So, before I call my clinic and ask this most muddled Q I thought I'd ask you ladies
I understand if you overstimulate then IUI is sometimes converted to IVF. But how about the other way around?
My logic is with IVF if I only produce say 3 follicles then I'd rather convert to IUI. We have no male issues and so why risk egg collection with so few follies. Part of my logic for IVF is to hopefully stimulate enough to freeze and with only say 3 pre retrieval i'm guessing those odds would be slim too.
When I had my consult I asked the clinic about if THEY would cancel, as I was worried I wouldn't stimulate well. My Dr said as I'm not expected to stimulate well they would never force me to cancel, with a SET policy anyway 1 is enough.
But now I'm thinking more I'm just not sure I will want to proceed with IVF in that situation, but rather convert to IUI? Is it possible? Common? Do clinics usually refund the difference between the 2 if I chose to cancel?
I too have DOR (FSH of 16) but wanted to share this with you. My OB said IVF was our best chance. With the RE I met with, she suggested we try least invasive/ and inexpensive first for 2 months before jumping straight to IVF. We were supposed to do a natural IUI this month with a trigger. Well, I had a beautiful 20mm follicle on day 15 (a Friday) but the estrogen level didn't match so I was instructed to have sex the next two nights and come in on Monday for another ultrasound and scan. I ovulated over the weekend and totally missed the IUI. Here I am 2 weeks later with a BFP which completely surprised me after 3 1/2 years. The only different thing we did from any other cycle was progesterone even though my levels were "normal". Progresterone is relatively inexpensive and might be worth trying.
So, there is hope with DOR to get PG on your own. I just wanted to tell you not to give up! Good luck to you!
Hi Val - congrats on the BFP!
So you didn't even get the trigger?! Do you mean you just have progesterone for your LP? I'm taking that this cycle for the first time (crinone).
I've been pondering all day if I'm rushing into IVF tbh, I just can't decide whether to 'try' for longer on my own or not tbh. My FSH is fine, it was my AMH and my antral follicle count that were poor.
Why did your RE suggest natural IUI, do you have male fertility issues too? I can't think of the benefit of IUI without stims for DOR otherwise?
I still have the trigger shot in my refrigerator!! I should've know that I missed it when the ultrasound tech asked if I triggered over the weekend and I didn't. I started Prometrium after that ultrasound. After the 21 progesterone test, the doctor didn't like the levels (10.8) and said that she would like to see them higher at 14+. She also put me on Crinone which I am still taking. The thing that really bugs me is that other doctors said my levels were normal which is true but should've been higher for me anyway. The level yesterday was 27 so I know it is working.
For me (I will be 39 next month), my FSH was 16, my AMH was bad too but I don't know what the actual level was, and only 4 follicles. It only takes one though...
As for the Natural IUI, I had polyops removed last month which could've been the problem as well. My husband wasn't working which also factored into the cost because I don't have any fertility coverage except for diagnostics. As soon as they did the IUI, everything would be out of pocket. We had no reason not to try. My own doctor wouldn't even try an IUI. If this cycle didn't work, it was on to injectibles (Bravelle).
Yes, we do have male infertility issues with motility although not horrible. My husband started taking Fertility Blend for Men per the doctor's suggestion about a month ago.
We conceived out daughter the first cycle of trying after a miscarriage in 2004. She is now 6 1/ and begging for a sibling. We found out on her half birthday. My husband just received a job offer this morning. So, I can't tell you how amazing and weird that all this has happened the in past week.
I hope this helps as any information that we share may lead to that BFP! ( If you are near Chicago, I can give you my doctor's name.) Good luck to you! If you have an other questions, please let me know.
One more thing, I started accupuncture after reading information on how it can help. My RE has a link to how it can help with regular and IVF cycles. It might be something to look into.
Even with a low yield, your chances are greater with IVF because they can control more variables.
My first attempt at an IVF cycle was converted to IUI because I only had 4 follicles -BFN
My last attempt with IVF, I only had 3 follicles on a max dose of stims, and we went ahead anyway with IVF -BFP
Well I must have been psychic when I posed this, the following morning I had my first ultrasound and hadn't responded (300 gonal f for 3 days) as expected. Of 12 follicles, 9 had done nothing and 3 were already 14/14mm. Lining was 6mm.
The clinic continued me over the weekend with my 300 gonal f does and started cetrotide.
My next ultrasound is tomorrow and the hope is some other follicles have caught up.
Silverdollar - I'm really greatful for you reply as it sounds like you've been in a very similar situation. Can I ask when you say 'they can control more variables' with IVF, what sort of things do you mean?
My logic was that 3 follicles wasn't worth me going through egg collection and possibly losing one or more of 3 through the process, plus the cost ( having never had a cycle of stimms and iui before ).
My clinic will only do single embryo transfer too, so it would be 3 left in for IUI v's 3 removed for IVF and (hopefully) 1 returned. I suppose I was hoping for more to increase the chances of making it to egg transfer and maybe even having some frosties.
Would SET change your advice to continue onto IVf v's IUI with 3?
With IUI they are simply giving the sperm a ride past the cervix. The
sperm have to find and fertilize the eggs in the fallopian tubes all by
themselves. The IUI must be timed well to have these events coincide.
Your chances with IUI are at best about 15% per cycle.If an IUI is not
successful, you'll never really know why.
With IVF the eggs are removed, and they can tell whether the eggs
are mature, and a little bit about the quality of them as they can
observe them under a microscope. The chance of fertilization is much
higher especially if ICSI is used. Then they watch the cell development
and select the best embryo(s) to place back. Success rates are in the
neighborhood of 50-60% per cycle for someone your age, if you get a good
embryo or two to transfer. This is where it is a bit riskier if you
have lower numbers because you can lose some embryos in the process. Usually SET is done if you can get to 5 days with a good blastocyst. I would have done an SET if we had blastocysts, but my clinic does 3 day transfers with lower yields, so we transferred the 2 we had. The theory was that an embryo may survive in utero, when it would not have in the dish. IVF
can be as much diagnostic as it is treatment, so even if it doesn't
work you'll have a better idea about at what part of the process things
are potentially a problem.
However, the cost factor is a big one.
Most clinics will recommend trying a few IUI's before moving to IVF if
there is no known factor that IVF is needed. Don't forget about the cost
of the medications though. 300 units of Gonal-F is a lot, and that's
thousands of dollars towards much lower odds if you convert to IUI.
Taking more meds will not necessarily mean more eggs. The eggs have to
be there in the first place (not all follicles contain eggs or will
respond to medication). Most people are saturated somewhere between 300
and 450 units, so if you did another IVF cycle your dosage wouldn't
likely be a lot different. Ask your RE what the plan is for your next
cycle, and if he/she would expect your yeild to be vastly different on a
different protocol. If the answer is no, then it might just make better
sense to push ahead now with the 3 you've got as long at the lining and
other factors look good. Some clinics are worried about their stats and
turn away patients who have lower odds, so do your research and be your
I truly believe the next big breakthrough in the IVF world will
be better odds with lower numbers of eggs. Currently the trend is to get
tons of eggs and to expect a lot of loss at each step of the process.
When they get to the point where they can harvest the one egg that a
woman produces, and keep it alive and thriving through each step, then
those of us with DOR won't be at any sort of disadvantage.
I hope that helps. Please update how your u/s went and what you decide to do.
Thanks Silverdollar, that all makes a lot of sense.
Today - Day 6 of stimms (300 gonal f a day for 6 days and 4 days of cetrotide so far). Follicles 18,17,15,12,11 and the remainder all very small. The nurse thinks I might go to ER with 5 follicles and it is scheduled for a week today with one more scan on day 10 of stimms. Aren't the 2 big follicles ready already? Is it bad quality wise they grew so fast and now will just be hanging around waiting? Lining still 6mm, not grown at all in last 3 days :(
It looks like we will plough on to egg collection and what will be will be therafter. I have learnt a lot from this first cycle though and I doubt very much I will be staying with this clinic for future treatment.
I am really unhappy there is no blood monitoring and that the nurses as kind as they are just want to 'fluff' everything up rather than us have a proper conversation about progress. I feel in the dark really....and the consultant has disappeared in a poof of smoke it seems, I am trying to get to speak to him on friday day 10 of stimms and last ultrasound before EC on Monday.
Your 2 largest follicles may be over-ripe by Monday, but perhaps they'll let those 2 go and aim to get the next batch instead. Your lining needs to grow a bit thicker before it will be ready for an embryo. I think the minimum is 7mm.
It concerns me that you haven't been monitored with blood work though. The estradiol levels are critical in determining medication dosages, timing, and what your body is doing. You are at very low risk of OHSS, but for someone who is at high risk, not monitoring blood levels is downright dangerous and could be fatal. It's definitely worth questioning your RE about that and looking at different clinic options if this cycle is not successful.
Thanks again SD - I really appreicate you taking the time to reply, I'm feeling a bit isolated with it all right now.
Yes the clinic said the minimum was 7mm for the lining, though i had hoped it be comfortably in the 'good' range tbh.
I've been thinking today (too much!) and i'm confused why now right when things are close, they are not seeing me for an u/s until friday......so I'll have had a baseline scan, day 3 stimms, day 6 stimms and then lastly a day 10/11 of stimms.
Seems to me like there might have been a point where my big follies might be say 20 -and possibly still ok - and then smalls might be 16, but we'll not know if they don't monitor me more closely and like you say the big 2 we'll probably have to just let go :(
I'm particularly concerned about ER on monday when last U's is friday, I chose this clinic as it was a 7 day operation and now it seems like I *should* be at ER on sunday but they're avoiding that schedule.
Re the bloods i've been googling that and looking on pubmed and everything about estradiol suggests it's only value is to assess if the ovaries are suppressed sufficiently/ true fsh on CD3 (ie is estreadiol suppressing fsh) and then monitoring alongside u/s is only really relevant for those at risk from OHSS. The studies that showed E2 doubling as important are now 10+ years old and seem to have been superseded by newer studies that contradict.
I wonder if that's why I have had no E2 beyond baseline bloods, because i'm not at risk of OHSS. Perhaps my clinic do monitor it for other patients.