This is from http://infertilityblog.blogspot.com/
Skipping the injectables and going straight to IVF. I just returned form the annual meeting of the American Society of Reproductive Medicine. There was an excellent presentation from a Boston group examining this issue. All patients in the study did 3 cycles of clomid iui. Those that did not get pregnant either did 3 cycles of FSH iui and then IVF, or no FSH iui and IVF directly. When all (I mean everything) of the expenses were compared, patients who skipped the FSH iui got pregnant faster and spent less money.
Now everyone is different and your situation needs to be individualized, but this study may help some people make a decision.
Hi Wendy -- We were chatting in the other thread. (I'm the one who is 46 and who just had a second miscarriage.) My RE said that ivf is far preferable to iui because they can control so many factors. In iui, they hope the egg and sperm will meet up, but really there's no way of knowing. I think you said you have had some high FSH levels. My impression is that REs have certain criteria you have to meet to be eligible for ivf (e.g., age 43 or less, certain FSH and estradiol levels, etc.); so I would be sure to ask if your RE has such criteria, whether he or she will offer you ivf in six months if iui doesn't work and your numbers get worse, etc.. It sounds like having a biological child is really, really important to you. If you meet those ivf criteria now and you really want a biological child, I think you should find the money (borrow, refinance your house, ask family members, etc.) and do what has the highest potential success rate (i.e., ivf). I agree with mlb that you could end up doing multiple iui cycles and still need ivf, and maybe at that point the RE won't even agree to do the procedure for you. I know ivf with your own eggs is costly, but it's only about 1/3 of the cost of using donor eggs or adopting, and really time is your worst enemy. I really am sympathetic to the financial stress (we feel it too in pursuing adoption and considering donor eggs). But I really think if your RE believes ivf might work for you, you have a really great opportunity that you won't have forever. I hope whatever you do works out for you!
Hi Wendy - I posted on this subject on the chiromom thread - so there is more info there.
We chose the IUI to start out because that was the recommendation from our RE. My issue all these years but never diagnosed (not sure how dum dums missed it lol) was that I wasn't ovulating. Our RE thought that if we could get my body to ovulate and then put the sperm up high - I had a good chance. It is a MUCH cheaper way to start out and find out if you can ever get pregnant. We got pregnant on both IUI's although we lost our son at just eight weeks into our pregnancy.
The procedure was VERY simple. On the 2nd day of my period I had to go in for an ultrasound so they could look and make sure everything looked good on my girly parts. (Not a fun ultrasound as its vaginal and can be messy depending on your period - but they were so respectful that it made it ok - sorry TMI) They told me what day to start the Clomid and how long to take it for. We went back for another ultrasound - another vaginal - after that to see if I had follicles ready to release and if there were, they scheduled the IUI. On the day of the IUI hubby had to do his thing with a cup - lol - and take the sample in. They wash the sample to get any crud out and to clean the heads of the sperm so they penetrate easier. Two hours later, we went back, I laid on a table (much like the pap smear) they inserted this long skinny tube (barely even felt it) and put the sperm high in my uterus where is has the best chance of meeting the egg and fertilizing. I had to lay there for a half hour on my back (easy part) and then go home and wait for two weeks (hardest part) to do the blood work.
Again, talk to your RE and trust in their judgement. Their job is to help you get pregnant. If he suggests an IUI try it. If he wants you to skip that and go straight to the IVF then its because he feels that is YOUR best shot at getting pregnant. They don't build their reputation by women walking away barren - so they are going to do whatever they can to help you achieve your goal. Good luck and keep us posted.
Oh - you also asked about costs - sorry - our Clomid was about twelve dollars at Walmart (with insurance - couldn't believe they helped pay for fertility meds) The ultrasounds were about $150 a piece and the IUI itself was around 500. Unfortunately, there is only ONE RE in all of Northern Nevada - thankfully his office is one of the top ten in the country - but he doesn't accept our insurance so we had to pay out of pocket. As hard as this sounds, you do get what you pay for and he is one of the best REs around - and we were able to get pregnant both tries and are now expecting our first baby.
Hope all this helps with your decision
that's great info from you all. Thanks so much. I will listen to my RE and see what he has to say. It's tough with IVF... and the cost, because if we do get pregnent, and then I have another mc, I don't think we could afford to do IVF again. So there will be a lot of pressure on that one IVF. uggh! This is quite a journey we are all on. I'm so glad that I have all of you for advice and support.
If you were able to get pg before (as you mentioned the m/c) than your chances of getting pg again are really good. IUI is a lot less expensive than IVF and less invasive. My insurance covered the dr appts and the ultrasounds but did not cover the IUI itself. So for each IUI, I paid $300. I got pg the first IUI and the third IUI (20wks pg now). The second IUI, I did not get pg, but that was because the follicle was on the side that doesn't have a tube, so my chances were really low anyway.
If you have no tubes or badly blocked tubes than IVF is the better option, but otherwise I think starting off with IUI is a good idea.. There really is no wrong answer, just whatever you decided.
Best of luck to you!!