In which there is much blathering, but no decisions are made
Really, people, can't you all convene in a private room before commenting here, and come to a consensus on the IUI-before-IVF question before commenting here? I can't handle all the conflicting advice! One message, people, that's all I ask. I'm completely unable to make decisions.
Or not.
Seriously, thank you all for your thoughts and opinions. You've given us a lot to think about, and I think our answer (of course) lies somewhere in the middle: ask Dr. Quixotic what he considers to be the minimum number of IUI cycles needed to formulate an effective IVF protocol (based on my body's responses to the drugs), and probably go with that. I expect the answer to be "one or two" - is that reasonable? Thoughts in favor of doing only one or two IUI cycles:
(1) Emotions. While IUI is easier on the body, I think the higher success rate of IVF is easier on the soul. I'd rather have a month(ish) of utter hell, with a 45%-50% chance of a viable pregnancy afterwards, than several months of intermediate hell to get to more or less the same cumulative success rate.
(2) Cost. I need to look into this more, but we do have some IF coverage, and if it includes IVF (probably) and does not require a certain number of IUIs first, then there's no financial reason not to jump to IVF at the first medical practicable opportunity.
(3) High order multiples. Twins, we can handle. Quads or higher, I'm nearly positive we'd selectively reduce down to twins...but we don't know our rabbi's opinion on selective reduction, and I'm petrified of asking and hearing a "don't do it" response (especially since I think we would anyway). But the really scary scenario, in my head, is triplets. The risks (to mother and babies) are so much higher than with twins, but I don't know if its enough to push me over the edge to abort one of them. And, yes, Ezra and I have discussed this, at length, but neither of us feel we can make a for-sure decision when it's all still hypothetical. The chances of high-order multiples (as many other women have pointed out) are much higher with IUI (where you may release several eggs, all of which could be fertilized and implant) than with IVF (where you select how many embryos to transfer back, and the only way you end up with more babies is if on of them happens to split).
(4) Long-term side effects. I'm at an elevated risk for ovarian cancer. We haven't yet spoken to a risk management specialist about this, but I suspect the general advice would be that the fewer times we kick my ovaries in the ass in an attempt to get them to cough up some eggs, the better.
...and how could I forget (5)? Inevitability. It's defeatist of me, but I'm just pretty damn sure that we're not getting a baby until we've gone through at least one IVF cycle. And with that outlook, why should we waste time on IUIs?
On the flipside, we have the issue of leftover embryos. I know it's something we should consider well in advance, and we certainly will come to a conclusion before said embryos are created, but...well, just "but." I don't know.
Any further comments from the peanut gallery are welcome, and I assure you we read every one. Well, I do, and then I shout down the hall to Ezra and disturb him from whatever he's doing and bug him with whatever new tidbit you've shared, and then he nods sagely and says, "OK, but how about we see whether the Clomid works first before worrying about that?"
Men.
A few people have remarked on Nurse Patient's decision to take me off the metformin. I admit that I was somewhat surprised by this decision of hers, and I do plan to bring it up before moving on to another treatment cycle. However, given my response to Clomid so far, I really don't think I'll be doing another round of it. The emotional meltdowns are petrifying, the visual effects have me worried, and the very thought of remaining at 100 mg - let alone increasing my dosage - has me running for the hills. On the off chance that I do agree to another Clomid cycle (and Dr. Quixotic will have to be very convincing), I'm pretty sure I'm going to insist on restarting the metformin, or else a good explanation as to why I shouldn't.
Now, if any of you you have any information on the use of metformin during injectibles cycles in women with PCOS without insulin resistance, I'd love to hear it.
Symptom watch, for anyone who cares: OPK negative (hey, I have to throw them out anyway); nothing but sad little horns from the Orchestra Pit; and my cervix is a tight-lipped, frigid bitch. I'm not expecting any good news after tomorrow's screening.
Labels: Clomid Monster
posted by Robber Barren at 9:53 AM
comments (9)
While the emotional impact of IUI is hard, the IVF is worse because you just put your body through some serious shit and when it doesn't work with the higher chances, well, there's always alcohol to turn to. I say go for the IVF.
Also, a good doctor won't pressure you into transferring more than two embryos if your religion poo poos (or you poo poo for that matter) selective reduction. It's such a personal decision and one that's not easy. But my doctor said that if I was ok with selective reduction, to go forward with three embryos. If I wasn't, then there was no question.
(how appropriate that the first part of my word verification is PIO. I can't escape it.)
Oh! Sorry if I wasn't clear - the selective reduction concern is with IUI, where there's always a chance that the ovaries will pop out more eggs than you want them to. We absolutely would not transfer more than two embryos in an IVF cycle.
(And speaking of word verification, what's this crap where I can't actually read the letters because they're too smushed together?)
I'm actually going through something very similar. I have PCOS, no insulin resistance, but am currently on 1500mg metformin. My doctor says it can be very effective even in women who are lean and not IR, but I've been on it for 6 months with no apparent effect on my cycles, so who knows. Also, I hate my RE and am looking for a new one, so there's that.
I just had my second canceled Clomid IUI--no response at 50 mg, one follicle at 100 mg but on the wrong side (I only have one fallopian tube). BTW, I actually used letrozole for my very first cancled IUI cycle (yes, I have had THREE canceled IUIs--ugh) and had a great response, but ovulated early (thus canceled)--but a study came out late last fall (http://www.medpagetoday.com/Endocrinology/Infertility/tb/2231) showing that women who became pregnant after taking letrozole have a slightly higher chance of birth defects, so my RE recommended that to be on the safe side, we switch to Clomid. On the other hand, my Clomid response has sucked and my letrozole response was great, so...
Anyway, because my Clomid response has been so poor, my RE wants to talk about the possibility of trying low-dose injectibles, either that or going straight to IVF. The risk of multiples is a big concern for me (I have a uterine anomaly that would make even twins hugely risky), which is an argument in favor of IVF. However, I only have $10,000 in IVF coverage, which as we all know would be wiped out in one round. So I'm very torn.
With that overly long comment, I guess I don't have any answers or advice for you--just wanted to say good luck with your decision, and to let you know others of us are struggling with the same thing.
Sorry I missed all the interesting debating that went on in your last post. I'm sort of going through the same IUI vs. IVF issue that you're going through, although I'm currently in an IUI cycle. If this cycle doesn't work or gets canceled, I would like to go to IVF, but for some reason my husband wants to wait a little longer. I think it is because of the emotional impact all of this is having on me. Unfortunately, he's the one who has to deal with all the anger and sadness that comes with a failed IUI, and I think he's terrified of how I'll react if I have a failed IVF. I personally don't care about my emotional well-being post-failed cycle. I just want an effing baby.
Dude, I can barely read the word verification letters, I usually get them wrong at least once before posting a comment.
And yeah, that's the thing that scared me with the IUI/injectable cycles. I really don't have the desire to compete with the McCaughey's.
P.S. Word ver: bqbqqm
And suddenly, I don't understand why I'm craving ribs.
I'm pretty late to the party, but yes, I think the main reasons people choose IUI over IVF are psychological & financial. If you're ready, and you have insurance coverage, there are a lot of reasons to just go for it. As you may know, my own cancer risk was also a major reason I wanted to move fast to IVF. We only did 4 cycles total before IVF, and I only agreed to the 4th so we could qualify for the NYS grant.
I think a couple of medicated IUIs might give you useful information about what protocol to use for your first IVF, and if so, it'd be a cost-effective way of finding that out. Maybe it would also give you an idea of how prone you'll be to serious OHSS with superovulation. But ask your doctor how much IUI can actually tell you about all this.
As to higher order multiples: I'm sure you know that even if you transfer two embryos, there's a slight risk of triplets. And from a medical point of view, selective reduction of triplets is not necessarily recommended. Not that it's likely to happen to you, and not that you're anywhere near there yet, but if you're the type that likes to plan WAY ahead (and I think you are) you might want to read more about it at http://raisingweg.typepad.com/raising_weg/selective_reduction/index.html.
What specifically are the issues regarding leftover embryos for you?
Would you want to use leftover embryos to try for subsequent children?
If "disposal" is part of the issue:
One thing people who have leftover embryos but wish they did not do with them is to transfer them with no other medical intervention.
If leftover embryos are transferred at "the wrong time" (right before menstruation is expected) and no steps are taken to help them along, the embryos aren't being destroyed, but a pregnancy will very most likely not occur.
Anon - if we had embryos left over, and if a future IVF cycle and pregnancy was not medically contraindicated, we'd probably hang onto them long enough to do another transfer. But, yes, "disposal" is the concern. I had never heard of the idea of transferring under conditions unlikely to result in pregnancy - very interesting and definitely something to consider. I wonder if any doctors would go along with it, though...
Ok, not to minimize the emotional issues involved with leftover embryos at ALL... but if you were wondering about the halachic aspect, you might be interested in this Q&A at www.yoatzot.org:
"Excess embryos outside the womb have no halachic status. Thus they can be discarded..."
Speak up!
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