Try letrozole/iui first or go straight to ivf?

[Anonymous]

I am about to start treatments after a little over a year of trying and I am debating whether to try medicated cycles first, or just do ivf immediately. I’m 35 with lean pcos and no other known issues. I was thinking to do IVF right away for the sake of banking embryos for a second child, but I’m second guessing that decision after seeing just how expensive it will be. My doctor initially suggested trying letrozole, but also agreed that banking embryos from my young-ish eggs is never a bad idea, so she wasn’t super helpful in making this decision. What do you guys think is the best course of action here? Am I likely to even get enough embryos that it’s worthwhile if I could get pregnant with the cheaper treatment? And if I have a ton of eggs (AMH is 11) am I really less likely to conceive a second child with IVF 2-3 years later?

[Anonymous]

I don't know the right answer for you. I have mild PCOS. We conceived on the 4th IUI with my oldest at 36 (the first round we did with injectables). Started with injectables right away for my second and got pregnant on the first IUI attempt at 38.

I don't remember my numbers as it was 5 years ago. I think we planned on trying 6 IUIs before jumping to IVF.

[Anonymous]

Generally speaking, you're likely to have success faster if you go right to IVF, and also likely to have embryos left over since you'll likely be a good responder. That said, for lean PCOS, I would try maybe 2 rounds of letrozole before jumping in. Often PCOS just needs a jump start to regulate ovulation, then you can conceive on your own. IVF is expensive and hard, physically and emotionally. If you haven't tried medicated cycles at all, it's worth a shot IMO.

[Anonymous]

We were making similar decision (trying for year, tempted to do IVF) and ended up doing letrozole -- got pregnant on first letrozole cycle for first kid, did letrozole + ovidrel for second kid.

[Anonymous]

If there’s partial insurance coverage and you’re paying partially OOP, I would do 1-2 IUIs since you have a diagnosis of light PCOS. If insurance covers it, skip to IVF and freeze any remaining embryos for future use.

[Anonymous]

IVF. IUIs are a waste of time, money, and emotional investment.

[Anonymous]

I would try the letrozole first! I also was diagnosed with lean PCOS this year after I spent a year coming off the pill with nothing happening—no periods, no ovulation. I conceived on my first 5 day course of letrozole at 33 years old. My RE suggested trying it first before I did anything else, then moving to letrozole plus trigger, then IUI, then IVF. She said that women with lean PCOS usually respond really well and have a lot of eggs.

I recognize that I was super lucky, but as an anecdote, another friend in her 30s is currently pregnant with her 3rd and she has conceived every time on her first try with Clomid from a different RE in the same practice that I go to. Might be worth it just for one cycle to see?

[Anonymous]

Anonymous wrote:IVF. IUIs are a waste of time, money, and emotional investment.

I know they aren’t as successful as IVF, but they can work. We didn’t have IVF as an option and are very thankful we went the IUI route.

[Anonymous]

Ivf

[Anonymous]

If money is no object, and you want multiple kids, IVF. But Letrozole can work, especially for PCOS.

[Anonymous]

I also was lean with PCOS and conceived successfully twice with FSH injections.

[Anonymous]

Anonymous wrote:I also was lean with PCOS and conceived successfully twice with FSH injections.

Also any cycle with clomid did not work for me.

[Anonymous]

Pro in vitro
Banked embryos
Probably faster
More control
If it doesn't work out you know you tried your best
You may not be ready for #2 in 1-2 years (e.g. c section)
Leaves door open for 3rd kid
Chance the IUIs will fail and you'll end up doing in vito anyway
If you do PGS you can possibly avoid miscarriages
ICSI will avoid male factor infertility being an issue

Pro IUI
Cheaper (unless it doesn't work and you have to do ivf, then it will be more expensive)
Lower risk pregnancy (the placenta degrades faster in IVF pregnancies, they may ask you to induce)
Lower risk of c section, less medicalized

For me the biggest factor would be how badly you want a 2nd

[Anonymous]

Another iui letrozole success, first got pregnant at 34 and second at 37. Lean pcos too. Regardless of what you choose, recommend 2 or 3 months of supplements like ubiquinol etc. to improve egg quality, as egg quality can be issue with pcos people. First baby came on third iui, second baby on the sixth iui, which we did bc we needed to do six before insurance approved I’ve. I also went on Metformin, which I know isn’t recommended really now with issues with met, but I did it to prevent miscarriage since I had one earlier. I also cut out sugar and empty carbs for egg quality, eating low glycemic, and took inisitol.

[Anonymous]

Lean PCOS. I responded very well to Letrozole (2 or 3 mature follicles each time), but 4 cycles of it resulted in no pregnancies. We moved on to IVF and had success with our first FET when I was 36. Looking back, I wish we had gone straight to IVF, but you never know.