New member with WWYD questions

[persa]

Hi, just did my intro post and I'd love some advice

I'm 40,TTC our second kiddo. First one was only 5 months trying and super easy pregnancy (she's 2.5 now), this time jot so much. I have low FSH and AMH(ovarian reserve) and just had a laparascopy to fix a blockage on my right tube last week.

Because of age/hormone levels, my RE, who I just started seeing mentioned at my pre-op appointment that he is inclined to "be aggressive". When I asked, "so clomid and IUI?" he responded "clomid isn't aggressive"... So basically he wants to do injectables (he does Gonal F) but I'm really nervous about it.
We're supposed to meet with him next week to decide but MH and I need to figure this out pretty much by then since I'll start my next cycle next week.

The part that makes me want to go for it is my daughter's age, I don't want too much age difference between her and a sibling... But the part that makes me hesitate is the high risk of multiples... I just dont know if i can handle that.

So the WWYD part is this... Would you give it a few months, maybe trying clomid and IUI(possibly against doctors advice, he seems to think it won't work) , before going to injectables or would you just go for the injectables?

I'm hoping y'all have some wisdom for me to help me make this decision. Sorry this was so long...

[persa]

May 15, 2013 21:24:43 GMT -5 @starflower22 said:

Hmm.. you need to decide how open you are to the possibility of twins. Really, Clomid and IUI can give you twins so even your plan is risking it. Regardless, I am a firm believer in (within reason) going w your gut and speaking up for what you really think is your best next step. Don't let your Dr pressure you into anything you're not ready for.

Right but it's a much much lower risk of twins, is it not? And he said he'd do whatever we want but I guess he feels injectables are the way to go. I just am so torn.

Also, I was thinking of trying acupuncture as well, some ladies on my local board swore by it.

[G22]

Welcome. I honestly don't know a lot about the injectables, since I'm not to that point yet. I'm doing femara/trigger/iui right now.

If your iffy and your current RE won't do clomid, is getting a second opinion and option? Its normal to be nervous before taking the plunge into fertility treatments.

I think its really a personal decision on whether to give clomid a try first over injectables though. I can tell you what I would do, if I were in your position. Even though I know multiples are a possibility, I am at a point where I'd be OK with it if it happened. Fertility treatments don't automatically mean multiples WILL happens, but its more possible then naturally conceiving.

[KaraOrNot]

Well, if IUI and clomid didn't work, would you regret the time and possibly money lost? If not, give it a shot.

For me, I am at the point where I wouldn't want to waste more time and money on something that the doctor doesn't think would be successful. However, i don't know much about injectables, so take that with a grain of salt.

[discogranny]

I skipped Clomid and moved straight to injects. For me it was worth the increased money and the shots for the increased chance of success.

If it were me and I was 40 and already facing DOR, I wouldn't waste a minute. Think of it this way, if IUI doesn't work of you and you lose 6 months to a year on IUI before moving to IVF, would you regret that time? Also doing an injects cycle will give your doctor a picture of how you respond to the meds used during IVF. This becomes important because if you do Clomid only with your IUIs you could be a poor injects responder and not know it until you are in the much more expensive realm of IVF. Time is your biggest enemy right now and if your doctor thinks Clomid won't work, there's a reason for that.

My answers are negative Nancy, but I'm being real with you about what I would do. Good luck whichever way you decide to go!

[awkwardpenguin]

I think it depends on how low your AMH is. At 40 and with DOR, I'd be inclined to be more aggressive as well.

Often in IF treatment the protocol is 3 cycles of each treatment, but you can always try Clomid for one cycle and see how you respond. I don't know a ton about DOR, but my impression from a few women I've known on it is that often they don't respond well to Clomid/Femara.

[linz]

I've never done injectables but did clomid for 3 months - only had a response to month 1 and then moved to femara. I've always only had 1 good follicle so I wouldn't let the multiples thing scare you. I would just listen to your gut. If you don't want the shots then don't do it. If you have to move onto another dr that has a plan that matches yours.

[HoneySpider]

I don't have any advice but just want to say hi & good luck The ladies here have a lot of wisdom.

[womet]

May 16, 2013 8:38:20 GMT -5 HoneySpider said:

I don't have any advice but just want to say hi & good luck The ladies here have a lot of wisdom.

Same here. No advice but the PPs have great thoughts/suggestions.

[Deleted]

Add me to this list - I don't have any advice to offer, but the PPs have good thoughts & suggestions. Welcome & good luck!

[Deleted]

I'm 32 and have DOR with elevated FSH, I think I'm a 12, and low AMH. Both REs we consulted with recommended an aggressive route and really pushed to limit or skip iui cycles in favor of ivf. We also have severe MFI requiring DS and I don't think we will pursue treatment, but my REs defined aggressive as injectables and pushing hard for ivf. I was told the risk of multiples was much less.

[Deleted]

Also, low AMH is a crapshoot. The last RE said he's had patients get pg on their own with undetectable AMH levels. Given your age, I would look to be more aggressive than less since your levels indicate time isn't on your side.

[bronxgirl]

I don't have a lot of useful advice, but if I were in your shoes I would move on to injectibles. That's how I conceieved my daughter and she was a singleton. Obviously that's an anecdote, but although your chances of multiples may be slightly higher than w/o injectibles, you still have a higher chance of just having one. I'm also 40 and working on #2, so I relate to you. :-)

[dana2006]

I'm 38 and just completed my first medicated cycle, which included 100 mg of clomid, gonal F, and trigger shot. My RE was clear that we need to be aggressive, even though my hormone tests have show nothing abnormal. He wants me to go through only 2-3 cycles of timed intercourse using the drugs listed above before moving on to IVF, and I'm comfortable with that. The odds of timed intercourse are slightly smaller than IUI, which is not that stella either, and he doesn't want me to waste too much time and resources on something with such little chance of returns.   

[persa]

Wow, thanks for all the responses ladies. You guys bring up all the points I've been thinking about. The more I think about it, the more I'm starting to lean towards injectables. It's sort of what a PP said, I feel like I might regret the months I waited if I don't get pregnant without injectables.

I'm pretty ready to have another baby. I get so blue when I see all my friends with kids the same age having their second kids now. We were lucky to get pregnant with our first but man, secondary infertility is no fun either.

Big hugs to all of you working towards your first, I wish you all the best of luck. I feel so lucky to have my little monster.

[jewel]

I'm 30 with no ovarian reserve issues, but I'd like to have a few children, so I feel like I'm in a bit of a hurry.

Because of our dx (male factor) our chances of conceiving naturally are less than 3%, 3-5% for Clomid/IUI, and 5-7% for injectibles/IUI. There is a chance of multiples on clomid, and slightly higher for injectibles. However, my RE prefers to cancel the IUI if there are more than 2 mature follicles, and definitely if there are more than 3. You could always choose to cancel the IUI on your own, if you have more mature follicles than you are comfortable with.

The doctor feels strongly that IVF is the way to go for us. But, based on my age, the doctor said there'd be no harm in trying several rounds of Clomid/IUI. The clomid round costs me less than $200 per cycle, and injectibles are almost $2000. Because of the difference in cost, and the fact that injectibles only slightly raises odds of success, he recommends going straight from Clomid to IVF.

So, if I were you, I'd probably start on a higher dose of Clomid and see how your ovaries respond to one round. If they respond, then it may be worth a try. If they don't respond, then I would probably move to IVF.

IF treatment takes a huge toll on your wallet, body, and heart. You should do whatever feels most comfortable to you. My approach is the path of fewest regrets, so I always think - which decisions might I regret more. If I were in your shoes, I don't think I'd ever regret moving on to IVF quickly (because I would never know if less aggressive tries would have worked), but there's a chance I would regret taking too long to try IVF.

[changedname]

Hi Guys, still in Cancun, just popping in when I get internet.

Hi Persa - honestly, I agree wholeheartedly with discogranny. Yes, IUIs might would but more than likely with injectables.
if you are really worried about multiples, the easiest way to reduce the risk would be to do IVF and transfer 1 embryo each time. Research has shown that 1 IVf + 1 frozen transfer for 1 embryo each time has the same success rate as one IVF with 2 embryos transferred but with only 1-5% chance of multiples versus 40% chance.

I did 2 IUIs with femara last year, collossal waste of time. I did one IUI with gonal and then decided to jump straight to IVF to avoid anymore buggering about and wasting my time/money. My doctor is agressive.

[rugbywife]

I am on a low dose of Clomid right now (only 25mg) and I have one follicle that is still really small (12mm on day 12)...honestly, if they give me the choice, I might jump at injectibles next cycle rather than go another round of Clomid.

But we are okay with the idea of multiples, I think, lol.

[persa]

Thanks again guys. We're going to the doctor today so we'll see how that goes. My husband is more inclined to wait but he also understands my urgency. I think he's fine with doing the gonal F and iui but I'm fairly annoyed with his blase attitude about it all right now. He hasn't read or done anything proactive. Maybe I've got a mistaken view on it but I feel like just because he's leaving the final decision up to me, that doesn't absolve him of the need to educate himself.

[persa]

Update:

We met with our RE last week and he explained that it's still a pretty low chance of success even with Gonal F and IUI and he just doesn't think clomid would work. He also explained that due to my age and AMH, I would be much less likely to have a risk of multiples, closer to 10% chance rather than 25-30%, so that made me feel sort of better (in a way, though it was a bit of a unintended slap in the face)
Oh, and the part that made my heart almost stop was when he said that if we did IVF, he would most likely put in 4(!!) embryos just to get one baby. Shit.

So we decided to do the Gonal F and IUI this cycle. I'm also doing acupuncture as well. He just went up on my dose from 150 to 225 yesterday since my follicles weren't that big and my estradiol level wasn't as high as he wanted. I go back day after tomorrow.

[KaraOrNot]

Good luck!