IVF v IUI any thoughts

[witchandchips]

apologies for posting here if you have all been through all this but couldn't find any thing on it on recent threads. Went to see the consultant today and he seemed to suggest that given my age (39) and the fact that we have been tttc for 2 years (and had to wait 3 years for ds1)we should go straight to IVF and not bother with IUI. Any thoughts from anybody around? I am particularly concerned about relative side effects (both physical and on our relationhips)
love
withchy

How much do you know about each procedure, and what diagnosis have you been given? Have you had any stims before?

Hi Withchy

We are currently going for IUI in Jan 08, so have had some experience from meeting with consultants.
I suspect in all honesty that the consultant is opting for IVF due to your age. I was informed by my consultant that IVF has a higher success rate than IUI and I think helps as they can determine egg and sperm quality, but obviously is more costly and involved. My consultant has suggested IUI to start with for us and if I have not conceived after that then he will review for IVF. But he did say he would only be concerned if I had reached 35 and I'm currently 32 and a half! . We have unexplained fertility, do you have any specific fertility issues?

I have not undertaken any treatment yet so have no advice on how treatment effects relationships. I suspect IUI will have a big impact on me and DH and of course IVF if we have to progress. I see IVF as being more daunting due to the drugs and egg retrieval, but I suppose IUI is still very involved. I think if you are having any treatment that involves 'taking over' the baby making it is hard.

Best wishes Xx

Would your IUI be a stimulated cycle or a natural cycle?

the tests that i had pre ds1 (4 years ago) were all normal and dps wrigglers were all okay too. We were thus diagnosed with unexplained sub-fertility. We had lots more tests again today, but given that i appear to be ovulatiing normally i guess that nothing much will have changed.
I just came out of the meeting today feeling a bit bullied into IVF, i felt that the consultant was really underplaying the side effects compared to IUI with clomid.

Haven't they put you on clomid at all yet? I though it would be standard protocol at your age to have been on 3 months at least before getting to this point?

If you haven't had clomid before, then I have to say that I'm surprised that this isn't the immediate preferred choice - it has such a high success rate in cases of sub-fertility that I know some clinics prescribe it whilst running the diagnostic tests.

If you have used it unsuccessfully then the addition of IUI has a relatively small incremental impact. And if clomid isn't doing much for you, then the next option is to stimulate the ovaries. Stimulation isn't the most exact of procedures, so they may manage to stimulate to just get 1 or 2 follicles, and given you run a similar risk of side-effects to the drugs regardless of whetehr a low or higher dosage is given, you may as well go the whole hog and go for IVF.

I assume that the consultant will also be taking your age, their waiting list and the time needed to recover between cycles into account. They may advise you to rest between cycles, so attempting 3 IUIs would take 6 months. Your fertiltiy will have dropped a percentage point in that time - not huge, but not insignificant either given the aim.

From my own experience a lot of the stress in fertility treatments surround the number of appointments and scans and so forth. For a monitored clomid IUI cycle you would probably need 2-4 scans and the IUI itself. With stims they may down-regulate you first which adds to the apparent length of the cycle for treatment purposes and would probably add another scan.

I'm not surprised that they have gone straight for IVF tbh (well ignoring the lack of clomid - that does surprise me). IUI success rates have never been that great and IVF offers a greater success rate for a similar number of appointments. And time itself is a significant factor. But it is poor if you have come away feeling bullied.

I have also been told to look at IVF as a series of treatments rather than a single treatment.
I was told that these various stage were like a diagnostic tool as well - they would do investigations at each stage.

We too have un-explained infertility and it is really frustrating!!!!

BTW I have gone through 3 unsuccessful IUIs and now onto IVF next month.
HTH

Any test results that were done over six months ago should be discounted. You should both have up to date test results.

Unexplained subfertility is infact no diagnosis at all; all this means is that they have failed to find out what is wrong.

It may be worth seeking a second opinion; some people are actually given a "diagnosis" of unexplained subfertility simply because they as a couple have not been adequately investigated.

Thanks all very helpful
x

Witchandchips. IUI has quite a low sucess rate - I was told with frozen sperm the success rate is only 5 %, but IVF would be nearer 20% and given that it took quite some time to conceive your dc1 then your doctor is obviously thinking that IVF would produce a quicker result, which is infact what you want. I am sorry that you felt bullied - is there another doctor at the clinic you could see? Are you visiting an NHS clinic? if so I would imagine that would be a very honest opinion, as the nhs cannot profit from your treatment and the doctors are paid the same regardless of which treatment you have. Good luck take your time to think about how you want to proceed with the treatment, not what the doctor say. Meanwhile have some acupuncture, there are some studies which show it helps with conception.

sorry haven;t time to read all replies but IIRC IUI only recommened in limited number of cases - using donor sprem of if you have hostile mucous. Otherwise no point. Got to run will read properly later.

Okay have been doing a bit of manic research on the internet and am really no wiser. Its really hard to get information on
a) how much of the decline in fertility with age is due to things you can measure. What i mean is that if i have the same hormone levels as a younger woman, how much less fertile will i be
b) what the success rate of IUI is when fertility is unexplained
c) what the success rate of IUI is on the first cycle and how fast it drops after that. You see my understanding is that those who IUI can work for will have fewer cycles than those who it won't work for. Thus the number of conceptions per cycle will give you an under estimate of your chances of conceiving
d) 39 appears to be a real dividing line? Is that because of the way they have done the states (i.e. easier to do 35-39 as an age group, rather than 38-42) or because of something that actually happens in your late 30s.

my understanding is as follows.

d) There are two marked drops in fertility one afetr 35ish then another after 40ish - obviously every woman is different but on average it is true.

b & c) I don't think IUI is used very often to treat unexplained infertility so douvbt you will find many reliable statistics.

a) - don't think it is straighforward but your FSH levels are usually a pretty good indicator of your fertility and the clinic should be able to give you an idea of how poor/good yours are. However one of the biggest problems with age is aging eggs which fragment rather than divide cleanly. No way of knowing your egg quality except IVF...

I dig out my old research see if any of it is relevant.

If you don't mind me being blunt, at 39 I wouldn't be hanging around, I'd be doing IVF.

If you're interested in the statistics then speak to Lister. They have kept a huge database on treatment of couples for about a 15 year period. They can feed in your age, dx and a few other things and give you a probability of success of different treatments.

39 is regarded as fairly old in the fertility game. Obviously lots of women still conceive at this age but the graphs that I've seen show a very real decline. I doubt that there is much research on IUI at this age though as most patients won't want to take the risk of hanging around for half a year and watching their chances at IVF dropping.

Have you had Clomid previously?

Thanks for the lister link, think cos they are a much bigger operation they have a bigger sample on 38 39 year olds who have been through the various procedures. My reading of the data is
a) there is not such a big difference between the probability of IUI sucess by age. The biggest difference is in the risk of miscarriage and non singleton births.
b) the difference in the per-cycle rate and the cumulative success rate per couple is much smaller for IUI than for IVF. To me this suggests that doing one cycle of IUI is worth it (if it can be done in the next month or so) but definately no more than one. If IUI is going to work it will probably work first time ifyswim

Agree with all the above -its really hard to get firm facts about any of this. Sadly so much is down to luck (or lack of).

In my opinion (with my experience of 5 years unexplained fertility, 4 iui and 3 ivf) I would skip the iui and go straight to ivf. Clomid has worse side effects than stims and less success and more risks (of multiples or m/c etc). If you are doing a super ovulatory iui (ie with stims not clomid) you nice as well do an ivf. Yes, ivf is much more expensive but much more controllable and more likely to succeed. ivf is a diagnostic tool and you can find out reasons for your 'subfertility' to help tailor any following cycles.

If you are v concerned with impact on =you both, perhaps an iui first might be a good intro to treatment. I found starting treatment quite hard - it is a huge roller coaster and commitment and takes a while to get used to. iui is easier on the emotions (if not using clomid) and less stress on your relationship (and finances).

Good luck with your decision - not an easy one.

HOnestly, the IUI success rates with your diagnosis are going to be only marginally better than trying on your own each month - say 12% chance rather than 8%. Since all of fertility treatment is about raising probabilities, and yours are low to start with at 39, and because UK clinics are conservative so you'll have 3 months between cycles, you should get going now and you should go for IVF. IUI is just a waste of time unless you do 1 cycle just to check out how you respond to the meds.

FWIW, I have always had low FSH but never responded well to the drugs. At our age (I was 37 when started treatment), FSH is only a proxy for response, it's not definitive. If your clinic measures AMH, that is a much more accurate measure of your likely response.

Side effects with IVF vary and are not necessarily that bad - everyone has a slightly different experience. Don't let that put you off.

I agree with Thaliablogs, I have slightly raised FSH always have and I respond extremely well to the drugs. Having done both IUI and IVF I would go for IVF every time. The night sweats I had with clomid were so much worse than the IVF drugs. Let us know how you get on.

Sorry to come late to this thread, but I've just seen this article about IVF versus lower tech methods.
slate article
It was a proper scientific study comparing IVF straight away first, versus IUI (with oral, then injectable hormones) then IVF if it didn't work. So exactly what you were looking for!

It's worth noting that the percentage figures (well, all the figures!) in that article are American - I wonder if British treatment is less aggressive. It varies acc to clinic - you will want to check this - but our success rates are a wee bit lower on the whole.

I have slightly raised FSH and always respond well, get lots of eggs. I'm told the quality is good. I'm 35 but apparently running ten years ahead in terms of FSH. There are other factors and a good clinic will consider those.

For me, the side-effects have varied each time. I have downregulated six times: sometimes ok, sometimes a bit hard, headaches and grumpiness. On the whole, it's ok.

Good luck. Make sure you research your clinic's success rates and bear i mind that people do travel for ivf in order to be at a slightly better clinic.

thanks everybody again