What Should I Do - 40 and Gay - Protocol/Next Steps Advice Needed Bigtime

[Anonymous]

I turned 40 a few days ago and started with IUIs at the very end of Feb. I'm gay (aka have not been trying) and so I have no idea what state my fertility is in, besides the age factor. I did a fertility workup at the clinic in Jan. and my FSH was 7, all other numbers were within the normal ranges, and on the Day 3 ultrasound, they saw about 13 antral follicles on each side (totalling 26). I did not do the fallopian tube flush/clearing. Protocol at that time given by the doctor: A few natural cycle IUIs and we'll see where we are after that. 1st IUI in Feb. was probably a bit late (I was confused with the OPK and got the sperm to the clinic late), on the second morning post an OPK positive reading. 2nd (and 3rd I guess) IUI in March, I did back to back following what I felt like was a + OPK reading. Since that time, I'm taking much better notes about what I'm seeing on the OPK. My nurse says don't wait for the line to exceed or even tie (I think I was waiting at least for a tie), but to count any clear line even if less than a tie. Most recent April IUI, I did not do back to back. Just came in a day after the "tie" on the OPK. The doctor, that time, used an ultrasound to guide the IUI b/c they always have trouble navigating to my uterus and he decided to be exacting. I asked the u/s tech if she could see if I'd ovulated and she said dummy you can't see the egg but I'll look for follicles and then said "Nope, don't see any follicles, might mean you already ovulated." My nurse confirmed this is what "might" have happened. I have regular periods and my OPK are pretty clockwork'ish on Day 14. But I wonder if I really need to get a jump on getting in for the IUI and go the day after I see any type of line, like the nurse said. Or maybe timing is not the issue. Also, my sperm donor has not had rockstar total motile count numbers post-wash, 10 mill (good), 7.9 mill (ok), 5.5 mill (not so good), 4.8 mill (bad). Motility percentages varied from 71% to 31%, but the numbers they give for the sperm's movement were always 1+ or 2 out of 4 I think.

Alright, what would be your next move? I feel like at 40 I want to have more urgency but also naturally am reluctant to go to the more invasive (physically and emotionally) and costly step ups. Should I continue with natural cycle IUIs, try some meds even though we have no idea whether I have ovulation issues, try no meds but a monitored cycle to try to get more info as to what could be the barrier, switch donors (I think I am doing this), try some sort of other fertility thing (supplements or acupuncture)? Help!

[Anonymous]

Hi- sounds like a less invasive natural cycle IUI. I did a natural cycle IUI and did the upfront monitoring (the blood work and sonograms in the morning), the HCG trigger shot, and then the insemination. It was ultimately successful for me and I knew that the timing was right. I think I'd try that once and see how it went - it would give you a lot more information and better timing. If that didn't work, I might also reconsider your donor - the numbers are ok, but it's not unusual to have much higher numbers after being washed. Of course, it only takes one sperm

[Anonymous]

I would do the HSG - to check the tubes and uterus. I had a polyp in my uterus which would have prevented me from getting pregnant. I had it removed. Also you might want to consider medicated monitored cycles to improve your chances. Also do 2 iuis per cycle, because there is a 48 hour window when you ovulate. As for sperm count, I had 5 million and then 7 million when I got pregnant.

[Anonymous]

Anonymous wrote:I asked the u/s tech if she could see if I'd ovulated and she said dummy you can't see the egg but I'll look for follicles and then said "Nope, don't see any follicles, might mean you already ovulated."

I hope she didn't really call you a dummy!

The previous posts both sound like good advice to me. Get the HSG just to make sure there isn't any obvious problem going on. Pregnancy rates are said to be slightly higher after an HSG (some kind of clearing/flushing effect?) so maybe that'll do the trick. I'd also go for closer monitoring and a trigger shot, but nothing more invasive/medicated than that if you don't want to go that route.

I'd also consider switching donors unless you're wedded to that guy for some reason. I'm a SMC wannabe using donor sperm and I had a count of 25 million post-wash. You're paying a lot for that stuff, you might as well get your money's worth.

If you aren't successful with those methods, the next move would likely be IVF. Medicated cycles don't work so well on women of our advanced maternal age (how I hate that term.)

[Anonymous]

PP here who suggested the natural cycle IUI with monitoring etc - I also agree that the HSG would help - it was a quick 2 minute procedure and was totally painless (and usually is unless there is a blockage - which would mean the IUI isn't going to work, so you might as well know) -
Also, for my IUI the sperm count washed was above 50 Million. Not to say that's necessary - but if you are going the donor route and paying for this, I think you might not be getting your moneys worth (unless this is someone you are heart set on for some reason).

[Anonymous]

Another SMC at 40 here--I'm the one who was asking about Shady Grove's natural cycle IUIs on another thread.

I would say maybe just pay for the monitoring and do the trigger shot, as suggested. Are you doing BBT charting? That should help you make sure you're ovulating.

[Anonymous]

i would do the HSG too.

[Anonymous]

I read somewhere that research shows that as long as the sperm count is 5 million or above, there is not a difference in success rates. The previous posters' suggestions are all good and don't involve a risk of significant side effects or multiples. Monitoring, especially with a trigger shot, should help with the timing. Reading OPKs seems to involve some guesswork if you're one of the many women who don't get a line that's darker than the test line or enough to read as a positive on the digital OPKs. Best of luck!

[Anonymous]

OP here. Thank you all! It feels good to know that people out there have knowledge and care enough to share it with a complete stranger. Beyond that feel good and support, it's actually practically helpful info!

Spoke to my Dr. and he is recommending 50mg of clomid, monitoring, and trigger shot. Before that, the HSG tube clearing. He said that the HSG takes a cycle or puts you out one cycle and you can't try then. I didn't get this, but it's disappointing to be out a month for it. But I guess it could be worth it if that's the barrier.

Apparently they really don't have a protocol for or do not seem interested at all in doing a monitored cycle without clomid. Dr. said yeah we would want to do clomid if we are doing all of that.

Though I have read the posts saying clomid for 40 yr olds is a waste or not a good protocol, I guess I'll try a cycle of what my Dr. is recommending and see what I think. If the clomid is heinous, then I'll suffer through one cycle and be done with that.

So this month will be natural cycle IUI, next cycle HSG, and cycle after that clomid/monitored cycle. I told him that I do not want twins, and he said we'll have to watch the follicles closely and cancel if we see more than 2. He said I may not have issues ovulating, so we have to be careful that the clomid doesn't do too much.

I wonder if I should give myself a tight timeline. Like at 40.5 I move to injectibles if not pregnant and then at 41 move to IVF.

[Anonymous]

OP - a few thoughts - I did my HSG same cycle as a treatment at DF and I had a friend who did it the same cycle as IUI at SG, so I don't see any reason to skip a cycle - In fact, there is a boost in fertility after HSG, so I'd push back and ask.
Second, if you don't want to do clomid, but want to do monitoring, then do it - that's ridiculous - I did natural cycle IUI at DF and have known several who did it at SG. That said, your odds will be better most likely with clmids.

Good luck!!!

[Anonymous]

Sorry for typo - clomid not clmids

[Anonymous]

PP 13:52 here: I wonder if he means by "putting you out one cycle" is that doctors usually wait around the time you are menstruating to schedule the HSG? They want to make sure you're not possibly pregnant, so they schedule it after your period ends, but before you ovulate.

In that sense, yes, you have to wait until the right time of the month to have the test, which does mean that's a cycle you might not do an IUI. But it's not like you have to wait ANOTHER month after that.

Doctors are are in love with that Clomid, aren't they? I've taken it, I tolerate it well, but I think that doctors can be a bit too kneejerk about it, becaues it's the first line of defense against unexplained infertility. But you're not necessarily infertile...like me, you have a "lack of exposure."

Definitely do your own research on this, but what I've been finding is that if natural/lightly medicated IUIs don't work, older women may want to skip injectibles and go right to IVF. So keep that in mind as you're considering deadlines.

[Anonymous]

Anonymous wrote:OP - a few thoughts - I did my HSG same cycle as a treatment at DF and I had a friend who did it the same cycle as IUI at SG, so I don't see any reason to skip a cycle - In fact, there is a boost in fertility after HSG, so I'd push back and ask.
Second, if you don't want to do clomid, but want to do monitoring, then do it - that's ridiculous - I did natural cycle IUI at DF and have known several who did it at SG. That said, your odds will be better most likely with clmids.

Good luck!!!

I'll email my nurse today and see if about doing the HSG so as not to lose a cycle. Good to know. Curious how much in advance of the IUI the HSG should be done. Hopefully my nurse can answer that. For yours, was it just a few days in advance?

[Anonymous]

Anonymous wrote:PP 13:52 here: I wonder if he means by "putting you out one cycle" is that doctors usually wait around the time you are menstruating to schedule the HSG? They want to make sure you're not possibly pregnant, so they schedule it after your period ends, but before you ovulate.

In that sense, yes, you have to wait until the right time of the month to have the test, which does mean that's a cycle you might not do an IUI. But it's not like you have to wait ANOTHER month after that.

Doctors are are in love with that Clomid, aren't they? I've taken it, I tolerate it well, but I think that doctors can be a bit too kneejerk about it, becaues it's the first line of defense against unexplained infertility. But you're not necessarily infertile...like me, you have a "lack of exposure."

Definitely do your own research on this, but what I've been finding is that if natural/lightly medicated IUIs don't work, older women may want to skip injectibles and go right to IVF. So keep that in mind as you're considering deadlines.

Ok thank you for these thoughts. I get what you are saying re: HSG and IUIs. I have un-exposed (aka lesbian) friends who around my age have had success with Femarra or injectibles and IUIs, so I'm holding out hope. I really don't want to undertake an IVF, though who does, right? The uncertainty and inconsistency of this all drives me nuts!

Lack of exposure, right! : ) Believe me, I've fantacized about getting some exposure instead of paying for and dealing with all of this. At age 40, with years of experience under my belt, I think I would even enjoy the exposure. But it ain't happening.

[Anonymous]

You may want to start a thread asking for a comparison of experiences of IUIs with injectibles vs. IVF (with injectibles) so you can get a better sense of what you are willing to try are after trying non/lightly medicated IUIs.

My understanding is that an unmedicated IUI with frozen sperm brings your chances to about that of intercourse. For women who haven't been able to get pregnant after trying for a while (not quite applicable to you), medicated IUIs seem to have a really low sucess rate (8% ?) per cycle and can end up being a waste of time and money compared to IVF because IVF has a significantly higher sucess rate. You might want to ask your doctor if your FSH and other test results point towards a more aggressive plan of action or what.