IUI with SG - How Do They Help You Avoid Multiples?

[Anonymous]

I'm am under 35 and going to be starting my first IUI at SG (not sure what medications I will be taking yet). We're trying an IUI due to mild male factor issues. I ovulate on my own with no problems and my egg quality seems fine from what I've been told (normal day 3 levels). I do have slightly low AMH levels so I'm not sure how I will respond to stimulation.

I was wondering (please forgive my ignorance as I am new to all of this) but how does SG help/monitor/guide...not sure what word to use here...so that if you, for example, end up producing 2-4 follicles from the medications you are taking...and then you do the IUI procedure....you don't end up with triplets or quadruplets. I know there is a strong chance for twins and we're ok with that but I don't want to up the subject for another reality TV show!

Thank you in advance for your response!

[Anonymous]

I have been through two IUI cycles at SGF recently (Clomid + FSH injection + trigger injection). We also have male factor. In my first cycle I produced three mature follicles (all on one side) but the IUI was not successful. On the second cycle I produced three mature follicies on each side (six total) and the dr. cancelled my cycle because of the high risk of multiples more than twins.

[Anonymous]

2-4 follicles is what they usually aim for - with that, there may be a chance for twins but usually not more. (Just because there is a follicle doesn't mean there is a mature egg inside that it also is both chromasonally normal and able to thrive). But they generally will cancel a cycle if you have a lot of follicles, unless you are older and have a history of failed cycles. They decide when you go in for your ultrasound just before you trigger, and they usually will base the decision more on your estrogen levels than your number of follicles (your estrogen levels will correlate to the number of mature follicles that you have).

[Anonymous]

what size is considered a mature follicle?

[Anonymous]

OP here...thank you so much for your responses. I'm starting to "get it" more. But it seems like IUI's are a little like Russian Roulette. You don't know what you are going to get until you pull the trigger...3-4 follicles that either do or do not have mature eggs inside that may or may not fertilize. And then there is the whole issue of cancelling a cycle due to overstimulation and getting the medications to agree with your body. Seems really tough to get this right with little success rates attached to IUI compared to IVF.

Honestly, is IVF the better way to go? If anyone had to do it all over again, would you skip IUI and go straight to IVF where there certainly are challenges but it seems like there is a little more control over how many babies you could end up with?

[Anonymous]

13:35 here. After our two failed/cancelled IUIs and my erratic response to the meds, we decided to move to IVF. Even though I was not very optimistic about IUI, I am glad that we started with it. We got over the major hurdle of doing injections at home (which was much worse for my husband than for me) and dealing with the bloodwork and ultrasounds, and I hope that having some experience with all of that will make IVF a little less intimidating. Insurance coverage is a consideration for some people. There have been some recent news articles about studies that recommend going straight to IVF - often you end up spending less money and you get pregnant faster. If you are concerned about multiples, I do think that you have more control over that with IVF. Kate Gosselin and the family on "Raising Sextuplets" both got pregnant with their sextuplets via IUI. I don't think that would happen at SGF, but it surprised me that it was IUI and not IVF.

[Anonymous]

I went straight from IUI with Clomid to IVF because of the risk of mulitples -- but I don't even want twins. The doctors we spoke to all agreed that since we considered twins to be an undesirable outcome for us, going straight to IVF made sense. (We have unexplained IF with slight male factor and I am 32). Good luck with whatever you decide!!!!!!

[Anonymous]

Just to chime in on what the pp said, if you know that you absolutely do not want twins, does that mean you shouldn't even consider IUI and should go straight to IVF?

(I am just starting this process also & am trying to learn what I can before I see the RE next week, but I'm 39 and already have children. We definitely do NOT want twins, and we do want to be fairly aggressive as we really don't have time to waste.)

[Anonymous]

You are right that there is much less risk of multiples with IVF. However, IVF is much more involved (and expensive if you insurance doesn't cover it). Its pretty standard practice to try a few IUIs before moving to IVF. I had success (1 baby) on try #2 at age 35 at SG with IUI.

[Anonymous]

18:22 here. I have no insurance coverage for IUI or IVF. While cost is an issue for us, we qualified for shared risk at SG and they are letting us do single embryo transfer on day 3 (or day 5) transfers, so that cuts our risk of twins to about 1%. Our doctor (Dr Widra) has been very supportive of our desire to avoid twins. Good luck to everyone -- it sucks to have to worry about cost and risk of multiples while trying to have a baby/figure out the best treatment. I hope everyone has success!!!!!!

[Anonymous]

Anonymous wrote:18:22 here. I have no insurance coverage for IUI or IVF. While cost is an issue for us, we qualified for shared risk at SG and they are letting us do single embryo transfer on day 3 (or day 5) transfers, so that cuts our risk of twins to about 1%. Our doctor (Dr Widra) has been very supportive of our desire to avoid twins. Good luck to everyone -- it sucks to have to worry about cost and risk of multiples while trying to have a baby/figure out the best treatment. I hope everyone has success!!!!!!

I totally agree...it does suck to have to worry about cost, multiples etc. Makes an already tough process even tougher!

Poster 18:22 - I don't mean to be rude by asking such a personal financial question but do you mind sharing how you are going to pay for SG's Shared Risk program. My husband and I also want to be considered for their program but we're not sure if we should wait and continue saving so we can just pay cash (Its $22k, correct?) or just try and pay for half and finance the rest. Any suggestions? Thank you!

[Anonymous]

OP here...again, thank you so much for your responses and sharing your stories. You have all been so helpful and have given me a lot to think about.

[Anonymous]

Poster 18:22 here. We were very lucky and were able to pay for shared risk with cash (it is $20K w/out ICSI or any of the other "extras"). Unfortunately, we are now finding that we did not budget enough money for drugs. Because I am a "below average" responder and am now on Ganirelex not Lupron, our drug costs are about $4K/cycle. Hopefully you'll only have one cycle and hopefully you'll respond better than me, but I thought I'd warn you. I think SG has financing options for the shared risk. You could probably get info about that from one of their financial counselors. Good luck!!

[Anonymous]

Anonymous wrote:Poster 18:22 here. We were very lucky and were able to pay for shared risk with cash (it is $20K w/out ICSI or any of the other "extras"). Unfortunately, we are now finding that we did not budget enough money for drugs. Because I am a "below average" responder and am now on Ganirelex not Lupron, our drug costs are about $4K/cycle. Hopefully you'll only have one cycle and hopefully you'll respond better than me, but I thought I'd warn you. I think SG has financing options for the shared risk. You could probably get info about that from one of their financial counselors. Good luck!!

So helpful...thank you so much for responding. We're going to try and pay cash as well but I will ask about financing options. And thank you for the warning about budgeting enough for drugs. I have a feeling I am going to be a poor responder as well and will need to fork over some major $ bucks for the meds. I wish you so much luck with this cycle. Hopefully no more $4K cycles for you!