the quantity and quality of my eggs. Unfortunately we had MFI and I had a septate uterus that I had removed this past Monday. Though my AMH was 4.17 and we retrieved 29 egg, 25 were mature, 21 were fertilized with ICSI Bc of Low count and morph and 12 made it to day 5. With those 12 again because of our age we did PGS testing, and out of those 12 we had 5 normal embryos and they are all frozen. I personally wouldn’t waste my time with IUI, though i never had the option of them and only know 1 person personally it worked for. If you guys can swing it I would say your best chance of conceiving is with IVF, NO DOUBT, with low AMH and AMA. I know it’s a tough pill to swallow, trust me especially when I see friends who are my age doing this naturally and succeeding but I bit the bullet and now we are just waiting for our FET this March and HOPE it’s works!

cseley321 · January 2018

Also just fyi, I had 6 IUIs at age 33 and all failed (my insurance required it)

libellula28 · January 2018

I appreciate all of your response, this has helped tremendously. I agree that it seems IVF WOULD be the best route to go. Does anyone know if you can increase your follicle count? I was able to raise my AMH, but would love to raise that follicle count, as well.

Again, thank you all so much. I talk to my bf, and he is supportive of anything I decide, so he doesn't help make the decisions. He thinks everything will work out and wants me to just stay positive, and it's hard to talk to him about the reality sometimes.

ndz2018 · January 2018

@libellula28 I would take exactly what you’ve been taking Your prenatals, ubiquinol( my RE told me 600mg a day I do 300 in the morning and 300 At night your best bet to get them in a higher dose is Amazon that is where i got mine), and Vitamin D I was Taking 5000iu. I don’t know much about DHEA, and don’t like playing around with Hormones but if your doctor recommends it take it. Lots of antioxidants, super foods filled with lots of nutrients, eat as clean as possible etc. Im not sure it it will help you count go up but it wouldn’t hurt to try!
Also if you’re going to do IVF, I would make an app ASAP unfortunately at 41 our chances decrease as each day goes by so the sooner the better. You should totally still try naturally while getting ready for the appointment but personally I wouldn't Wait on this. I wish you the best of luck and if you have any questions or concerns you’re more than welcome to DM me! Have a good day doll!

Irisheyes81 · January 2018

@libellula28 I think it is amazing you are considering all of these expensive and invasive options to grow your family. This is a hard place to be!
My advice would be:
Skip the IUI. I asked this group this question in the beginning of my journey and got similar feedback that you are getting. I should have listened. IUIs provide so much hope (follicles will grow, sperm count is good etc) and then it fails and you have no explanation why.
With that said, IVF is very expensive, emotionally draining and tough on a marriage. If you can see yourself being happy doing anything else, I would say do that. For most of us on here (me included), I never would have forgiven myself for not trying absolutely everything. 30K is a ton of money but it's also a drop in the bucket compared to a lifetime with your child. There are great financing options and ultimately, it's money. If you don't spend it on this, you will spend it on something else.
Finally, my friend had a really high FSH. She was only 34 but was diagnosed with LOR. She had 4 follicles that they could count at that point. She did stims (a LONG stim cycle) and ended up with 15 eggs retrieved. She responded really well to the medication and the doctor was slow and steady but pretty aggressive and it paid off. ***TW*** her wife is pregnant by reciprocal IVF now (their transfer was last month) and she has two frozen embryos. ***End TW** They did PGS as well and all three were genetically normal. It seems you never know what is going to happen! I'd make sure your RE has a great success rate in your age group and they have a protocol specifically for your diagnosis. Good luck!!

libellula28 · January 2018

@Irisheyes81
Did you choose to do IVF, and was it successful for you?

I can understand how to IUI could be a let down month after month, because you're right, everything is working right, but the outcome isn't what would happen when everything IS working right. It would be very taxing, I'm sure. I guess I am scared to go ahead thinking, IVF will work, and it not. I don't know how all of you have done it, and so bravely!

tosh24 · January 2018

@libellula28 My clinic requires a psychologist consult before proceeding with IVF (not like a psych screening, but just a consult to discuss expectations, realities of treatments, etc.). Even if yours doesn't, it might be worth getting the contact info for a fertility therapist (your clinic may have one) and sitting down for a chat. Basically, the psychologist I spoke with took a brief history where we discussed our struggles and how we ended up considering IVF. We went though realistic success rates and she basically tempered our expectations. She didn't say the odds were not on our side, but she did discuss the possibility of needing multiple cycles before finding success, or possibly not finding success at all and how it would be a grieving process in order to move on with life. It was kind of nice to just sit down with her and work out everything that was swirling in my head. Basically, it came down to regrets for me. Would going through IVF and not being successful be completely devastating? 100% yes. But would I be able to move on with my life and not have the "what ifs" consume me years down the road if I never tried? For me, the answer was "no". So, that's how our decision was made. It is a total leap of faith and there is some inherent risk in that. As much as we all like to compare ourselves to other peoples' stories and their successes, unfortunately, none of us have a crystal ball. It's really going to come down to whether or not you are willing to take that risk and how you will be able to cope with potential failure vs. never trying at all (or choosing a different path to expand your family). GL!

dragonette505 · January 2018

Just popping on quickly to say:
The reason they may have increased your success percentage is because they are planning multiple cycles. The real deal is that over 40 statitistically you don’t get to 40% and higher till you hit like 7 cycles
https://mobile.abc.net.au/news/2017-07-24/ivf-success-linked-to-multiple-rounds/8736186

Theres more articles and you tube vids on this subject. I’m 44 and have actually done 7 ivf cycles so trust me I know it’s not a little thing to consider.
the baseline success rate in your 40’s on the high end is around 20% or so.
But we aren’t just numbers...
my suggestion is to start with ivf and HOPE you only need one cycle! It totally can happen and I think it’s important to approach this thing with hope even while knowing the math...
hoping it all works out!!

Irisheyes81 · January 2018

libellula28 ***TW*** I did have success with IVF. We had 3 pgs normal embryos and am 13 weeks pregnant now after our first FET***End TW*** Every diagnosis and situation is different and you really can't predict how it will go (IUI, IVF, TI etc). I also think the stress and expectations will be there regardless of your statistical outcome. It's a mind F@#K regardless.

Irisheyes81 · January 2018

@libellula28 I just felt bad when I published the last reply. It's hard to see someone in the beginning of this process and not talk about the struggle BUT there is no reason to believe treatments (whatever you, your husband and doctor) decide wont be completely successful. I hope you will be aggressive just because time is the enemy with pregnancy but you'll do awesome whatever you decide. Sorry if I came off like a jerk.

How to know what treatment option is best.

Re: How to know what treatment option is best.

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