When to start considering IVF

[JJB92]

We have been officially on the infertility journey since April, after trying without success for a year before that. We have done a lot of blood draws, HSG and semen analysis. Besides a short luteal phase, there is nothing clearly wrong.

We are now on our 5th medicated cycle with TI. The first 3 was just letrozole, but we have since added a trigger shot and progesterone post ovulation. This is out plan for this cycle and the next and then to re-evaluate in January.

I'm wondering what next? Does it make sense to keep trying medicated TI a bit longer? We really have no indication for IUI, but perhaps we should try it anyway. Does it make sense to do a laparotomy or should we just jump straight to IVF? I don't want to waste time, but IFV still feels really overwhelming to me, both from a physical and emotional standpoint.

Our doctor advised us to think about it this holiday. I'm really confused.

Any advice or experienced at welcome.

Thank you

It can be tough OP. Do you live in the UK? How old are you? Does your area provide any NHS IVF or are you self funded?
Personally, I'd get the ball rolling with IVF. If you are eligible for the NHS route, there might be months to wait anyways. You can always decline down the line if you change your mind or get pregnant.

Why would you have a laparotomy? Has this been recommended? Do you have irregular, painful periods? Signs of endometriosis?

We TTC 12yrs, also no cause for sub-fertility found and lost 3. We also did rounds of IVF. I assumed it would make me moody or feel emotional rollercoaster. I didn't find that at all though. No hormonal mood swings at all. Yes, it was sad when I MC'd or didn't get pregnant, but I didn't find it so overwhelming that I couldn't carry on with day to day life. In the end, we don't have any living children, but that isn't that common. Happy to answer any questions you have and wishing you all the best.

Thank you so much for the feedback @JC03745 . I'm glad that the IVF was at least not completely unbearable for you. I'm sorry that you have had such a long journey and that you haven't had any success yet 🌸

I'm not in the UK and if we go the IVF route it would have to be self funded. It won't be easy, but we should be able to fund one round, maybe two. I'm 32 so I technically still have time, but my husband is turning 44 so we don't really want him to be much older.

I don't really have painful periods, but I do have deep pain during intercourse. Apparently that could also indicate endometriosis. I didn't know that, but the doctor picked up on it when I flinched during a vaginal ultrasound. But it sounds like the laparotomy doesn't really make sense if you jump straight to IVF so I'm not sure.

I think it make sense to get the ball rolling. As you say, there would probably be quite a wait anyway. Do you know what that initial process typically looks like? Although I'm not sure if it would be the same outside of the UK.

Which country are you in? I used to live/work abroad part of each year and was so fed up with my UK GP. I paid for private testing when I was working abroad, so not 100% sure of the UK process. The UK did accept all our test results and I was referred straight to the fertility clinic. From memory we had:
-Hycosy. Similar to HSG but uses ultrasound rather than X-ray
-Day 21 blood test to check ovulation
-AMH to check egg reserve. Mine was very good for my age, but I assume the quality was no good
-STI screening for us both
-Semen analysis

I also bought a book called 'It starts with an egg'. You can buy them cheap from ebay. It had some useful changes you can make day to day which 'might' help reduce toxins which can cause fertility issues. Buying chopped tomatoes in glass or carton instead of a tin, washing hands after handling receipts due to the ink on them etc. I also started DH on a supplement called lycopene. Its found naturally in red fruit/veg, but some studies have shown it can improve sperm health. Some people try acupuncture, yoga, Chinese herbal medicines too.

I've heard a lot about that book. Perhaps time to give it a read. Thank you for the recommendation!

I did IVF earlier this year and wish I'd started the process earlier. Even with private clinics you have to wait for appointments, they're not instant and you need the consultations etc. so it's worth cracking on. The reality is that if it doesn't work you can still go back to different options.

I found IVF tough, although didn't realise quite how tough until I stopped. Not necessarily physically but emotionally it's quite draining, and suddenly you have to organize your life around appointments, often last minute, phone calls etc. It wasn't successful for us, although we are lucky enough to have one DC so have just counted our lucky stars and drawn a line under it.

My advice would be to start sooner rather than later.

Thank you for sharing your experience @BirdIsland ! I'm sorry that it did not work out for you at the end.