IUI again after failed IVF?

[Hyppyb]

So I”m at a crossroads… I have my follow up call with doctor in a few days regarding my first failed IVF, not sure what to do next.

Im 39, 40 in Dec. I’m single, from 38 I did 4 IUIs non medicated with trigger they failed. So the clinic I’m with only do Natural and Mild IVF. I paid for Mild IVF, started injecting, at the first scan was told I have a fibroid outside my womb which would block my left ovary from the IVF equipment, was annoyed to say the least, I knew I had fibroids but should have been told prior about one blocking an ovary from all the scans I did prior, not after this commitment. They said the dominant ovary isn’t blocked so to not worry.

Egg collection they got 4 eggs, left some behind in the left ovary. All 4 eggs fertilised, 1 on day 3 was a 8 cell, no fragmented embryo, the rest arrested. That 8 cell was transferred via a FET (couldn’t do fresh because the eggs left behind) and got a BFN. Quite down. Never felt so low in my fertility journey. I just think ivf is so much money for sometimes such poor results. I am fortunate I have savings but still aiming to be a single parent with money.

I feel low…I think I want to go back to IUIs and have a break from the intensity of IVF. IUI the sperm has access to both ovaries vs IVF it’s only one ovary. I also thought maybe I should do conventional ivf, get more eggs from the one ovary vs mild ivf, but that means leaving more eggs behind and I was severely bloated painfully from the couple left behind with mild ivf for a week. So may be really sick with conventional ivf. The doctor at the clinic said the egg quality and results with mild ivf is better I’ve read contradictory info.

i know it’s a pot luck game, anytime you attempt could be successful. I also guess the stats that say first 3 IUIs are most successful are based on women who tried for a year prior, whilst I never did, the clinic is my first attempt. So I’m weighing a lot up.

What do you think?

Thanks for any feedback.

Fertility journeys are so hard both emotionally and physically.

As someone who's been through it, I think it's always worth thinking what your 'enough' point is.

For me it was the 3 NHS IVF cycles. If they hadn't have worked I'd walk away. I will also say that part of my journey to IVF was starting to process that some people can't have a child and that is ok. There is a life for me that doesn't involve children.

I'm really sorry your cycles failed. Perhaps before taking the next step you access some support to find out your enough point. Like you say, you don't have infinite funds to keep going and going.

I hope you can find a path that works for you.

So were you successful?

As I said I want to continue that's not the issue or my question. It was more what would you do in my situation?

I do have a lot of money but I'm trying to figure out what next and what's best. Like from my story iui with access to two ovaries may actually have the same success rate as ivf with access to ovary.

I’ve had 6 IUIs and 4 IVF cycles. Two children, both from IVF.

I went down the conventional IVF route and while it’s obviously a lot more drugs, it does have a better success rate. As my consultant said to me: sometimes IUI is like bringing a knife to a gun fight. Sometimes you have to go hardcore to get the results you want.

I was thinking of conventional ivf too but as I said they would have to leave loads more eggs behind in the ovary they can't access. With the mild ivf they left like 2, was told leaving them behind gave off eostrogen, which wasn't good, so took cetrotide to help rid the eggs, I was pretty ill for a week. Conventional could be like 10. I could look into getting rid of the fibroid blocking the ovary but doubt the NHS will help with this, won't be speedy.

I wish I hadn't bothered with IUI at all tbh. I understand your concerns re leaving the eggs behind and being ill, but if I were you I'd go for a conventional round of IVF. Get as many eggs out and embryos made as possible, then you can have more FETs and have a good chance of getting pregnant. IUI might reach both ovaries but the success rates with IVF are much higher

Thanks I will ask the doctor about conventional ivf. This current clinic just does mild ivf. Another clinic might not allow me to do conventional because of leaving loads of eggs behind and OHSS. Of course i can ask. I think part of me feels like the stats where IUI if successful is mostly at the 3rd or 4th attempt is made up of mostly women who before IUI tried to conceive naturally for a year or more. Before iui I never tried to conceive, it's 4 iuis that equal 4 times of ever trying to conceive ever in life so that's partly why I don't want to write iui off. I'm open to anything.

Could you try an IUI with Clomid rather than a fully medicated or unmedicated IUI?

In your situation I wouldn't be rushing for more IVF if some of the eggs are wasted and they only have access to one ovary. Did they have any issues with the embryo transfer?

I had an issue with fibroids during first IVF and had an abdominal myomectomy before doing another round but had to pay privately (it was approx £5k) as the NHS weren't willing to do it. I was able to do another round of IVF four months afterwards.

Also take a look at success rates for clinics rather than sticking to the same one.

Unicorn2022 thanks for sharing.

I was told any medications with IUI for me would not be good, as it may produce multi births as I already ovulate ok and produce one dominant follicle monthly.

Most people try naturally for a year and then do iui. With me I never tried naturally prior, 4 iuis were my first ever attempt with conceiving as I'm single, 4 times ever in life that's why i don't want to give up on it completely.

Embryo transfer was good. The subserosal fibroid is on the outside of my womb blocking the ivf instruments that's why it doesn't affect iui or transfers. Like you I feel the nhs won't do it for free, I have no symptoms it's just it affects ivf can't access one ovary. I also feel its too soon to have surgery until ive exhausted other options you know?

I have my phone call with the doctor tomorrow will ask him questions. The success rates at this clinic are excellent. But I can't apply the rates to myself with the access to one ovary. It's almost like the iui and ivf with one ovary is around the same success rate. So much to think about.

Yes I understand, it sort of feels like you would need 12 IUIs to get to the starting point of where most people start fertility treatment.

I wonder if another clinic would have more luck with accessing the other ovary, maybe if they had different equipment. I think it would be worth doing a medicated IVF if you knew you were going to get enough embryos for say six months of FETs - I think it would then be worth pushing through the awfulness and possible side effects just for that month.

I did a couple of cycles at the ARGC which was absolutely gruelling and almost put me off for life but then moved to Barbados Fertility Centre (which is run by an Irish doctor) and the experience was so night and day I barely realised I was having IVF. The equipment and the way they did it was completely different.

In your case if you have unmedicated IUIs you could have one every month (finances permitting) so I would be tempted to do another few IUIs in that case.

Unicorn2022, i like the way you think. 😊 Like you totally understand my circumstances.

Tomorrow afternoon I will talk to the follow up doctor regarding the failed ivf. I will put a long list of questions to him and see what he says. I'm 6 days late for my period because of the eostrogen and progesterone from the failed cycle so even that I need to ask him.

From reading, all clinics use a long needle near the cervix into the outside of the womb into the ovaries. Looking back mild ivf was kinder on my body because there were only 2 eggs left behind in the ovary, conventional ivf they may have cancelled the cycle once they realised there were loads of eggs they would leave behind because they emitt eostrogen in your womb making you ill and bloated. I'm might of had OHSS with conventional ivf.

Were you successful with the Barbados ivf? Sounds lovely. Travelling abroad would be tricky for me, I'd have to go back and forth with work, could never do a fresh transfer with the eggs being left behind.

Yeah I'm thinking another iui. Some clinics recommend 6 iuis if you have no known problems. It's over £2k per cycle half the cost is the donor. So much cheaper than ivf, nowhere near as intense, i dont have known fertility issues and I can always return to ivf if needed. Might do one in Nov and another in Jan if needed then return to ivf if not successful.

Have you tried x2 inseminations with IUI? Before and after ovulation? I know they tell you it doesn't make any difference but I had success with this for 2 pregnancies. I had to insist. I knew when I was ovulating and always felt the treatment was too late. x6 IUIs for the first one and x4 for the second one. I was a few years younger though. It's tough. Good luck. My bundles of joy are 17 & 19 now. 😊

Rainbow725 thanks for sharing.

I could ask the doctor tomorrow about 2 IUIs in the same cycle. It's certainly cheaper than ivf. It's good to hear you were successful with IUIs, that you had loads of IUIs and surpassed the 3 they say to stop at. Gives me hope 🤗

Could you get the fibroid removed?

I'm going to ask the ivf doctor if it's worth removing the fibroid. I have 6 fibroids. Saw a nhs doctor about another one inside my womb, he said sometimes it's best not to remove fibroids unless they're too big and blocking your fallopian tubes (mine aren't) because it could distort /weaken your womb and or create scar tissue that could make it hard for the embryo to implant.

Also the NHS will unlikely help, it's not causing symptoms, it's not blocking both ovaries, pregnancy is still possible the fibroid there, would have to go private.

My gut is saying it's a last resort surgery, to try other things before looking at cutting fibroids. My dominant ovary, the one that produces the most eggs is accessible. I do think the eggs left behind could have had the eggs that would have gone on to a baby.

Just wanted to give an update. Might help others.

i spoke with the follow up doctor, they said, I had a grade 1 embryo, but without PGS testing they can’t see if the genetic make up was ok, so that’s likely the reason it failed.

The doctor would recommend mild ivf again, but a heavier dose to get more eggs. He said ovaries and womb move about all the time, like with our bowels, so just because one cycle it couldn’t be accessed doesn’t mean another cycle it can’t be accessed.

So I’m thinking ivf again maybe December…