When to move to IVF?
Hi ladies. I've been lurking here for a while and not "officially" moving on to IVF- but this is where my question comes from.
When did you ladies decide to move from whatever protocol you were using (I'm assuming for most IUI/injectibles) to IVF? I know everyone's story is different and it depends on these situations, but I am really struggling with this and thought it might help to hear others stories.
AFM- we've been TTC for 2 years. I went off BCP in Nov. of '09 and we were JLIH, but obviously didn't work, so in April of '10 we began actively TTC. I did 4 cycles of Clomid with my OBGYN then was referred to RE. I did 4 cycles on Femara, 1 cycle of Femara/IUI, and 2 cycles with injectibles/IUI- all BFN's. This month, we are taking a break and I have a LAP scheduled for May 18th to rule out endo. They can't find anything wrong with me or DH and RE doesn't really expect LAP to show anything, but we are doing it just to make sure.
Here is my struggle, the nurse told me over the phone the other day my RE traditionally wants to do 2-3 more cycles of IUI/injectibles after the LAP. We are paying out of pocket for everything, so as you know, it can add up really fast. I'm struggling with why we should do 2-3 more cycles of IUI, especially if the LAP doesn't find anything, when it will just eat into our IVF budget. I know IVF is more invasive and expensive, but I also know it gives us a better chance than IUI. It sounds terrible to say I want to get the most bang for my buck- but when you are paying out of pocket- it really is the case. Also, I am a teacher and this summer it would be a lot more convenient to go through all the appts I know IVF will require. Soooooo I feel like there are so many "what ifs" and I have no idea what direction to move in. End of the school year + big decisions like this = super anxious me.
Hi Meg, I don't post much anymore, though I'm still around and reading.
For us, it was the final next step. I was 42 when we married so we figured we'd have problems, and were open to adoption. Lo and behold, 6 weeks later there was that positive pg test! It was quite a surprise, but our joy was shortlived - I miscarried at about 8 weeks. 11 months later a chemical pregnancy, and 3 months after that another pregnancy that ended by 7 weeks. At that point we sought more extensive medical help, lots of testing and 4 failed IUI's, at which point we decided we had better success rate on our own. 15 months after the third pg, an almost perfect repeat of the first. With the first and last we saw heartbeats, and then it was gone.
I won't go into the heartbreak - it's devastating to lose over and over again.
We never expected this. To not get pregnant was what we anticipated - we weren't prepared for multiple loss. After a lot of testing the answer seems to be age-related, and our doc is recommending adoption or donor egg.
We've vacillated a LOT on the donor egg - I was so unsure how I felt about putting myself through the stress of a pregnancy for a child that wouldn't be genetically my own. Then, in Feb, not long after my last loss we met with a family member with a newborn and I held that baby, and cuddled him and realized that I was too caught up in details... I honestly, at that moment, realized I didn't care anymore if the child was genetically mine or not. I still feel that way. Adopted, donor egg - it doesn't matter to me anymore. I'm done grieving the genetic loss. Dear Hubby is having a harder time with the genetic loss than I am - he wants to keep the DE a secret, while I don't.
We've decided to go the DE route for a few selfish and a lot of pragmatic reasons. Selfish- we'd like a genetic link to at least one of our future children and, once you get that pg test you have a definite time line for the family expansion; Pragmatic; it turns out that the DE program nearby is cheaper than adoption. I don't want to live the uncertainty of waiting for a call from an adoption agency - especially if there'll be a long wait. I'm already going to be a very old mother, I don't want to compound it anymore than we have to. :-P
We've talked to two different centers, and found out that we have some financing options that we were not aware of, so *fingers crossed* things will start happening soon.
I was in the same boat as you expect with possible sperm problems (controversial - ie we still don't know). My re still insisted we do clomid and iui even though I ovulate normally. We have insurance but I didn't want to waste our time. I think he thought we would get pregnant, but we were also approaching the two year mark without a pregnancy. . He agreed at the outset to try ivf if 6 mo of clomid and iui didn't work. So here we are. Egg retrieval is Friday. I agree with you that the summer is best if you are not working. This has been difficult for me professionally but the constant doctor visits are soon over. And the expense is overwhelming. Only time will tell if it was worth it. I can't tell you what to do, but I would ask what he would do if his sister was in your shoes.
Our IF journey started in 2006. I charted and most of my cycles looked textbook perfect, but I didn't get pg. We had basic bloodwork done with an ob and quickly moved on to an RE (my FSH was elevated; my DH has super sperm). Sitting in his office, we were given our options: 1) try Femara/IUI, 2) try injectables/IUI, 3) try IVF, 4) try IVF with DE. We were never told that we had to do any treatments in any order, but we just weren't quite ready to jump to IVF (with or without DE). My DH and I were told to tell our RE what we wanted to do. We started with Femara/IUI (maybe 3 cycles?) before deciding that we might as well go for the "big guns." We decided we were willing to try two IVF cycles with my eggs before moving on to DE. It was an agonizing decision to make. IVF is expensive, time consuming, and emotionally difficult because you have so much invested in a cycle. I didn't make it to ET in either cycles because of my poor egg quality. At that point, we decided to try one more IVF cycle, but with DE. We had to save up for a DE cycle and decided to use the remaining Follistim that we had for an injectable/IUI cycle (which worked). In retrospect, I am still happy with the decisions we made. There are no right or wrong decisions about when to move on and try something else. If you feel that you're ready and would like to try an IVF cycle this summer, I would talk to your RE. Oftentimes, they don't know which patients are OOP. Yes, you will save money if you get pg without jumping ahead to IVF, but if you don't get pg with IUI and wind up doing IVF later then you're out that money. IF is a game of odds and your odds are definitely higher with IVF (although the cost is higher, too). Is your DH any help? My DH, even now, just says he'll go along with whatever decision I make about IF treatments.
It is a hard decision to know what to do especially when you are paying out of pocket for everything. It's not as easy to do what the doctor wants when the cost is more.
In my situation my RE didn't even want us to try IUI because he felt it wouldn't work. At that time we knew we were dealing with MFI. He wanted to jump straight to IVF. DH and I want to rule out that IUI didn't work before moving to IVF. We were paying out of pocket and felt we would always question the "what-if's" had we not tried IUI first. We did three cycles of clomid/IUI that failed. We then moved onto IVF and did 3 cycles. 2 failed cycles and one cycle that resulted in pregnancy and ended in m/c.
Meg, Your thoughts are exactly what I had! DH and I couldn't afford to try all the options if IVF was really the best for us. Luckily, my RE agreed. What is your diagnosis so far? I know you are getting a LAP done to rule out endo, but what has been discovered up to this point? I had unexplained IF for two years. I didn't get my fully diagnosis until a loss and then IVF.
DH and I went to IVF because we couldn't afford to keep trying other methods in hope it would work. Also, when we did get a diagnosis, it confirmed that other methods aside from IVF were useless.
First, I would want to know what the reasoning is for doing another series of IUI/injectibles after a lap, especially if the lap shows nothing, there are no different variables afterwards than what you have right now. When you talk to the doctor, maybe he can give you success rates for people in your situation (unexplained) with the different treatments.
My original doctor suggested IUI/clomid, followed by injectibles, followed by IVF. Me being stubborn, was convinced that after my surgery that I could conceive naturally and decided to try naturally. After about 9 months, I saw a new doctor, who talked all in statistics. He said based on the condition of my tubes and time since surgery, he estimated I had a 2-3% chance of conceiving naturally (and a huge chance of ectopics if I did get pg-I actually did have 2 m/c during the time I tried naturally that were suspected ectopics). With IUI, a 2-3% chance, maybe a little bit higher just because of multiple follicles. IVF-30% chance of a baby. My diagnosis is primarily tubal damage/endo, and with the time since surgery, it was pretty straightforward for this second doctor.
Even with that information clearly spelled out to me, it still took 3 more months for me to actually decide to start IVF. I was very anxious and sad about it, and I had a very hard time making the decision. After a failed cycle in December, I hit a real low and suddenly I just KNEW that I did not have a chance unless we did IVF. I just KNEW I was wasting my time and spending a lot of emotional energy on trying naturally and I was just DONE. The decision just became totally clear to me at that time. So, I started IVF without ever having done any IUI's.
Since you are paying out of pocket, I can especially see why you are questioning more IUI's. If the success chances are really different between IUI and IVF at this point for you, I'd probably move to IVF sooner rather than later, if I were you. I hope once you get all the information, your decision becomes easier. Good luck!
I agree with you. When you look at cost/chance of actually conceiving, I sometimes wonder why they really send us down the IUI route. I would ask your doc what the chances are that endo surgery is going to work. If they find endo, the next thing to do may still be IVF. I would ask about that.
Hope you can move ahead with this soon and that your TTC journey is coming to an end soon.
Thanks ladies for all of your responses. This is such a tough decision and it really does help to listen to all of the factors everyone considered in their own decision.
I do have unexplained IF. They can't find anything wrong with me or DH. RE said the only reason we are doing LAP is because it is the "textbook" thing to do next as there aren't any other factors he can find wrong and there are things that apparently a LAP can uncover that he wouldn't see on a u/s.
DH is very supportive- but we both feel confused. Our mentality has always been once step at a time. We are trying not to look too far beyond the LAP as we have no idea if they will find anything, but for me this time, it's hard not to consider what the next step will be.
To try to stay positive, I have at least age in my favor. I'm 27 and know I have time ahead of me to hopefully get PG- but still its been over 2 years and I want to make the right decision for us. I can't imagine going through this for two more years.
So much of what you've said really lines up with how my DH and I have been feeling about things. (Right down to being a teacher, and summer being MUCH more convenient for dealing with the major time factor!) It's so hard to make the decision to move to IVF. For us, our ages and the multiple losses have made the decision for us. We really do feel like if we gave it more time and were willing to chance the additional losses, we would eventually be successful with IUI. We know we can conceive...we've done it repeatedly. But, we can't stay pg. Because time is working against us, and because my sanity can't stand the constant wonder about WHY, we decided that it is now time to move on to IVF. Because we have no idea what is causing the IF and the losses, we are hopeful that one way or the other we will at least have some kind of answer about the egg quality question after the chromosome screening. We can decide what else to do, if anything, from that.
In the end, you have to do what feels right for you. Whatever that is, it is the right decision. I've got everything crossed for you! We've both been at this for about the same amount of time, and it is time for us both!!! :bigarmhug: