Anyone Injectables + IUI?

[BurberryLvr]

I've had 6 cycles of Clomid or Femara + IUI and am finally moving on to Follistim. I'm definitely a little apprehensive - both for the injections and the efficacy of injectables with IUI (DH has morphology issues).

Has anyone been through this? Should we just progress to IVF? TIA!

[beejerry]

I've just finished one cycle of injections w/ IUI. I did injection once a day for like 7 days, depending on the day of O. I find it helpful since even if you go straight to IVF, you still have to do injections yourself. I got four follicles from the injections, I only got one without drugs. So I would say it up your chance of getting pregnant. IVF isn't that much advance if you don't choose assist hatching. So if your insurance covers the cost (it is $2300!) I'd recommend it.

[sarahsar]

Originally Posted by BurberryLvr

I've had 6 cycles of Clomid or Femara + IUI and am finally moving on to Follistim. I'm definitely a little apprehensive - both for the injections and the efficacy of injectables with IUI (DH has morphology issues).

Has anyone been through this? Should we just progress to IVF? TIA!

It really depends so much on your situation. IVF definitely increases your chances of pregnancy overall (even without other techniques mentioned like assisted hatching), but a lot of it depends on your reasons for infertility. For example, if you had tubal issues, IVF is going to be far superior, since even with injectables/IUI, the egg and sperm have to be able to get from point A to point B, and if there is a problem with the tubes, they may not be able to do that on their own no matter how great of a response you have to the drugs. With male factor, you may also have good reason to go to IVF, since they can do things like ICSI, where a single sperm is injected directly into each egg, improving the chances of fertilization. With other issues, it's less clear why IVF would be better, although statistically the chances are better overall, but not as much better as with tubal and male factor. A downside of injectables/IUI is that there is a higher risk of higher order multiples than with IVF (triplets, quadruplets, and more), since with IVF you have more control over how many embryos you put back in.

On the other hand, IVF is definitely more expensive and more invasive. The drugs may be pretty much the same, but the doses will likely be higher (so more expensive), and you have to have an egg retrieval, which is a minor surgical procedure for which they may use anesthesia. Some insurance may cover IUI but not IVF. If it wouldn't cost you much out of pocket to do the IUI, it certainly would be worth a try. Everybody's insurance is different, though. I have one friend who opted to go straight to IVF because her insurance allotted a certain amount in total for infertility treatment, so she chose to use it for one IVF rather than a few IUIs (my insurance paid for nothing no matter what, so that was not a factor in our decision).

If I were in your situation (and I have been), I would sit down with the doctor and ask them some tough questions about your particular chances with each method (since it may be a lot different from other people you talk to who may have a different reason for infertility), what it is going to cost you, how many tries with IUI/injectable they would recommend before going to IVF, etc. Three tries of IUI followed by an IVF may end up costing you a lot more than doing IVF in the first place, but then if you succeed with your first try of IUI you'd be way ahead. No one is going to be able to tell you exactly what the right choice is, but at least with some data behind it you can make a more informed decision. I would also recommend looking at the info on the CDC website. This is for IVF, not IUI, but it helps to get an idea of what the success rates are for different clinics, different ages, reasons for infertility, etc. All of these treatments, be it IUI or IVF, cost a lot of money and put you through a lot emotionally and physically, so you deserve to be given as much information as they can give you so you can make the best decision possible.

Good luck to you whichever you choose! We will be rooting for you!

[BurberryLvr]

beejerry and sarahsar - Thank you VERY much for your input! Congrats on the pregnancy Sarah!

No one outside of DH, my mom, and I know about our whole infertility issue - and funnily enough - there is a lot of comfort in being able to spill my beans anonymously here. Thankfully, my tubes are ok (a nice-feeling HSG confirmed that ), but I do have PCOS so I don't ovulate typically. On Clomid, I'd get 2-3 mature follicles, but my lining would never thicken. With Femara, I'd get 1 mature follicle and slightly thicker lining - but my last cycle had to be cancelled bc I had NO mature follicles. I finished my last dose of Prometrium yesterday and am now waiting for good old AF to arrive.

Insurance covers 50% for us, so about $700 for Follistim per month - which isn't horrible, but since DH has morph issues (which seems to be a point of contention between different doctors - some who immediately want to do ICSI and some who say wait it out for a year to see what happens) - I just wonder how effective IUI will be for us even though increased follies is definitely a good thing.

The worst thing about the situation is that I feel our RE is pushing us so hard towards ICSI and IVF (ever since Day 1 even before we started Clomid and Femara) that he doesn't really listen to us. I would consider switching, but supposedly he's the best in the area. We're hoping he knows best and just isn't that great at conveying the reasons. Thank you for listening!

[sarahsar]

That is great that you have some insurance coverage. That definitely helps! Would it help with IVF or at least the IVF meds, or just IUI? I'm sorry that you feel your RE is pushing you towards IVF, although maybe it is an issue of conveying the reasons better. I wouldn't feel at all bad about pressuring him for some more information and explanation, because it is a big decision.

Just for some insight into how we decided - we ended up skipping from Clomid/IUI (did only 2 of those) to IVF, so I have never done injectables alone. In our case, we made that decision because I felt pretty sure there was an anatomical issue keeping the sperm and egg from ever meeting up. I didn't want to have a laparoscopy to prove it (insurance wouldn't pay for that either if it was for fertility reasons and I wasn't excited about having surgery that didn't have a high chance of getting me pregnant), so it was a bit of a leap of faith based on a suspicious, but not completely diagnostic, HSG. It turns out I was right (proven when I had a C-section and then later a laparoscopy after all) because I have extensive endometriosis with adhesions all over everything, in particular the ovaries. We could have done IUIs monthly for a year and it would never have worked because no matter how many eggs I made, they just weren't getting anywhere.

It is great that your HSG looked good, because that gives you more options and even a chance of spontaneous conception, but maybe your RE is thinking that with PCOS+male factor, two things working against you, IVF will maximize your chances. That is probably true, but how willing you are to do it depends on how squeamish you are about IVF/cost/etc. in general. I wasn't too freaked out about the IVF process myself, and I felt like it would be more cost-effective just to go for it because I didn't know how many cycles of other stuff we could afford to keep doing. I also was pretty nervous about the chances of higher order multiples with injectables alone. You also still have some of the same risks with injectables as IVF, because a lot of the risks are from the drugs (like ovarian hyperstimulation), and I wanted to subject myself to that as few times as possible. I can certainly understand, though, where a lot of people feel differently about all of those issues.

Not to sound overly pragmatic, but I think the bottom line with all of this is that ideally you would get pregnant as quickly as possible, subjecting yourself to as few procedures/drugs/cycles as possible, for as little money as possible. Whether that would mean trying injectables alone first or going straight to IVF for you in particular, you would better know. I don't know how old you are, but maybe that is playing a role in your RE's recommendations as well? The older you are, the more likely they are to go straight to IVF, while if you are younger time isn't as crucial. This is where I think it is so important to be able to trust your RE. A good one will have the same objectives you do (healthy baby as quickly, cheaply, and painlessly as possible), and enough experience to have the best guess of what will work in your case. It sounds like your RE has a good reputation, but maybe needs to give you a little more insight into his thinking in your situation.

I wish you the best of luck and lots and lots of baby dust! This infertility stuff is a rough road, but it will be worth it in the end!