40, Gay, No Known Fertility Problems, But 4 IUIs & No Success - Help me with questions to my RE!

[Anonymous]

Hello, I am going to ask for a meeting with my RE. I am at SG and have had 4 unsuccessful IUIs. First two were unmedicated, third was with 50mg Clomid, and most recent was 75 iu of Follistim. RE has indicated protocol for next cycle is the same as the last, 75 iu of Follistim. I respond find each time and have excellent antral follicle count, good mature follicles upon stimulation (for medicated, 1-3 mature and then lots of smaller ones behind), good Estrogen levels mid-cycle, clean HSG, and fine FSH etc.

I don't know if RE is on auto-pilot with my protocol or if he really thinks IUI represents a good chance for me. I am going to schedule a meeting with him, but I don't know exactly what to ask and last time I met with him I kinda of became a shrinking flower and yes woman. ("Ok sounds good ok ok right, thanks.") My goals are to make sure that he is paying close attention to my case (which admittedly is kind of vanilla), that he/we are doing everything we can, that he is individualizing my treatment based on what has happened so far down to each detail of the cycles, and that he discuss with me a longer term approach and when moving to IVF should happen and why.

I think I'm being hampered by fear of IVF and also the idea that I plunk down $15k for it and boom if my 35% chance of pregnancy doesn't work out then it's over or almost over. I'm scared to risk it all on one IVF. It seems mentally easier to risk $3k multiple times for IUIs that have a 15% chance, but yet here I am lots of cash in already and no success. Same issue many have.

Please help me make a list of things I can or should ask or say to my RE. I think I actually need to bring in something I've written down with me or I'll waste the opportunity.

[Anonymous]

The problem is your 40 and you should be more aggressive although I think a 35% chance of success may be generous. I'm 41 and have fallen into the 65% unsuccessful group for 3 cycles of IVF.

[Anonymous]

You honestly seem like you have things covered. Your second paragraph about the things you need to is quite incisive.

1. Doctor, do you think IUI is really the best for me, based on what you've seen in my charts?
2. Are there other protocols we might be trying? Anything I can do on my end to improve chances?
3. What do you see as my next steps. If I am unsuccessful, when would you recommend moving to IVF, and why?

[Anonymous]

"things you need to KNOW...." sorry.

[Anonymous]

See below. This is interesting. Let's say at age 40, with otherwise stellar fertility, your doctor has said you have an 16% chance each cycle. After 6 cycles, you have a 65% chance of becoming pregnant after 6 cycles. Maybe keep going....

IUI - Clinical Pregnancy Rate Probability

This chart looks at the probability of becoming clinically pregnant after n IUI cycles. The IUI Success Rates are hypothetical (not CFAS). Refer to your clinic for their expected success rate.


IUI Pregnancy Probability Chart
IUI Success Rate 1 cycle 2 cycles 3 cycles 4 cycles 5 cycles 6 cycles
06.00% 06.00% 11.64% 16.94% 21.92% 26.60% 31.00%
07.00% 07.00% 13.51% 19.56% 25.19% 30.43% 35.30%
08.00% 08.00% 15.36% 22.13% 28.36% 34.09% 39.36%
09.00% 09.00% 17.19% 24.64% 31.42% 37.59% 43.21%
10.00% 10.00% 19.00% 27.10% 34.39% 40.95% 46.86%
11.00% 11.00% 20.79% 28.97% 36.78% 43.73% 49.92%
12.00% 12.00% 22.56% 31.85% 40.03% 47.23% 53.56%
13.00% 13.00% 24.31% 34.15% 42.71% 50.16% 56.64%
14.00% 14.00% 26.04% 36.39% 45.30% 52.96% 59.55%
15.00% 15.00% 27.75% 38.59% 47.80% 55.63% 62.29%
16.00% 16.00% 29.44% 40.73% 50.21% 58.18% 64.87%
17.00% 17.00% 31.11% 42.82% 52.54% 60.61% 67.31%
18.00% 18.00% 32.76% 44.86% 54.79% 62.93% 69.60%
19.00% 19.00% 34.39% 46.86% 56.95% 65.13% 71.76%
20.00% 20.00% 36.00% 48.80% 59.04% 67.23% 73.79%

[Anonymous]

i agree with the PP that said she would be more aggressive. At 40, you are going on an uphill journey of sorts because it could take a while to get pregnant, egg quality is an issue and miscarriage is more of an issue - the chance of miscarriage/poor egg quality could put you back at stage 1 of trying to conceive again and with each try your age gets more close to 45 bringing more risks.... I think I would want to go to IVF sooner and also I think that with gay women, it is so much more difficult to predict the amount of trouble they will have conceiving. Unless you discovered you were gay later in life and have some history with heterosexual sex and lack of contraception along with lack of conception they could be looking at unexplained infertility without knowing it. I know so many women who are straight and can tell a dr that they have been with multiple people, had a variety of situations where they could have gotten pregnant and didnt, or even young pregnancies followed by termination proving they COULD at some point get pregnant....you get the idea. You also arent able to hope for a surprise BFP with regular sex happening at home that could result in a pregnancy should you get so lucky. These are just my thoughts from having discussed this with various gay couples I know hoping for the same and struggling with their decisions.
All of that being said, I think you are very smart to bring in something written down. I freeze in front of every dr and then berate myself later on the way home. Strategy is important and you will feel better once you go over a list of things with them assuring you you are on the same page.

[Anonymous]

did you ever stop to think your child will wish for a daddy? It takes two parents to raise a child.

[Anonymous]

Anonymous wrote:did you ever stop to think your child will wish for a daddy? It takes two parents to raise a child.

Are you effing kidding me? Get lost.

OP, I'm surprised they haven't been more aggressive. SG is really pretty quick (at least in my experience) to go for the gold so to speak. I can't believe they haven't brought up IVF yet. Can you possibly ask another doc to consult on your case?

[Anonymous]

OP here, I know, my RE at SG seems so not in a race with this protocol. I'm not sure of how kosher it is to ask for another RE there to review my case, but maybe I'll see if Chang can review. My guy is not a newbie there by any means though. He should know what he is doing.

[Anonymous]

One benefit of Shady Grove (and one reason I may switch there from CFA, even though I like CFA) is that they have many more ways to help cope with the costs of IVF because they do such a volume business.

They frequently conduct studies that are looking for participants in return for reduced IVF, they have financing plans, they have the "shared help" program that offers reduced fees to people who meet certain income requirements. While you are continuing with IUI or trying to figure out your next steps, it may be worth meeting with a financial counselor and really nailing down the cost of IVF for *you*.

No doubt, it's going to be expensive. But if you could get a sizable discount or a payment plan you could live with, maybe it'd be easier to make the leap.

Good luck, friend. I am right there with you, just a smidge younger.

[Anonymous]

Shared risk is just another business move to increase SG's bottom line, it's a factory that takes from many to help a few.

[Anonymous]

I wasn't talking about Shared Risk. I said "Shared Help."

http://www.shadygrovefertility.com/shared_help

[Anonymous]

And, I mean, maybe this sounds callous but I never got the idea that Shady Grove is a charity. All REs want to make money. So of course Shared Risk is a business move on their part -- that's why they screen out women they don't think they can get pregnant in six tries. It is what it is.

[Anonymous]

Clever marketing, but they are experts at that!

[Anonymous]

Chang used to be at CFA. 15.34, you are a jerk! I am single, straight, ttc, too. Would you consider embryo donation? More expensive than IUI, less than IVF.