Unexplained infertility: IUI or IVF?

[Shoegal30]

Apologies for this topic as it's a bit long but am in need of some advice on what to do next.

I am in the unexplained infertility camp. Me and DH have been TTC no 1 for over 14 months with no luck.

I have regular periods, am ovulating and all my tests and DH tests have thankfully come back clear.

After being referred to the hospital after 12months I was told I would need a HSG which would take 8 months. If after 2 years if not pregnant then will be eligible for IVF but again will still be a long process.

Anyway me and DH decided to sacrifice Christmas presents and got the HSG test done last month privately which also was clear.

After all this AF has turned up again and me and DH have decided that we would like to consider going private for treatment as we have some disposable income.

However, with a very unhelpful GP and as we are unable to get a hospital appointment I have nobody to ask for advice.

What are our next steps? Should we go for IUI first or straight for IVF? Do I need to speak to my GP first or can I go directly to a clinic?

Thanks in advance for the advice...

Hi,

Sorry you are going through this a similar thing happened to me and my gp wouldn't refer me. In the end I went to see a see a different gp-could you do that?
If you don't mind me asking how old are you? I know this is going to sound really annoying but I wouldn't rush into IVF after only 14 months ttc. I know 14 months feels like forever (three years here!) but it can take some couples up to two years. Fertility treatment is very stressful and expensive and I really wouldn't do it if it wasn't necessary.

We are unexplained also and have done two iui so far, the first ended in miscarriage and the second didn't work. My opinion is that a few rounds of iui are always worth a shot!

Have you done ovulation sticks or temping.

Good luck, this ttc malarkey is the most upsetting and frustrating thing ever! X

Thanks for the response guys. I am almost 32 years old.

I have been using the CBFM for over 10 months and have also been temping for the past few months too.

I am in the Midlands. I could go back to the private clinic I went to for my HSG test. I take it I don't need the doctor or hospital to refer me?

Oh and good luck with your treatment Buggerlugs. I know somebody who was successful with their first round of IVF and she said the Marisa Peers book Trying To Get Pregnant and Succeeding was instrumental to their success. The book is about visulaisation and positive mental attitude x

At your age, I would be tempted to leave it a bit longer. You might hit the jackpot without help.

We are unexplained. We had 2 rounds of IUI with no luck, and then got a BFP (although I miscarried) on our first round of IVF. So clearly IVF overcame some unidentified problem for us. It is a LOT more expensive though, and a much more difficult process, both emotionally and physically. I needed to go through the IUI step first, as I have struggled with using such an artificial process as IVF to make a baby.

You can self-refer to most fertility clinics. Be aware that it takes a lot of people more than one round to get their baby (we are now on our 4th), so if you needed more than one round, would you be able to fund this? And bear in mind that in some areas you can lose out on your NHS entitilement if you have private treatment (every PCT has different criteria so you will need to check this).

OP, I'm sorry you are going through this. Unexplained sub fertility is a deeply frustrating diagnosis, isn't it? However, although 14 months seems like forever your chances of conceiving by the 2 year point, especially at your age, are going to be as good as an IVF cycle would give you so I would personally consider giving nature another 8 months, whilst using the time to focus on physical and emotional health and to go to clinic open evenings etc and line up my plan B. There is academic literature you can find online which models the prognosis for unexplained infertility according to how long you have been trying. These sort of stats can be helpful when making difficult decisions about timing of treatment. I can dig out references if you'd like.

I began treatment after we passed the two year point, which is when the stats said my odds of getting pregnant in the next 12 months fell below my odds with an IVF cycle. My choice was to go straight to IVF, rather than trying IUI first, but I was 37. I also hoped that if IVF failed the cycle might at least give us some answers, whereas IUI wouldn't offer us any new diagnostic information. I am 39 weeks pregnant with a frostie from the first cycle so for me IVF was the right decision. However, as others have said you may need several cycles - my clinic advised looking on treatment as a course of 3 cycles - so need to consider this when deciding whether to self-fund, if you have a choice in the matter. As euro says, you would generally forfeit any entitlement to NHS funding after a certain number of privately funded cycles.

In my area, the NHS infertility investigations feel like (and are) a long process but once you are referred for treatment things happen just as fast as they do for private patients. This might be something you could find out about at clinic open evenings.

Unexplained infertility is not any diagnosis at all; what this means is that they have failed to find out what is wrong. It can be given to couples when they have not been adequately investigated. I would also ask you how thoroughly they have tested your man; one semen analysis for instance is by no means conclusive.

It is also fair to say as well that some NHS units are far better than others. Making you wait 8 months for a HSG is never acceptable.

Some tests are often missed out as well; I will give you a list of the commonly missed ones:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up tests and velocity testing. However, when they are done, they often uncover a hidden cause for the supposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries.

I would push to be further and more thoroughly investigated particularly with regards to male factor.

I would keep trying naturally with temping and opks / monitor. For a bit
Consider if you have any fertility issues in family thyroid problems,
Find out if you start privately if you can go back to nhs to get the free one(s) in your area.
I think some areas wait 3 years before referral for unexplained so important to check all the rules
Take a look at the stats of your clinic. Ours showed a lot less success after 35. For ivf.
I would imagine you have more chance of success overall doing the iuis first as you can do several.
Although the clinics do understand more than the gps so a consultation may provide more info
My sister was unexplained and had no success with iuis (at37) but icsi worked. I feel you learn a lot from ivf ie if you have a lot of eggs and they either don't fertilise or carry on growing you understand why trying naturally wasn't working (it would have taken a year to find the egg that carried on dividing)
With ivf you are given progesterone for implantation which I'm not sure if you get for iuis

We exactly the same... unexplained infertility and were told we should do IVF straight away... no other alternatives were mentioned. As there was 'apparently nothing wrong with us' we continued trying for another year. Nothing. We then did IVF privately as couldn't wait 2 years on NHS (we were referred by helpful GP), we were older - me 35 - and luckily 1st round of IVF worked and now have a lovely DS. Don't give up hope, explore every option, and don't leave it too late. x

Im new to this forum and this is my first message so firstly Hi to all,
We was diagonosed with unexplained infertility about a year ago, We have had all our tests done and I have had all the examinations - no problem, my egg count is on the higher scale 29.9% my husbands sperm is a bit low but as in the doctors word should be enough to be able to concieve. We cannot get IVF through the NHS as my husband already has 2 children so a year on we have decided to go private. We went to a couple of open day fertility clinics and looked at there statistics and the equipment, and made our choice from that. We go to our first consultation on the 12th Feb then going to start in March.
May I add my doctor was useless, very inconsiderate and just wanted to get rid of me. I did all the pre tests on NHS through my doctors and it they was so unorganised we had to do a couple again, it took me 1 month to get all the pre test paperwork together!! x x x

Hi reemarsh, does the nhs not even cover iui in the situation or Clomid if there are children already?

Unexplained infertility means that they have failed to find out what is wrong. Its not a diagnosis at all.

My guess too is that you as a couple have not had all the tests done - or have only had done what they made available to you. How thorough were they with regards to your man, they made a comment about the sperm being a bit low. That warrants further investigation itself.

Good luck with the private clinic and do ask them lots of questions, Write down anything you want to ask well ahead of time and make sure you ask them everything you need to know. It is vital that the three of you can and are able to work as a team.

Some tests are often missed out as well; I will give you a list of the commonly missed ones:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up tests and velocity testing. However, when they are done, they often uncover a hidden cause for the supposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries.

No naty1 the NHS wont give us any help whatsoever, apart from all the blood tests and xrays. He was so so rude, tbh going to a private clinic you get treated like royalty (Obviously at a cost) and the NHS I have found to be very abrubt and dont care what you are going through. I have heard a few storys about people getting NHS infertility treatment when there husbands/partners have children but obviously I never ticked the right boxes. Im starting to think now going privatly was the right step anyway although it costs £££££ you are relaxed, comfortable and hoping with that in mind it will give me a bit more of a chance in becoming a mum.

Hi Ree,

Regarding you question on IVF versus IUI, I think a lot depends on reasons for infertility and the length of time you have bee ttc. We had unexplained infertility and after 4.5 years went to a private clinic where they said we were welcome to give IUI a go but that considering the amount of time we had been ttc for the chance of success was not any higher than normal intercourse. We opted for ICSI (by this stage DH sperm had diminished in quality) and are now 10 weeks pregnant.

Best of luck

Sorry you're going through this. I have one hopeful thought to offer - you have an increased chance of conceiving naturally for about 3 months after hsg or hycosy, so it might be worth seeing if that could work for you. After 2 years unexplained (now 37) I finally got a bfp 2nd cycle after a hycosy and I'm convinced that it helped. Hope that or something works for you.