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Tuesday, 01 July 2008

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Aurelia

You know, every time I read that study about folic acid, I just want to jump for joy.

How many years did I feel guilt about my supposedly lousy eggs causing my son's death, when meanwhile it was just as likely my husband's sperm causing the problem? I mean, yea, it's sad if it was him too, but holy, at least I don't have to feel the full weight of all the blame.

Oh about those aromatase inhibitors? They might be effective for pain relief, but every time I've taken them I've turned into a serious bee-yotch. Mood swings galore. But then again I'm moody whenever I'm hormonal so that might be it as well?

Heather

Interesting articles all of them. I will have to disagree a bit on the IUI front. For some, IUI is the only affordable option. For others, like me, it works. I recognize that a higher rate of multiples is dangerous. However, if done properly with proper monitoring there should be no surprises. I am glad that I was able to go the "old fashioned technology route" and not have to deal with ER or ET.

I will also add that my clinic is participating in a study that is researching IUI vs. IVF.

Betty M

I have to say the bypass IUI and go straight to IVF was the best advice I ever had. Luckily for me I did get a free cycle on the NHS which was successful so this is easy for me to say but it gave me an extra year to play with when it came to a sibling which it turned out was pretty necessary as it then took 3 cycles to get success.

This article was getting some press coverage today http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.00
02562

which essentially is about which factors are important in accurately predicting the chances of success of a cycle. It seems to suggest that you need to look at all the embryos and not just the best ones to predict accurately.

Rachel

Lots of interesting articles, but I really think the cost of IVF in the U.S. (and the fact that almost no insurance covers it) makes IUI a necessary step for many couples. That article also doesn't give a sample size or indicate if they are looking at couples with female or male factor infertility and the average age of the couples. I also don't buy the argument about less multiples with IVF at all - my friend couldn't find a clinic that would consider a single-embryo transfer (at her request) and most doctors put back at least 2 embryos (remember, most Americans are paying out of pocket about $10,000 per cycle). We got lucky with injectables (no IUI at all) but for a couple like us with no male-factor problems and no tube problems ovulation induction is almost as effective as IVF so I'd be careful recommending to your readers that they skip a procedure that cost us about $2,000 out of pocket (and that was with daily monitoring to prevent multiples) as opposed to the $30,000 the clinic wanted up-front for IVF.

Katie

I think a lot of people are still being offered/recommended PGS...

Motel Manager

Very interesting stuff. One thing I've always appreciated about my clinic is how research- and evidence-based they are, and they have consistently taken this line on PGS, saying it's only recommended if you have some timebomb (e.g., Huntington's) in your genes. They're also big into SET, which is unusual in the US still.

I am also pro-IVF over IUI, but, then again, I had good insurance coverage. If I'd been paying out of pocket, IUIs would have been very tempting.

Finally, yay for possible endo pain relief! Though boo if it causes mood swings.

Geohde

Feeling smug here too..... we chose to go straight to IVF/ICSI.

J

Karen

I'm feeling pretty smug about #4 also... since I spent the better part of 6 months BEGGING to move on to IVF for fear of ending up with triplets. "Oh, it'll never happen to you, don't worry! You'll get pregnant - with a singleton - very quickly! You really shouldn't go through the invasiveness and expense of IVF" Six IUIs, $20K worth of drugs and treatment, a miscarriage, and a set of triplets later, I'm left wondering what part of this was less expensive or less invasive than IVF. (especially considering I had full insurance coverage... IUI was only eating away my coverage... by the time I was done with all those IUIs... had I not had a baby or three, I would not have had much insurance coverage left over to try IVF)

nikole

Thanks for all of these great links. Hope you are well.

Sandy

Some docs recommend that using clomid or injectibles (monitored to avoid HOM)with timed intercourse is just about as effective as IUI in couples with unexplained IF. The trick is in the ovarian stimulation, not in the insemination. Since this is so relativly easy to do and clomid is so cheap, I think it is worth a try. I was lucky and I got pg on my first clomid cycle (with timed intercourse). I realize that this puts me in a minority but I'm glad I was given that chance rather than having to go through IVF.

fisher queen

8 unsuccessful IUIs. It still infuriates me.

I'm really glad someone is pursuing the questions surrounding implantation. I think it's a big factor in IF in general.

Bea

I won't click through to the articles - I trust your summaries! - but it's great just knowing advances are being made.

Bea

Flicka

YES YES YES to #4. I've been saying that for years but no one takes me seriously. Good grief, yes!

(Sorry it's taking me so long to catch up on blogs these days. I think I can read about one a day if I'm lucky.)

Jenjen

I have one wonderful ds who is the result of IUI with injectibles (Repronex) whom I wouldn't have been able to afford to conceive if IVF were the only option (because IUI was covered by my insurance and IVF was not). And it worked for me, with PCOS. I got pregnant on the second cycle.

millie

Totally with you on the iui thing. I do think that here in the US we need to fully cover IVF. I've always felt it should not be about who can afford it but just part of standard medical coverage. Then we'd have few multiple births (could get all enlightened and move to single transfer like the sane parts of the world) and more success earlier on.

Heather

Very interesting post. I never thought about #4. We just moved to IVF after 3 rounds of IUI with injectibles. I felt like a failure having to move to IVF. Now that I read that, I don't feel that way so much. Thanks!

Sarah

share the smugness after wasting a year to IUIs, but i do think they were a necessary first step for me before i was ready for the big guns. i just had to believe i'd tried everything else first before i was ready.

Heidi

In defense of IUI...over prescribed? Absoultely! Completely worthless for everyone? No.

Our main IF issue is MF viscosity. (All around sperm quality is not stellar either, but overall numbers are on the high side of not optimal.) Timmed intercourse alone is completely useless here because ain't nobody going nowhere. But wash it up, eliminating the viscosity factor, get a head start and chances are drastically improved. I think most would agree that in this situation trying IUI first was quite practical. (And because everyone is mentioning the cost factor, our insurance covered a lifetime max of $5K our choice. That would cover 4 IUIs for us or 1/3 of one IVF cycle.)

As far as the multiples angle, unmedicated IUIs were presented to us as the first option since there was no FF known. On 25 of Clomid I produced 2 follies instead of the regular 1. We were told that Clomid increased our chance for multiples to 10%. Interestingly, at the very same clinic, with two fresh transfered via IVF average jumped to 45%. Obviously, you mentioned high order multiples which would be a different stat altogher, but I thought these numbers were still interesting.

Can't help but to mention that my neighbor and I had successful cycles days apart, mine via IUI and hers with IVF, same clinic. I had a single, she had mono/di twins.

Wish I could remember where I read it, but within the past year I read that ratios of identicals to fraternals was higher in the IVF population, and that perhaps something in the procedure encouraged eggs to split.

Best wishes!!!

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