IUI/Clomid/IVF - should I /is it ethically right??

[Grakster]

Hi,
To cut a long story short, TTC for over 2 years now naturally. After doing basic tests to check for any abnormalities on myself and DH, all back "normal" (although Im in the "low fertility" bracket after ovulation reserve test, consultant said he's not worried).
My main question to people on this site is that to me, it would feel "wrong" to start on Clomid/IUI etc when on the surface, it appears that we should be able to conceive naturally?? I can't help but feel that if it's not happening naturally, then is it good to "force" something that is naturally not meant to happen to your body?? Do you know what I mean??
I'm not against other people going down the "artifical route" but I see that as more when you have serious problems.
I know how IUI works, but don't understand how that will help us if it's not happening naturally anyway?? I know the sperm is placed higher into the cervix, but surely, if the sperm were healthy enough, this should happen naturally and "interferring" with the process is not right?
As you can see, I'm very confused as what to do - hopefully my email has come across in the right light and that someone out there understands what I mean.
Thanks

I understand where you are coming from. I used to think "if it happens it happens" and if not I'll enjoy a life of nice foreign holidays and childfree restaurant meals, etc. But now I am trying (and it's not happening naturally) I have a huge desire to know what, if anything, is wrong and would go as far as Clomid/IUI/IVF if need be. I don't think I would go as far as donor egg/sperm or adoption because my desire for kids is a biological urge to procreate rather than a desire to parent, if that makes sense. I know those things are right for some people and I have huge respect for people who adopt, etc but my own personal desire to have kids is more "selfish" than that, if that makes sense. I didn't want kids for years but now something inside is screaming at me to carry on my genes.

Dh and I appeared to have no problems but still couldn't conceive. We tried IUI which also didn't work and then went onto IVF. I conceived DD first round of IVF on a single embryo transfer, same with DS two years later. Both easy pregnancies / labour/ healthy etc so IME, it isn't as straightforward as your post suggests. We clearly had no medical obstacles to being parents, we have two lovely children but it took IVF. As Eurochick says, my desire to be a parent was more important that whether IVF was ethically right and IMO, well worth it.

Grakster It sounds like my DP and I are in a similar situation to you. We have had basic fertility tests which all came back as normal and have recently received a diagnosis of unexplained infertility and were advised (in part due to my age - I'm 35 and time isn't on our side) to have private IUI.

I think that I understand in some ways your reservations about fertility treatment in that I have found our diagnosis difficult in that we haven't got a clear cut answer. The unexplained infertility label seems to imply that there may be something wrong but there may not. We could fall pregnant naturally next cycle or spend the rest of my fertile years trying with no luck.

Before all this I would have said that if I was advised to pursue IUI I would have been chomping at the bit to get the process under way but now finding myself in this position I am not so sure. I don't particularly want to put myself through invasive procedures if, on paper at least, we can fall pregnant naturally. Also I don't particularly wants to spend a lot of money on a procedure that may not be needed. It's a real quandry for me - though DP is still convinced that we will conceive naturally so is less confuddled! I would add that if we were told that there was no way we would conceive naturally then I would be beating down the door to the nearest fertility clinic for any kind of treatment.

We have decided that we will try naturally for another 6 cycles or so, this will bring us up to nearly two years of trying, and then we will probably pursue the IUI route (in the meantime I hope to sell a kidney to fund this treatment!). I think this decision is due in part to the statistics that most couples will fall pregnant within two years and also due to the fact that even though basic fertility tests have come back normal apparently in cases of unexplained infertility there can be a whole myriad of other problems that the NHS either don't or can't test for. Perhaps if I was younger we would try naturally for a little longer.

Sorry I've droned on a bit but I wanted to let you know that I understand where you are coming from.

I think you've hit the nail on the head with the comment that if you were younger you'd try naturally a bit longer. But as you know time isn't on your side either naturally or for assisted conception.

No-one can tell you what is right for you, but you have been trying yourself for a decent length of time.
In cases of 'unexplained infertility' sometimes the process of assisted conception can give you an explanation - for example if none of the eggs fertilised in the lab, or the embryos stop developing very early or are all of poor quality. As you'll appreciate these aren't things that can ethically or easily be tested without doing the treatment, so I think you are a little harsh to say the NHS don't or can't test for these..(sorry, bit sensitive about NHS being considered the poor relation when it comes to infertility, but that's another topic!!) But I understand that 'unexplained' sounds like a cop-out (but it isn't) and must be a hard 'diagnosis' to live with. Good luck

OP, what might help to understand is how Clomid works. It basically (as I understand it) gives you a massive shot of the hormone that naturally occurs when you ovulate. It just gives your natural system a massive kick up the backside - you take as part of your natural cycle so its more of a boost than an interference IFSWIM?

When I was given the same diagnosis as you (don't know whats wrong but something is) I took it one step at a time. Its a long road and you don't have to decide everything at once. Clomid will probably be the first step and it isn't invasive at all - just a couple of tablets. And it works - two DCs to prove it.

Then if that doesn't work you move on and cross that bridge when you come to it. HTH.

This is diverting the thread a little, but I have to disagree on the NHS issue. Someone I "know" through another message board had been trying to get PG for years and had 4 unsuccessful rounds of IVF. The she went for private immune testing and it turned out that some of her cells were quite closely matched with her husband's meaning that her body was attacking the embryos as it viewed them as a mutation of her own cells rather than an embryo. After a lot of immune suppressants and intervention, she now has a baby, after her 5th IVF cycle. On the NHS, she would have been left with a diagnosis of "unexplained fertility".

I understand that the NHS doesn't have unlimited resources but that is why I would like a different system!

freelance you raise an interesting point about the route of assisted conception perhaps showing up underlying problems - I hadn't considered that before.

BTW when I said about the NHS "can't or won't test " I mean't that either the tests don't exist or are not possible like you say maybe for ethical reasons or that the NHS won't do them due to lack of funds. Maybe I didn't make that clear enough in my post & reading back can see that it could be taken a different way! For what it's worth I am very grateful for the treatment I have received and for the most part have no complaints.

I have a partially blocked tube and low grade eggs but really the ivf just bypasses part of the natural process. It produces more eggs for a greater chance and ensures that only the good embryos are used to maximise chances. In that respect there is nothing unethical about it.

I am in a similar position and usually hate to take even panadol (don't press me for a reasoned argument on this, it is just a sense of being natural rather than a deep conviction). However, I have just started on clomid and hcg jabs and progesterone. I don't live in the UK and things are less tightly controlled but the attitude seems to be "you are 35 and you want a baby, you are paying, we will make it happen.". I was nervous at first but the doctor has a kind of baby magic status amongst many mums I know so am just going with it. It is assisted conception but the rest of it sure is natural:)

I do know what you mean. We had an 'unexplained' diagnosis, after 4 years of trying. Fantasticaly lucky to get pregnant after 1st round of IVF, result was a premature and initially very sick child who is now healthy and fantastic. I still wonder if I 'made' my body do something it wasn't supposed to and have baulked at going back to do it again, irrationally (perhaps) I feel we would be pushing our luck and we should just be incredibly grateful that we have her at all. (Which we are!!)

Sorry ? this is a ridiculously late reply, better late than never I guess though?

Wow ? thanks to everyone above who took the time to reply in such a detailed way to my post and for being so honest, I really appreciate it! For the past 2 years, I?ve been keeping my thoughts in and it?s so nice to finally be able to share and see that I?m not the only one to think like this.

Eurochick ? thank you for your comments, all makes sense.

Azazello ? your line ?As Eurochick says, my desire to be a parent was more important that whether IVF was ethically right and IMO, well worth it? has really struck a chord with me and I now understand what you mean. Its amazing as time moves on, how your opinion changes. After trying for over a year, I didn?t agree with assisted conception, but now after almost 2.5 years, strangely enough I have changed my views!!

Poutintrout- agree, it is frustrating not having a clear cut answer in terms of diagnosis.
What is the latest with you? Since this last post and discussing more with DH, I have come round to IUI after DH making me realise the problem might not necessarily lie with me and so having IUI wouldn?t make something happen that wasn?t meant to naturally happen if you know what I mean?!

Anyway, currently on our 2nd IUI attempt whilst taking Clomid and feel more than confused about it all but just trying to remain calm.

Freelancescientist ? had never thought of your point before about if you go for further treatment, you might then discover reasons why you?re not conceiving. This is initially why I felt more comfortable going down the IUI route, more to gain a bit more insight in what my body/DH?s body was doing and hopefully anything else that comes with it is a bonus!

LilQueenie ? thanks for your comments. They made me feel that the whole IUI/IVF process is not actually as unnatural/unethical as I had once thought.

Jebel ? same with you thanks so much for your comments, ?it is assisted conception, but the rest of it sure is natural? ? I really liked that!

Thanks again!

We have just had IVF with ICSI for the first time (don't know if it's worked yet), and I am surprised by how I feel. I never considered that IVF was wrong or unethical in any way, but going through it was very hard. It felt so cold, and detached, the clinic was horribly busy and impersonal, and I feel very attached to the embryos that didn't make it (only 1 did), like somehow I didn't have the right to have them created in the first place, only for them to stop developing. I didn't know I would feel that way, but there it is. On the other hand, I am desperate for another child, and I'm pretty sure I would do it again if it didn't work.
We have a clear answer for why natural conception isn't working, but if there isn't, and you have time enough on your side, I would go for the least invasive option at every stage.

ellan, if it helps even with completely natural conception, many embryos are created that don't develop or don't implant. It's just happening in a different place (clinic lab instead of your fallopian tubes or womb) with IVF.

We're RC, assisted conception is basically a fast track to hell, so I struggled initially with it all. The "not natural" argument is an interesting one, because on that basis do you refuse all other treatments if a bit of you isn't working properly? From a dot of Calpol to chemotherapy, none of it is natural (although perhaps surprisingly one of the biggest chemotherapy drug groups, taxanes, are derived from Yew trees!) so if you take the view that you're going to stay natural, will you extend that into other areas of your life?

On a different point, I'd say have a look at "is my body baby friendly?" by Alan Beer, which may highlight some areas not looked at before for you, including compatibility biologically with your partner.