Weighing IUI vs. IVF

[Anonymous]

My RE has giving us the option of trying IVF, with the caveat that the chance of cancellation may be high because of my high FSH and age (39), or trying with IUI. DH and I have a number of factors to think about, including $$ as my insurance only covers the meds. But one thing that I'd like to get a better sense of is how difficult it is to go through either process. Is IUI really that much easier? I'd be doing injectibles, but obviously at a lower does than with IVF. But if we have to do 3-4 cycles of IUI to get the same results as IVF, maybe it would be quicker and easier to try IVF? On the other hand, the recent thread had a number of women my age respond with good results doing just IUI, so maybe we should just try that first. We do have one child, so as much as we want another this isn't a situation where we feel absolutely desperate to have a baby, although we're willing to try reasonable means and spend some money to have a second.

Any thoughts appreciated!

[Anonymous]

I have not yet had experience with IVF but I definitely think it is easier on the body to do IUI than IVF. This is such a tough decision because IVF has so much of a higher success rate the IUI. With IVF you are looking along the lines of 40%+ success rate where IUI is only 8%. Huge difference. I guess your decision would be based on how quickly you are looking to get KU. If you have the time and patience to spare I would go with a few cycles of IUI and then proceed with IVF. If time is a factor than I suggest going directly to IUI....hope this helps.

[Anonymous]

I agree with PP, the success rate is an important factor in making the decision. Your chances are much higher with IVF. Another important thing to consider is that the risk of having multiples is higher with IUI than with IVF since with IVF you can control/choose the number of eggs that are being transferred. If I were you and if money wasn't an issue, I would go with IVF but I know that IVF is extremely expensive and money is an issue so I don't know, maybe you want to try IUI a couple of times before going to IVF if IUI doesn't work. Maybe set a limit as to the number of times you want to do IUI: like 2 times max. and then IVF if it did not work. If you can do it financially though, I think you might as well go straight to IVF especially at your age, I don't know that you have that much time to waste...

[Anonymous]

What is your FSH?

[Anonymous]

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]

OP, here. Thanks; it is useful to hear others' experiences. My FSH is 18, so some of the usual success rates won't apply and there is a big question mark as to how I'll respond to the drugs. My RE gave us the same success rate doing 1 round of IVF, if they don't have to cancel the cycle, as doing 3-4 rounds of IUI. I don't think multiples is as big of an issue because it is unlikely I'll produce that many eggs. The 3-4 rounds of IUI would be less expensive than 1 IVF, but I wonder if the physical stress of doing all those cycles plus the emotional roller coaster of all those two week waits would really add up, or whether it would just be easier to give IVF a shot.

[Anonymous]

OP, I agree about the emotional roller coaster. The two week waits are very hard to take emotionally. I was reading an interesting article the other day in which they were saying that when people stop fertility treatments it is usually not b/c they run out of money but b/c they are emotionally exhausted. I would do the IVF. Get it done in one cycle is better than stressing out for 4 months, not to mention all the many doctor appointments/ultrasounds that you will have to go to.

[Anonymous]

Anonymous wrote:OP, here. Thanks; it is useful to hear others' experiences. My FSH is 18, so some of the usual success rates won't apply and there is a big question mark as to how I'll respond to the drugs. My RE gave us the same success rate doing 1 round of IVF, if they don't have to cancel the cycle, as doing 3-4 rounds of IUI. I don't think multiples is as big of an issue because it is unlikely I'll produce that many eggs. The 3-4 rounds of IUI would be less expensive than 1 IVF, but I wonder if the physical stress of doing all those cycles plus the emotional roller coaster of all those two week waits would really add up, or whether it would just be easier to give IVF a shot.

First, the bad news: this internal conflict your having will very likely be moot - with an FSH of 18, you are unlikely to produce enough eggs for them to be able to proceed with an IVF cycle (four mature follicles is usually the absolute minimum). I could be and hope I am wrong in your case, but just a heads up.

Now, the good news: I had a highest FSH of 18.5 (averaging more like 12 on most months) at the age of 40 when ttc. I was doing IUI with injectibles (rather large doses too) and only producing one mature follicle each cycle. My RE was beginning to talk about donor eggs and let me know in no uncertain terms that I was not a candidate for IVF. An additional challenge in our case was that we were using frozen donor sperm (lesbian moms), which is far less successful than fresh sperm. I started doing acupuncture and taking traditional chinese medicine (individualized herbal blends that are brewed specifically for you based on the assessment of the acupuncturist) to augment our efforts. Acupuncture usually has a lag effect due to its nature of working to shift your own body toward health rather than just ramp something up artificially. The first month of doing acupuncture and TCM, my FSH reduced to 9 - still one mature follicle but more antral follicles than previously. On my second cycle during the period of doing acupuncture and TCM (in addition to the IUI and injectibles) my FSH was 6, and I produced four mature follicles and ended up pregnant.

We now have a healthy, amazing 3 year old dc.

So, I guess my advice is get thee to a practitioner of acupuncture and traditional chinese medicine who has expertise in treating infertility ASAP - and GL!

[Anonymous]

Not Op here but thanks PP, I also had a similar story- I don't agree that IUIs are gentler on the body than IVF- the entire IUI process up to insemination is the same as IVF- and the biggest arguments re. ART are the hormones- which- in my case and for what I am reading a common thread- is the same for IVF.. so- hormones- same- major prep and u/s- same- the added part of IVF is that your eggs will be retrieved - that is the biggest- DH still has to provide timely sperm as IUI, embryos will be placed inside of you instead of insemination (in IUI), very similar process- not invasive.. I am lucky since I had one IUI baby and after many failures an IVF baby too- we are a complete family!

[Anonymous]

I had 11 (yes 11!) failed IUI's & a resulting ectopic pregnancy resulting in the emergency removal of a fallopian tube...not a typical experience, but a possibility. IVF had just seemed too extreme over that year of trying with IUI. Waited a year, regrouped & had 1 IVF with only 5 retrieved, 2 fertilized, which resulted in one healthy DD. I wish I had done IVF earlier.

Good luck whatever you decide.

[Anonymous]

For the earlier poster who mentioned her success with accupuncture, can you share the name of your practitioner? I saw one earlier this spring who I liked very much, but didn't see much in the way of results.

Thanks!

[Anonymous]

OP - if you decide to try one IUI before moving on to IVF - try a back to back IUI. This worked for me. The process is the same as a regular IUI except that you come back the next day and have one more insemination. This helps in the event the egg release is "off" which I think was my case. I felt that my RE was telling me to have the IUI done too soon (even with the last shot that forces the egg to drop) (ALWAYS trust your instinct - it is not an exact science) and I told her so. So, she recommened the back to back and it worked!

Also, although I cant prove it, I think acupuncture helps. I did the acupuncture and herbs for about 2 months and then took a break from everything and then got pregnant the next month.

[Anonymous]

I have gone both routes successfully and would STRONGLY recommend IVF over IUI in your position for the following reasons. First off, your FSH floats around, so while it is 18 one month it might be lower the next. Our clinic had pregnancies with FSH as high as 13 or 14. I had a 13.5 one month and a 3 the next. So, while a high FSH is indicative of diminished ovarian reserve, it is not always predictive of stimulation response. (By the way, I am 41, six months PG after two IVFs; have 1st child after 1 IUI at age 37).

That said, onto my rationales for IVF.
1) In my experience, it is the fertility medicines, not the procedure that takes a toll on you. The more rounds of fertility meds you do, the more weight you gain, the more moody you get, and so on. With IUI, however, when it fails,( which for older women is at least 80 percent of the time), you typically have no idea why it failed, ie. did the egg fertilize but not implant, did the sperm not penetrate the egg, was it just poor embryo quality, etc. With IVF, however, you at least know whether the eggs fertilized, what quality they are and whether there is any sperm issue (ie penetrating the egg). This happened for me during efforts to conceive our second child. Having lucked out with the first baby on the first IUI, we went that route 3 or 4 times this second go round. My FSH was borderline still and my husband's counts normal. No luck and 5 months later we decide to go for IVF. First try, only one of 8 eggs fertilized. Surprise: Sperm problem that cannot be detected during normal sperm screening. So, second IVF, 8 eggs, all fertilize with ICSI, 3 implanted, 1 baby on its way. Had we continued with IUIs, we would have never known why we couldn't conceive and would have spent the same or more money doing so.
2) The whole anesthesia thing is a piece of cake. I was totally freaked by the prospect and after doing it, found it actually quite pleasant(think really deep refreshing sleep for about 20-30 minutes). In any event, it was a heck of alot easier than childbirth. You're out for 15-30 minutes and recovery is an hour.
3) There are only marginally more meds for IVF. All in all, the meds are the worst part--the extra few shots needed for IVF made no appreciable difference. And, here it also depends on the clinic. Some take a kinder gentler approach (Columbia)--I was able to skip taking birth control pills (I get migraines from them) and have no progesterone injections (painful) after the IVF. Plus, when one cycle was less successful, my MD (Preston Sacks) really examined the meds and made changes to the protocol to yield a better result. Some clinics take a one size fits all approach to meds--following several set protocols.
4) Cost--multiple IUIs with meds add up. An IUI is about 2-3K a pop. My IVF was about 8-10K (I am fortunate that my insurance covered it all). Also, some clinics (Columbia Fertility) help you get more of your meds covered by insurance than others (Shady Grove) by ordering them for you. Plus, in the end, if you are successful and have a beautiful baby, the extra money will seem like nothing.
5) Time: is not on your side. IVF does have higher success rates for older women (I was given a 40% chance at age 41) vs. IUI--18-20% (best case scenario). You can waste valuable time with IUIs.
6) Emotional toll of failure. You are no less disappointed when an IUI fails than when an IVF fails, and in my experience, I was more disappointed, because I didn't have any answer or idea why.
Hope this helps.
Good luck.

[Anonymous]

Anonymous wrote:For the earlier poster who mentioned her success with accupuncture, can you share the name of your practitioner? I saw one earlier this spring who I liked very much, but didn't see much in the way of results.

Thanks!

That's me. My guy, Dr. Mike Berkley, was in NYC, but perhaps they can give referrals in this area:

http://www.acupuncturecenter.com/

[Anonymous]

Very interesting discussion. I am currently in the 2ww of my 6th IUI and believe this will be my last. I have a feeling that my RE will want me to do one more since my insurance covers one more and I may consent to that only if it fills the time getting ready for IVF. I will never regret doing the IUIs because I think DH and I needed to emotionally prepare for IVF. But, I have come to believe that IUI increases our chances very, very little, if at all. The success rates for IUI are not much higher than trying naturally each cycle. I just completed an injectible cycle where I was doing well and producing a good amount of follicles but when my lead follie reached maturity they triggered me. This essentially means I may have ended up releasing 1 mature egg which is what I would have done on my own anyway sans all of the b/w, u/s, drugs, and IUI! So, what was the sense?
Anyway, I personally believe our chances are better with IVF, but think the whole process will be much more emotionally and physically demanding not to mention the $$$$$.