Hop right to IVF or try IUI?

[Anonymous]

Hi, dealing with secondary infertility. I have preschool age son and had a missed miscarriage at 12 weeks this fall. In the middle of testing now and trying to figure out my next steps. So far, everything coming back "good". 19 follicles, AMH of 2.9, HSG was clear. I know I should wait for a consult with my dr to figure this out, but I am so impatient. What would your treatment path be in this scenario? Jump right to IVF? Try an IUI or two first? IUI is covered by insurance and IVF is self-pay. I am 39 and DH is 41. Thanks for any input.

[Anonymous]

At your age I wouldn't do more than one or two IUI (if any). Your numbers are great so you are likely to have success with IVF. IVF would also allow you to screen embryos to make sure they are genetically normal before transfer.

[Anonymous]

OP here, thanks for the quick reply. I don't have anyone in real life to talk with about this, so I appreciate this space. I think part of my hangup is that since the numbers are "good", I am reluctant to spend the money for IVF and wish it would just happen the old fashioned way or the free-to-me way with IUI. I know that is something I need to get over, but it is where my head is at right now.

[Anonymous]

I’d try one iui if you are ok with twins.

[Anonymous]

I’m in a very similar situation as you. My numbers were very good. Even higher AMH. We are trying TI with clomid and trigger for now. My doctor suggested it’s reasonable to start there given the cost.

[Anonymous]

I wouldn’t bother with IUIs unless you’re PCOS or sperm issues, and you can afford IVF. IVF itself is at minimum a 6 week process once you’re all set to go. I wouldn’t waste time with IUIs- for the most part they’re basically the same odds as conceiving naturally.

I did three IUIs, ended up miraculously conceiving naturally while waiting to start IVF, and am now in the middle of IVf for my second. My doctor did not even recommend bothering with IUIs this time, and I’m 31.

[Anonymous]

The IUIs are probably not going to work but your IVF chances won't decrease much if you try one or two for peace of mind. If the IUIs are medicated it might prime your eggs a bit for the IVF. There is some value in trying for the IUI in that it is a somewhat lower risk pregnancy.

[Anonymous]

I’m so sorry about your loss. You don’t say how long you have been trying, which I do think is relevant. If you have been trying for a while with no luck IVF probably makes sense, but if you didn’t try for much longer than 6 months for the baby you lost, I think trying IUI makes sense. Honestly at your age, the biggest advantage to IVF is the ability to test the embryos and reduce your risk of miscarriage. Although you can still miscarry a genetically normal embryo, but having a tested embryo definitely reduces your risk at your age.

[Anonymous]

I’d do one IUI and then do IVF.

[Anonymous]

OP here, thanks for the feedback. We got pregnant this summer on our second month of trying, which is the pregnancy that resulted in the missed miscarriage and D&C. We have had three tries since then, though, with nothing.

[Anonymous]

Anonymous wrote:OP here, thanks for the feedback. We got pregnant this summer on our second month of trying, which is the pregnancy that resulted in the missed miscarriage and D&C. We have had three tries since then, though, with nothing.

Did you do genetic testing on the POC from the D&C. If there was a genetic issue, I’d personally go for IVF with PGT-A to minimize the chances of a repeat miscarriage. But it depends on your tolerance for a repeat miscarriage vs the cost and effort of an IVF cycle.

[Anonymous]

Anonymous wrote:OP here, thanks for the feedback. We got pregnant this summer on our second month of trying, which is the pregnancy that resulted in the missed miscarriage and D&C. We have had three tries since then, though, with nothing.

That’s really not that much. I think you have a good chance of getting pregnant again naturally.

[Anonymous]

I had a consult and bloodwork at 39 at GWU, and decided with the doctor to go straight to IVF for the reasons PPs note. So my vote is for IVF if you can swing it. Our insurance didn't require IUIs, though.

[Anonymous]

Yes, we did genetic testing. I am not sure all the correct terminology here, so I apologize if this is not the right way to say it, but the loss was due to down syndrome.

[Anonymous]

I’d skip IUI. I think they’re a waste of time and money at that age. (Speaking from experience.)