If you knew then what you know now....

[maybebabiesrus]

**Warning - Very Long**

For those of you who still lurk or participate on TTTC, you may have some background already, but I'll give you the basics here:

Me: 33, DH: 32, Married 8 years

Off BCP since spring 2013, diagnosed with PCOS at 19 and had history of anovulation/irregular cycles/missing cycles.

My understand was that the "rule of thumb" was that BCP could take a while to get out of my system, so I gave it 6 months before I pursued any treatment.  In that time, I had long, irregular, heavy, or missing periods for the whole time.  

In December of 2012 I went to a new OBGYN to discuss these issues, and she ordered blood work and an ultrasound.  My first ultrasound was scheduled for January, but I missed it to to a weather-related travel issue.  I rebooked for late February, and she saw suspicious areas on the ultrasound that could have indicated a uterine polyp.  She said a polyp could lead to my heavy bleeding and could also act as a defacto IUD, so I had a follow up ultrasound and eventual HSC and polyp removal.  

Following recovery, my husband did an SA (all normal), and I did three cycles of 50 mg Clomid, unmonitored (June-August).  I caught a positive OPK in June and July but not August and had a very long cycle (40+ days) before a long and heavy period.  When I didn't have a positive OPK in the August/September cycle on day 20, I called my OBGYN to see if she would do "day 21" blood work to see if I missed it, and she instead referred me to the RE. 

I met with the RE for the first time last week.  While we know that I will have trouble ovulating on my own, so I'm sure that we'll have some sort of drug protocol to induce ovulation, he roughly explained the odds of success with a variety of therapies.  Since I have not had any tubal views done yet, he obviously can't specify the odds in our case, but it seemed pretty clear to me that he views Clomid/Clomid+IUI/injections/injections+IUI on a narrow spectrum of success rates (i.e. not a whole lot of data proving one is significantly better than the others for patients with clear tubes and good SA) as compared to the significantly better success rates with IVF. 

Since we are 100% OOP, finances will obviously impact our decisions.  Also since we're 100% OOP, insurance won't require us to do X number of IUIs prior to IVF or anything like that.  My doctor seems to be willing to go straight to IVF, if we decide that's the right choice for us. 

Clomid/Clomid+IUI/injections/injections+IUI all range from about $800 to about $2400 per cycle, where as IVF is more like $18,000 per cycle. 

I realize we could do multiple cycles of the non-IVF treatments for much less than one IVF cycle, but if we were not successful, we might still pursue IVF and would have been better off saving that money for the more expensive treatment. 

Obviously this is a position far too many of us have been in, as we deal with IF.  I'm sure every couple has their reasoning for the decisions they make.  

If you knew, at the beginning of your treatment, what you know now, following a positive pregnancy test, what do you wish you would have known?

From a wholly economics standpoint, I have to imagine that IUI cycles must usually result in a cheaper overall fertility treatment plan, since they are so often required by insurance companies, who are watching their bottom line and wanting to make a profit.  That fact leads me a bit toward the IUI-type treatment, but maybe it's too simplistic a view. 

[awkwardpenguin]

We decided for us, monitored Clomid IUIs and then on to IVF made the most sense. I stand by that decision even though it took 3 IVFs to be successful. We decided against injectable IUIs because of the risk of both overstimming and multiples. DW had a cancelled cycle on Clomid due to over response.

DW and I were just talking the other day about how if we were OOP we would have done a shared risk plan, especially if one offered elective single embryo transfer (eSET). Since IVF success rates hover around 50%, shared risk makes a lot of sense.

ETA: it sounds like monitored Clomid or Femara to get you ovulating without IUI might make sense as a first step.  It sounds like you may not have been ovulating this whole time.

[catscatscats]

We were in a similar situation, OOP, polyp that had to be removed, and we also had some MF issues with morphology, and I had diminished ovarian reserve. My doctor predicted 10% chance of getting pregnant with IUI.

We decided to give IUI a shot for a few cycles, and I'm glad we did. It's all a numbers game, and I was very lucky to get pregnant on the second cycle.

After the first cycle I was so discouraged, but I think it was a lot easier to be $800 discouraged than $20k discouraged.

[aliciar6]

When we first started TTC, I could tell that things would not go easy after I had 6 months worth of very long crazy cycles and the exceptionally rare positive OPK or temp raise to indicate ovulation. I tried clomid with my OB for 2 cycles and that didn't help. Had I known now, what I did then, I would have skipped our first RE. I should have known after leaving his office and feeling worse every time, that he was not the one to help us, and I would have skipped doing IVM and wasting that money.

We switched RE's and found one that had multiple treatment plans we liked that we could chose to take. So we switched insurances last open season since we found 1 that did cover IVF and meds where this RE was in network. We had to do 3 IUIs before they would approve IVF since I did not have any issues with my tubes being blocked. If I wouldn't have had the insurance, I would not have done the IUI's.

I didn't expect the IUI's to work, I had seen so many women with 4+ IUI cycles and no luck, but I held out hope since there are those who do get pregnant 1st or 2nd time. But it was a lot of wasted time going to the appointments. The IUI with injects was about triple the appointments from my clomid ones, and I had mild OHSS after it and had to take a cycle off.

We were lucky our first IVF worked, we didn't have any make it to freeze so if it hadn't we'd have been doing a fresh cycle all over again. At that point even with the insurance, I don't think I would have done it again, OOP, I know I wouldn't have.

Like catscatscats spending $800 vs $18,000 and it not working is a bit easier to take, but ultimately it's what you feel most comfortable with and the success rate really is what would have moved me to go straight to IVF.

I had a coworker who went through ARC (I think or Attain) and did a Once cycle plus package with the refund guarantee option. That was another thing we had looked into as well.

[busterpup]

The biggest thing that I learned (that saved us a ton of money and might with you, too) is that since DH has no medical issues and inducing ovulation was the problem, IUI really was not a good option when paying OOP. To me, IUI helps some just because it gets the good sperm in there, but it's really helpful for couple who have male fertility issues. For our husbands, plenty of good sperm would make their way into the uterus regardless.

What eventually worked (after paying for an IUI OOP, ugh) was to do injectibles and TI. The injectibles created multiple mature eggs so much better than the oral meds, which is what I was having trouble doing, and then the TI was fine because there were no sperm issues. I would try that for a few months and then go straight to IVF.

Note that your doc doesn't make as much money this way because TI is essentially free, so we had to specifically advocate for it. It wasn't one of the original options that he gave us. (It could have nothing to do with money, but that's my suspicion.)

Good luck!

[calliejo]

Hi, I've never actually posted on TTTC but I really wanted to respond to this post! It hits so close to home. For unexplained infertility I did...2 clomid rounds, 1 clomid IUI, IVF (Fail), FET (baby!).

My doctor is very aggressive with his recommendations and tells many (all?) patients to go to IVF instead of trying IUIs. I like this because in the end, it made my journey with infertility much much shorter than many people's. Of course there is a chance that I could have gotten pregnant for much cheaper, but I'll never know. I don't regret my decision because for me, time is worth more than money. I don't think I could have gone through failure after failure after failure of multiple failed IUIs. I don't know how these people with 7 or 8 IUIs can handle it!

Of course, it looks like your diagnosis is different. But I think you should listen to your doctor's suggestions and then take some time to think it over. Whatever you are most comfortable with is what you should do, because you are the one who has to live with the decision.

On the other board some people have questioned that your doctor is leaning toward IVF without even having all of your results. I don't think that makes him a bad doctor...if he has had great success with IVF over IUI it makes sense that he would guide people toward that route. I don't think that is necessarily a bad thing.

Good luck to you and your family!

[maybebabiesrus]

busterpup, that is an option on the list for us, but thanks for your input; it's good to hear others' experiences.