Weighing IUI vs. IVF

[Anonymous]

for any readers of this thread who go to Columbia Fertility's Bethesda office----be sure to doublecheck your insurance benefits. I have found the insurance coordinator in that office to be extremely unreliable. She told us this summer that our policy required 6 IUIs before proceeding to IVF. Distraught, I contacted the insurance company independently and was told there was no such policy. The rest of the Columbia Fertility office has been absolutely fantastic----really warm, knowledgeable and responsive. So while the medical staff is great, just know that you should independently verify all of your coverage information.

[Anonymous]

OP, I'm glad you brought up this question as it has generated some very helpful answers and suggestions. I'm turning 38 soon and had our dc naturally at almost 35 but had some complications of bleeding that has now left me so that I don't ovulate and my estrogen stays low. We would a second child and recently started IUI. The first cycle had a slow response but produced 3 mature follicles but unfortunately no pregancy, just overstimulation syndrome (very bloated swollen abdomen). Then for the second cycle of IUI they bumped up my FSH injection just a bit and I ended up with 9 medium follicles that they were afraid would all mature if we proceeded. They gave me the option of switching to IVF, which looking back now I wish I took, but we weren't emotionally ready to give up on IUI and proceed with IVF. So they stopped the injections and triggered early in hopes that only a few will continue to mature. The second IUI cycle was also a failure. We are currently on a break as I still had cysts left from the 9 follicles on day #3. We were planning on a 3rd cycle but as I started my period and am on day #1, I'm serious thinking that IVF may be better. After several months of going into the clinic every other day and getting blood drawn and u/s as well as rushing back to work in the mornings, it's very draining both physically and emotionally. Part of me wished that while we were on the break from our IUI that we would naturally get pregnant, so as my period started this morning, I was tearing.

So based on my experience, perhaps try one IUI but don't waste the time, then go onto to IVF. Especially if you work fulltime as I do.

[Anonymous]

OP here. Thanks for sharing your experience, PP. We started with IUI, in part because Shady Grove's lab is closed at the end of the month so we could get in 2 IUI cycles while waiting to start IVF. I've actually found the process pretty easy (notwithstanding numerous red tape and lost meds dramas), but I only have to go in for a day 3 & day 11 ultrasound, the IUI, and then the pregnancy test, and most of my appointments have been on weekends. My first cycle, I didn't respond well, but I had 11 follies at my Day 3 for this cycle, plus my meds have been upped, so I'm hopeful. If it doesn't work, we'll probably move on to IVF.

[Anonymous]

Anonymous wrote:There are a lot of misconceptions out there about higher success rates for IVF. There are so many factors to consider (age, factors contributing to infertility, etc.) that I don't really think those statistics are reliable. I am 37 years old and conceived my first child (now 18 months old) on my first IUI attempt. We have been trying for a second, and have now had 2 unsuccessful IUIs and 1 failed IVF attempt (with 3 seemingly "good" embryos). Before the IVF, my doctor told me the success rates for a woman my age are almost the same for an IUI and for IVF (about 36%). We went with IVF because (1) our IUI attempts had failed the second time around, and (2) I lost one fallopian tube during my first pregnancy, so we thought we needed to be more aggressive. Another factor for us was finances - our insurance does not cover IVF and we had a finite amount of resources to devote to the process. I can tell you that from a physical standpoint, IVF was (surprisingly to me) much more draining. The higher dosage of injections is not a factor because they are removing your eggs (so hyperstimulation is not as much of a factor) but the procedure involves general anesthesia and, even though the it's very quick, it is kind of challenging physically. From an emotional standpoint, I think the anticipation period after and IUI and an IVF are the same, it's just that the failure of the IVF is a lot more difficult to digest given the financial aspects. My advice would be to talk with your doctor about the pros and cons and make sure you ask lots of questions. In the end, you are taking your chances with either route because there are obviously no guarantees. My advice would be to do one IUI and if that fails go straight to IVF. This is simply because IUI is so much cheaper, especially if your meds are covered. If that fails, then I personally wouldn't bother with any more IUIs. I hope that helps. Good luck!

[Anonymous]

In regards to the anesthesia and wear and tear on your body, most IVF providers do not use general anesthesia. Instead, they use a mild IV sedation. As one PP said, it's a nice deep sleep for 20-30 minutes. As someone who has been through IVF sedation as well as general anesthesia for major surgeries, there is typically a HUGE difference in how you feel. For those off you who've had the severe post-op sore throat, the nausea, and lingering fatigue of general, you'll know what I mean. I just wanted to clarify so that noone gets freaked out by idea of the sedation used at most IVF facilities around here. You will probably want the day off (when you have an egg retrieval), but you will feel fine the day after (with the exception of the soreness that some women feel from the retrieval itself, and OHSS, which you can also have with an IUI).

I was an IUI failure, and an IVF success story. Like one of the PPs, it took me awhile to make the emotional jump from IUI to IVF. However, once we made it through a round of IVF (which took some doing for this poor responder!), I was thankful to have the bigger picture (where my eggs good quality? did my husband's sperm actually fertilize anything? etc.) -and I felt that way even before we found out we had a BFP!

[Anonymous]

I don't disagree that IVF may work better in OP's situation, but I wanted to share a different viewpoint as well. We had a unique situation, in that we had no trouble conceiving, but kept having miscarriages or chemical pregnancies. Long story short, we had 3 failed IVFs with PGD with one doctor, who was strongly suggesting DE. We switched to another doctor and asked about doing IUIs. Our reasoning was that if I produced multiple embryos, our chances were reasonable that one would be a "good" embryo and implant sucessfully, even if the others failed to implant and/or did not grow/were reabsorbed. We also felt that IVF/PGD might be too hard on our embryos. Our second IUI produced 4 mature follicles, two embryos implanted, giving rise to one vanishing twin and one beautiful DD.

Our situation was somewhat unique, and IVF may be the answer for most people, but I want to point out that IUI may work well for others. I also felt that IUI was easier -- I took fewer meds -- the monitoring was easier. The protocol was different for an IUI -- no Menopur-- and I responded more strongly to this protocol--our first IUI was actually canceled due to overstimulation.

[Anonymous]

OP here. Thanks. The IUIs didn't work for me, so now I'm on to IVF, which for me is MUCH more difficult on my body - horrible headaches, exhaustion, forgetfulness, etc. The IUIs were a breeze in comparison, and I'm glad I gave them a shot, although now I'm looking forward to giving IVF and assisted hatching a shot.

[Anonymous]

I'm 39, have a dtr from IUI at age 37. Failed IUI once again with not one 'mature' follicle and now have cysts, high FSH (13) and possibly endometriosis. Our insur does not pay for a thing so cost is a big consideration. I've started accupuncture (I wish someone told me about this a long time ago). We are struggling with what to do. IUI with higher meds or IVF. There does not appear to be one answer. Thanks for all the thoughts.

[Anonymous]

I had a Ectopic Pregnancy After that I have lost my Left Fallopian tube after waiting for 6 months I started planning normally but it didn't worked so I am going for IUI for last 2 times it didn't work but I will wait for at least 3-4 cycles more I hope by God's grace I may get pregnant. Pray for me Please............

[Anonymous]

I would also recommend acupuncture along with either IVF or IUI. My FSH was a little elevated, but dropped appreciably after one month of 2x a week appointments (I didn't do the herbs, but perhaps that would have helped even more).

[Anonymous]

It was really nice to find this discussion. I am going through a similar dilemma today, trying to decide between IUI and IVF. I was already leaning towards and after reading everyone's posts, I feel even more comfortable with this decision.

I'm 39 years old with an FSH around 8/9, and after over a year of trying naturally & doing accupuncture, I decided to go straight to IVF because I was also doing PGD to screen for a rare genetic disorder. My first IVF attempt this summer only produced 2 mature follicles so my doctor (also Preston Sacks) and I decided to do IUI. It did not work so the DR upped my dosage and I tried another cycle. The 2nd cycle I had at 7 mature follicles and 4 smaller ones. Out of that we ended up with 2 embroys suitable for implantation, but I still did not go pregnant. I started my third cycle two weeks ago with the same, higher dosage as cycle #2. However, this time I only have 4 mature follicles. My DR said he was leaning towards IUI because I did have some less mature follicles this time, which is an indication that I might have more if I try again another time. None of this is covered by insurance, so finances are a factor. However, even with only 4 mature follicles I still feel that IVF gives me a better change of getting pregnant or at least better understanding of what the issues may be if it does not work out. I have another 2 hours to decide, but I think my mind is made up.

Here's the DC area accupuncturist that I used: Dennis Barrow - http://www.dennisbarrow.com.