Why try IUI if success rates are better with IVF?

[Anonymous]

I've read that IUI success rates are low. I'm new to this whole part of TTC, so I'm wondering about the thought process here. If success rates are not any better with IUI than trying to get pregnant without any help, why bother? Is it just because it is a less invasive, less expensive option or am I missing something? We've been trying for a year with no success, why would the thought be that IUI could help?

It would seem that 3-4 cycles of IUI cost the same as one cycle of IVF, why wouldn't IVF the first time around be a better option?

Also, generally do docs limit the number of times they will try IUI before they roll you to IVF?

Like I said, I am new to all of this, so I am really just trying to understand options, pros/cons, etc. Thanks!

P.S. I have my first RE appointment in two weeks, so I plan on asking him those questions then. Just thought I would ask you all while I am waiting for the appointment.

[Anonymous]

Here was my thinking for going directly to IVF...

I had read about this clinical trial, which shows the benefits of going straight to IVF and skipping IUI w/injectibles http://dms.dartmouth.edu/news/2009/06/26_reindollar.shtml

Also, before you decide whether to do IUI or IVF, think about how comfortable you are with having twins. I really wanted to avoid twins, so I insisted on going directly to IVF after failed IUI with clomid. With IVF, you can decide how many embryos to transfer, which can limit the risk of twins. Also, there are "shared risk" programs for IVF, I haven't heard of that for IUI (this only matters if you are self-pay).

Otherwise, IUI is less invasive and less expensive, and some insurance (including mine) only covers IUI. But (I imagine) IUI is also pretty emotionally stressful and you still have to go through the two week wait (the worst part of fertility treatments, in my opinion). Good luck with whatever you decide!!!

[Anonymous]

I did three rounds of IUI and got pregnant with a singleton on the third round. We would have gone to IVF if the third round failed. Here was my rationale:

-IVF is significantly more invasive.
-My insurance covered 3 rounds of IUI.
-We had unexplained infertility and this is what the RE recommended.
-I think part of me still hoped that my egg and DH's sperm would find each other and fertilize the old fashioned way. Obviously with IUI, you're flooding the system with sperm/eggs, but you're not doing anything beyond that to assist with fertilization. I'm not saying this reason is at all rationale. In fact, it's kind of stupid. But for some reason, it was in my head.

[Anonymous]

To me, it boiled down to be MUCH less expensive. I DID NOT HAVE the money to try IVF. If I had, I would had gone to IVF.

Our case was unexplained IF and the RE recommended IUI - our insurance didn't cover anything. We tried once, it failed. Second time it worked.

We also changed insurances in DEC., to MDIPA and they covered 50% of IVF after you tried less expensive methods. They cover also 50% of IUI for 6 cycles.

I lost the pregnancy and went on to have my last IUI (now 28w pregnant) with the thought that if it didn't work, we would try to get a loan from capital one and do a shared risk thing.

Anyhow, I had a total of 3 IUI and 2 of them worked. After the first one we kind of found out what the issue was (DH needs more time to "recoup" the number of sperms, so we need intercourse or masturbation in a cup with at least 36hrs in between).

[Anonymous]

PP here:

Just wanted to add that I remember now why I preferred IVF, even though I didn't have money for it and ended doing IUI:

I like to have some control over things - I work as a nanny and had the opportunity to care for twins and singletons, and while twins are ADORABLE, I would prefer to have one baby at the time. First, I can keep working and going to school and down the road, it will be easier to pay for one college at the time.

Another reason that REALLY appealed to me after my miscarriage (it was a triploidy baby) was that with IVF I had the option of having genetic tests done on the embryos BEFORE implantation, and thus avoid future miscarriages due to a chromosomal abnormality.

And third reason, was the fact that I really hoped to have plenty of embryos left and use them on my schedule, as opposed to deciding to have a second and third child sooner because I am "getting older" and my eggs are getting older too.

[Anonymous]

OP - My RE definitely offered going straight to IVF on my initial consult visit, and I was 31. She said she would try IUI first, but there would be no problem in going straight to IVF if we had financial (or other) reasons to pursue it right away. IUI(s) didn't work for me, and now I am going to do IVF anyway. I did like that I got to understand the process while doing IVF, how the monitoring worked, how the injectible drugs made me feel, etc. before proceeding straight to IVF. I think I would have been way more freaked out if I hadn't done that. I only wish I wasn't exposed to the medicines unnecessarily, that is my only regret. The stats are pretty low for IUI success...but there seem to be alot that it works for. Good luck!

[Anonymous]

IVF is just way more stressful on the body, and emotionally. You'll have many more drugs in your system for longer periods of time, and many more shots (I think I did more than 40 each cycle, and that did not include progesterone support). Also, between the preparation, the cost, and what you are going through, most people find it more difficult to deal with a failed IVF cycle than an IUI. PP has a point about being able to freeze embryos for future cycles, but that assumes you'll have enough eggs and will be able to make enough good embryos to freeze.

[Anonymous]

One more thing to talk about with your RE... one round of IUI w/injectibles might help them better predict how your body will respond to an IVF round and what dose of drugs to give you if the initial IUI doesn't work. For example, I looked like I'd respond well (age 32, lots of follicles, FSH of 9, unexplained IF) so I started on a low to medium dose of the stims. It turns out that I am a poor responder (lucky me) and my first IVF round was almost cancelled. They later increased the stim doses, but it might have gone better if they had known from an IUI how I would respond to the drugs. But this is just a guess - might be worth discussing with your RE though...

Good luck -- all the initial decisions can be very stressful!!!!

[Anonymous]

Most insurances won't cover any IVF cost unless you try an less invasive means first (i.e. IUI). Simply a matter of cost for me....

[Anonymous]

1. Never planned on doing IVF, even though the dr told us that it would be the only way to get pregnant.

2. Insurance paid for some parts of IUI, while it wouldn't have for any IVF.

[Anonymous]

My insurance pays for IVF but not IUI. Nonetheless we are doing IUI. That's what the RE recommended. And I'm not sure we will ever do IVF, even if IUI doesn't work. So for now we are focusing only on IUI.

Like a PP said, IVF is much more demanding all around - physically in terms of the amount of meds, logistically in terms of monitoring and procedures, and of course, emotionally. We already have kids and I'm doubtful could handle even the logistical aspects of an IVF cycle with all the other stuff we have going on. Also, I don't want to be faced with having embryos "left over" and deciding what to do with them (I know not everyone has embryos left to freeze, but lots of people do and if we had a successful IVF, we would not ever use any frozen ones for future cycles).

[Anonymous]

Have done both. Got pg with both. IUI is cheaper, but less control as previously noted. I would disagree, though that IVF is more invasive or harder on body. Everyone is different as to how they respond to meds--maybe I was lucky. I responded to relatively low doses of meds with each (my MD--Sacks at CF was very good about being conservative with meds, let me skip taking BCP, e.g.) I had been nervous about IVF--thinking it was so much more involved, but frankly, it was easy. At CF, they do not do a mock retrieval like they do or did at SG so you are not put under more than necessary. I found the anesthesia to be quite pleasant actually.

Best thing I can say about IVF over IUI is if you have unexplained infertility, you may end up knowing more after IVF--we learned our issue and fixed it, got PG second time. Turns out our IUI success was a TOTAL and complete miracle. Our insurance covered our IVF so cost was not an issue.

I found the 2ww equally stressful with each and the shots were no worse for me with IVF. I also found monitoring to be the same--still the daily blood work and u/s during stimming. Never had an issue with leftover embryos--my md was Very conservative with me stimming (since I had already been PG/had baby)

If I were in your shoes, I might do a few rounds of IUI(2) and then move to IVF. But don't be afraid of IVF--I was and it is just no big deal. And I have the most beautiful little girl now too...

[Anonymous]

I agree with previous pp regarding IVF possibly telling you more. That was our case. After one cycle of IUI we moved on to IFV. Found out after the first round that we had 0 fertilization. It was an easy fix (with IVF) and we got pregnant the next IFV cycle. Also, I did not find IVF hard on my body at all. No side effect to the drugs, etc. Everyone is different so it may not be that hard for you. I just know if we had tried the recommended 3 cycles of IUI we would have wasted a lot of time so I'm glad we moved quickly to IVF