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Friday, 08 August 2008

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LEB

I was thinking about this this morning.

We went straight to IVF - we were told that for unexplained IF the pregnancy rate was exactly the same as well timed sex. They offered to do a natural IUI on the monitoring cycle but we didn't bother.

Even if we could afford it I honestly don't think I could do another IVF but the thought of years of monthly failures spread out before me with associated crap sex life/strain on marriage etc has made me think of IUI again. If it has the same pregnancy rate as timed intercourse could we not do it instead of calendar sex? Is the pregnancy rate quoted for stimulated as well as natural cycle IUIs? (although with two second trimester losses now I'm even more terrified of multiples than I ever was before).

But I'm feeling particularly desperate today.

How are you?

susie

My problem was recurrent pregnancy loss. It was unexplained, but my feeling was that it was an egg quality issue for the most part (ovulating with immature eggs). While IUI worked for us, I believe the key to our success was actually the injectables. We were successful on our first injectable cycle. I am sure we could have done the hormones and then achieved pregnancy with intercourse, but the IUIs (2 on subsequent days following trigger shot) provided an increased chance of success in the cycle. I was very glad not to have to pay for those drugs for another month, at any rate.

I never felt that IVF would help my miscarriage situation, so I was glad our RE never pushed us in that direction.

swisschard

I think a distinction needs to be made: between "natural" or unstimulated iui -- in which no drugs are given to produce multiple follicles or to control the growth of a single one -- and stimulated iui. The Aberdeen University study that's just come out was comparing unstimulated iui with clomid and with no treatment. The results may have been more discouraging for iui and clomid than researchers expected, but those who argue for the use and success of iui are usually talking about the stimulated version, which involves gonadotropins, washing sperm, monitoring follicle growth (with ultrasound), timing .... well, many things that are also involved in IVF, but a less intense version and no invasive procedures. IUI, even the medicated version, is much cheaper than IVF.

I have been, for too many years, a patient in a public health care system (Belgium) that pays for IVF -- six cycles for women up to their 43rd birthday! Incredible! (Incredible, too, but in a not so fabulous way, that I used up my 6 cycles!) My clinic is a factory, but also the leading research hospital in Europe. And despite the fact that some 4,000+ cycles of IVF are done there every year, women are not sent on to IVF right away. The treatment will depend on a number of factors, including the state of the fallopian tubes and the sperm analysis, but for many, the first treatment is six cycles of IUI. The IUIs are medicated and monitored. If the woman produces more than three large follicles, some are punctured to reduce the risk of multiples. And the cumulative success rate for those six IUI cycles (done in a selected group of patients) is about 50%. That's not bad. And it saves enough money to fund those of us who really must do IVF or ICSI. So in our case, the "generosity" of the system depends on relying on less and more expensive procedures depending on the patients.

So I would still argue for medicated IUIs, in a group of selected patients. I don't think you can discount the political motivations of the Aberdeen Study and the press coverage: trying to get the UK to better fund IVF. That's a legitimate goal, but the study wasn't looking at the sort of IUI that has been shown to work, and that is cost effective. And I'm most certainly not arguing that IUI is good because it worked for me. IUI did not work for me -- or, rather, it didn't get me pregnant (despite our dutiful attempts). But IUI does work in my public health care system, and my health care system works for me.

All that said, there is a more pressing issue: I really hope that you are doing well. That either this cycle will work for you or that it will somehow decide you and H and P about your wonderful family.

Heather

I think I would've gone straight to IVF if I saw this report earlier. I did just see this on the news this morning. I have to say I am living proof of this study. I have unexplained IF and IUIs weren't working. I just did my first month of IVF and we're pregnant!!!

I hope there are some changes in the IF field because of this study. IVF is in many cases the better route to go.

Rachel Inbar

Well, in Israel fertility treatments are paid for by socialized health, but that doesn't mean you get to choose what you want to do. Unfortunately, IUI is part of the process you have to go through (unless, perhaps, your chances are nil to conceive with IUI). It used to be that you had to have 6(!) cycles of IUI before you could move on to IVF, but I don't know how it is today. For subsequent pregnancies, of course, you go straight to IVF (if you were successful with it in the past) unless your RE recommends otherwise.

Jenn

I'd also be interested in seeing numbers where IVF is easily attainable. I'd also like to see the money numbers on that. If it actually saves money in the long run to have the correct treatment (obviously depending on the situation) with the highest success rate offered first instead of a last resort.

We had IVF covered by our insurance and paid nothing for it. But for the other six treatment cycles, I spent thousands. I wonder if we had gone straight to IVF if we would have saved so much money and time and heartache. We have no way of knowing. And of course IVF wasn't an option until that time because of restrictions on insurance.

PBfish

This is very interesting. As someone who was diagnosed with high FSH and did 1 unsuccessful IUI and then got pregnant 7 months later "naturally", I've often wished I had that $3000 bucks back! I'm curious about what you said about knowing whether you ovulate. My RE didn't take the time to ascertain whether or not I ovulated, I had tested with high FSH, been trying unsuccessfully for a little over a year and that was enough for him. So I'm wondering what REs would do to ascertain whether you have actually ovulated??? Or do they all just jump to IUI? I have to say that I did want to get treatment, and now that I have the luxury of having a child, it's easy to 2nd guess my decision to get treatment. I just have to wonder a little about whether RE's aren't just kind of shooting darts in the dark with their treatment recommendations...

PBfish

oops, my IUI cost $1200, not $3000...

AMH

PBfish, I would think at a minimum that your RE would have had you use OPKs, maybe chart your temp, and then do a blood progesterone test 7 days after apparent ovulation to confirm whether you were ovulating or not. I'd think that one natural cycle with testing might not give you the whole picture, but maybe at least a clue.

Lori

I felt very vindicated when I read the report on this study. When we were going through the treatment process and our RE explained the stats for the various treatments, what we saw for IUI just didn't make sense for us (lower chance of success yet higher chance for HOM). We went straight to IVF (we were unexplained). At the time I felt like I was cheating or skipping ahead, as if I wasn't paying my IF dues. Ha! It was the best decision we could have made under the circumstances.

Tinker

From the beginning, I have been very strongly under the impression that IUI patients are second class at my clinic and that they, for the most part, aren't even really wanted there.

When we did the first few Clomid-IUIs, the only tests we had behind us were day-3 bloodwork, an HSG and a sperm analysis. I didn't know it at the time but was later floored to realize the carelessness of no monitoring during the cycle whatsoever -- and patients were timing their IUIs exclusively on OPKs.

I was optimistic about IUIs because we had gotten so very lucky on our first, but 7 failed ones later, I pressed on.

I sure hope that more in this field take note of these studies and talk to patients about it. We may have done a few IUIs anyhow because we pay everything out-of-pocket, but certainly we would have done fewer.

Orodemniades

I was on the waiting list at the Aberdeen Fertility Clinic for 4 years before we got kicked off (I was 'too fat', although my weight didn't change at all during that time). IUI wouldn't have worked for us, IVF/FET was/is our only option, and quite frankly, getting kicked off the list was ultimately a godsend. Aberdeen is a horrible, horrible clinic and I still hope various doctors (like all the ones I saw) rot in hell.

That was our experience, anyway. I'm sure others had better ones. Probably. Maybe.

Bea

I hear your point, and I think it's a good one. On a less scientific note, WHY WOULD YOU THINK YOU COULDN'T GET PREGNANT ON YOUR OWN WHEN THE FIRST TIME YOU TRIED, EVER, WAS WITH A CLOMID/IUI CYCLE AND THE SECOND SUCH CYCLE WORKED? SO PLEASE STOP TELLING ME A) THAT FERTILITY TREATMENTS CURED YOUR INFERTILITY WHICH YOU DIDN'T HAVE AND B) THAT IT WILL WORK FOR ME, TOO.

Sorry, T, almost completely off-topic but had to get it off my chest.

Bea

Meg

I agree with you 100% Thalia. It just proves what I have been observing in blogs for years now. In fact, I'd go as far as to say that its all just a swindle to get even more money out of people. In Australia, if it hasn't worked by three IUIs they won't even give you another one. I know so many people with unexplained IF who just skipped straight to IVF here. Course, it's subsidised by the gov't and costs about the same as what people are saying IUIs cost in the states, so that makes a difference.

Another thing that makes no sense to me is giving people stim drugs for FETS and DE cycles.

Silver

In the States (Dallas), I had six failed IUIs (added up to lots of $$$$). Looking back, I should've fired my RE (and when I think about his fancy schmany clinic, I cringe thinking that I helped fund that place). We switched to USCF in SF for IVF (unexplained infertility). We had a son.

I was scheduled for a FET this summer, but on a whim, decided to do a stim IUI here in Korea (cost me $500 USD - shots included). I'm now 11 wks. I think IVF costs $2000 USD here.

Fertility clinics are good here and very affordable. Makes me mad at US hospital bills! Why they made a difficult situation already so much more difficult due to the money.

Used to be a super skeptic about IUIs, but now I'm a believer.

Karen

I'm still in total agreement with you, despite having conceived my trio via IUI, or perhaps because of it. I begged to skip straight to IVF to avoid the risk of triplets (or higher... I was rereading my posts from the cycle that conceived them and I'm damn lucky I didn't have quintuplets, to be honest), but was told to keep doing IUI.

IUI is such crap. I spent just as much money on my IUIs as I would have on a shared-risk-IVF, for results that weren't nearly as satisfying (per cycle, I mean... I'm not trying to suggest that I'm not satisfied with my trio, though I would have much preferred to have them one at a time).

Not, you know, that I'm bitter, or anything.

Lut C.

I read about how little IUIs help with unexplained infertility back before we moved on to IVF. And in hindsight a very good thing that we moved on to IVF quickly (after only a couple of IUIs). Then it became apparant that we can't make embryos without ICSI.

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