IUI - not sure what difference it will really make...

[JessieMcJessie]

DH and I have been ttc for about 8 months, had one BFP but miscarried at about 6 weeks. His sperm analysis is tip top and I have regular 28-30 day cycles. I get good positive OPKs bang on time every month (know that doesn't prove I have ovulated but I am fairly sure that I am.) We're definitley timing the DTD right.

I am however 41 so we are already on borrowed time. Private clinic has suggested medicated IUI so I'm going for a scan tomorrow and will start taking the drugs this week. I need to feel like I am doing something but I'm not sure that we have any of the problems that IUI is designed to fix. In other words I suspect that our issues are probably either chromosomal abnormalities in my eggs or something that is preventing implantation.

Doc described the process as improving chances because (a) I will ovulate more than one egg; (b) the sperm are supercharged by the washing and don't have so far to swim to reach the egg; and (c) timing is more scientific.

Has anyone with no obvious ovulation or sperm problems had success with IUI where normal well-timed DTD failed? I am thinking if it doesn't work first go we should just save our money for IVF. I'm not convinced my doc will tell me straight as his clinic does IUI but not IVF.

My circumstances are not identical, but does have similarities. I am also 41, but am using donor sperm via IVF as I am single. The first thing I'd ask, is have you had any blood work or tests? Do you know your FSH levels or AMH? I was led to believe by my previous crap clinic that I was fighting fit reproductively, including my AMH, and it was not until I changed clinics that I discovered my AMH is actually low...3.03. Any responsible clinic would initially undertake a batch of tests to get a base-line interpretation of your reproductive status and that of your DH too. Maybe they have...there is no mention in your post?

I was also recommended to have IUI initially...and until I did my own research, was in agreement. However, I then discovered that the failure rate is so high (and particularly at the age of 41) that I honestly believe clinicians should be having 'honest' conversations with patients, particularly given the finances etc. I have therefore jumped straight in with IVF (short or flare protocol). My first cycle has just failed, suspected low progesterone, but at least I know my chance of success is significantly higher with IVF than IUI. But the odds are still not great in contrast to a younger woman.

My perspective is that at the age of 41, our chances of success with own eggs are significantly lower anyway. At this age, I feel as though I need to maximise my chances as my time is fast running out.

I'd be interested to see too whether anyone in their 40s has conceived / delivered a baby with IUI.

We're just about to start ivf after a string of failed iui's (9 I think!)
In hindsight I'd go straight to ivf instead of wasting time as I'm going to be 40 this year. However, my very close friend was told that ivf was the only way. She begged for one try at iui and lo and behold her wee one is just about to turn two.

Hi Darkchoc. Yes, have had all the basic blood tests. My AMH is low but not abnormally low for my age (9.8 pmol/L or 1.37 ng/ml, not sure which units common in the UK as I am in Hong Kong). Haven;'t had FSH tested on the right cycle day but have had two scans that show no PCOS.

I haven't had my tubes tested for blockage as doc reckoned with no history of PID etc and having had a previous pregnancy it would be a waste of time and money.

DH has had sperm analysis are there other tests he should be having?

Hope your IVF works next time - is it not normal to give progesterone as a matter of course? I am getting it with the IUI.

14575 thanks for the encouraging story. Can you remember why exactly the docs told her IUI would not work?

Actiually sorry 14575 that was insensitive of me, I should have said I am sorry to hear that IUI has not worked for you. Going through it 9 times must have been very tough.

No problem jessie, it is tough going for sure but I wasn't really ready to accept that we needed ivf. I think it was a process I had to go through to get my head around it if it makes sense. Especially as we have a child from a very straightforward pregnancy previously. I think with my friend he just thought they didn't have time on their side as she was 41 then and had an amh of less tfan2.

Well, bit of a game-changer this morning. Went for my scan to start the IUI and the doc flicked through the notes and said " we've already explained the sperm issue..." and I said, "er, no, what issue?"

Turns out DH's morphology is only 1%, when 4% is the minimum normal level. He has high count and motility which I understand to be encouraging because although only 1% of his boys are any good, the absolute number is still quite high. But this explains why we've been having problems (though am sure is a combo of us both).

Why we were not told this before I do not know. DH wasn't with me this morning so now I have to explain this to him - he'd seen the results sheet before but we didn't know how to interpret it and my GP had said it was "fine". At our first appt with the consultant GP had not faxed it over so he didn't have the info during the appointment (though I seem to remember the nurse looking at it when it finally did arrive and saying it was OK.)

Anyway we're going ahead with the IUI so I have had my first gonal-f injection today and four more to do. I'm toying with not telling DH until after the insemination in case he gets too anxious and can't perform. But I think honesty is probably the best policy.

Bit of a surprise, he's only 36 and doesn't smoke or wear tight pants (in fat he is well known for lounging about commando at home, ew). But he does like a drink, isn't always the healthiest eater in the world and could do with losing a stone and doing more exercise.

Doc says that IUI isn't the best fix for this problem (that would be IVF with ICSI I think) but that IUI will improve the chances beyond natural DD so we may as well give it a go. However if it doesn't work then we'll be straight to the IVF clinic. Still processing all this...

I hope this will be an encouraging anecdote - I have just completed my second round of iui and walked away with a bfp for the first time ever. I was undiagnosed, and while I'm 33, I was pretty sceptical after 3 years of trying everything. So much so, I had already booked in for ivf. I have no idea why it worked this time, the cycle itself was a disaster with drama after drama.

What I would say is that on the day of iui with you both there to legally check the paperwork and the sample that he will be told what count you have for the procedure. Probably best to prepare him, it would be upsetting to find out there while you're legs akimbo waiting for the magic to happen.

Remember, it only takes one, and this way they are getting a massive shortcut to the action. And if nothing else, it makes you feel like you are trying everything!

Good luck

I got pregnant on my third cycle of IUI, with a minimum dose of Menopur. Previous two IUIs had been unmedicated. Slightly different issues, but you might find my story useful.

Background: me 40, DH 52. Me no identified issues, good egg reserve (AMH 44!). DH reasonable count and morphology. Motility was ok when first tested, but "a bit slow" in subsequent sample we used for IUI (we froze for the IUIs as he had performance problems when under pressure). He also tested weakly positive for antibodies.

Because of my high AMH, we kept my Menopur dose low (37.5 for 4 days) to avoid OHSS, and I wanted no more than two follicles. In the event, we only got one, it just grew quicker than usual. I totally thought the cycle would be a waste of time, and we would have to go the ivf route, as the sperm sample used only had 3 million after washing, when they ideally like more than 10. However, I am now 32 weeks pregnant.

In summary, I'm glad in hindsight we went the IUI route, as it was cheaper and less invasive than ivf. If it hadn't worked, though, we could have funded 2/3 of an ICSI cycle with what we spent. Plus we would have lost 3 months. It's a gamble. What swayed it was that we were at a clinic with a good success rate (Lister) and I was really nervous about egg collection! Also, if the anti-sperm antibodies were the problem, then the sperm washing could do the trick. We did agree to do no more than 3 IUIs, as success becomes much less likely after 3 non-successful attempts.

Good luck, OP!

Thanks both for your encouragement, and congratulations! I really appreciate it and I agree that it has to be a shortcut.

Hi Jessie, I just wanted to comment on your thread even though I know you've decided to go for iui. I'm 35, ttc 2 years unexplained subfertility. DH has really good count, 99 million post wash with 60% motility. We we're recommended three rounds of iui on NHS which didn't work and are now due to start IVF this month. I have only found out recently my AMH is 9.4 which explained why I only produced one mature follicle at each IUI (there were other smaller ones). In hindsight we wished we went straight to IVF after one fail as my ivf consultant explained why the iui didn't work. My uterus cramped a lot on insemination day after the catheter was inserted and I spotted several days after that, my consultant said that this is not normal. However, one good thing is that I do think iui prepared me for ivf with regards to the drugs and scans so I feel more relaxed about it all. Plus my clinic has since moved to new premises with better results which we would not be going to had we not done iui which I see as fate.

Best of luck with your treatment.

Thanks noncoformist that's interesting and appreciate you taking the time to reply. I'm pretty sure we won't do more than 1 round of IUI if it doesn't work.

When you say your consultant explained why it didn't work, do you mean the low AMH (think mine's similar) or the cramping? Was s/he able to say why the cramping might have happened?

Soory you had such a tough time and very best of luck with the IVF.

It was the cramping and spotting he said which explained the failure despite the nurses saying to me it was normal. IUI uses a longer and more rigid catheter compared to IVF and is put in blindly. IVF embryo transfer uses a camera with the shorter, softer catheter so they can avoid aggravating the uterus. Each time I felt the catheter hit the top of my uterus (I think it's called the fundus?) it caused immediate sharp cramping for me. It wasn't a pleasant experience but most other ladies didn't have this and got their BFP.

I would just see how you get on with one round first. As your AMH is similar to mine, you won't want to delay IVF further. Fingers crossed you won't need it!

Hi guys
So glad to have found this thread. I am currently waiting for my next fertility appointment (which is on Thursday) and I am nervous as hell as I will have a scan and find out the results of the AMH and repeated FSH level. (They were 17 last time) so I have convinced myself after ttc for 20 months for baby #1, it's just not going to happen. I flit from thinking it's not the end of the world, there are other options to thinking it is the end of the world!
Whilst I am sorry to hear of other people's difficulties, I am so glad not to be in it alone!

Thanks for explaining further nonconformist and hope the IVF works for you. I also hope that I don't get those cramps when I have my IU this week, they sound unpleasant.

karlafox I too have those emotions, and the problem is that you get so caught up in TTC that you forget what it was like not to have it as the only focus in your life.

Having found out last week about DH's low morphology, which is something that can't be fixed really, only worked around, I had to stop and wonder how we'd feel to live the rest of our lives without children - funny I found that very hard to picture when it is less than a year since we had to sit down and think very carefully about whether it was something we really wanted. I've decided not to go down taht route until I am told definitively after IVF that it is not going to work and still early days on that front. How old are you?

karla there's a TTC for more than 10 months thread with a lot of regular contributors, you might find that helpful and there are people on there who do get BFPs so it's also reassuring.

Hi
Thanks for the info
I'm 34 and DH is 31. All was ok with his results fortunately, it's just me that needs further investigations.
You were right to suggest not thinking too far ahead, that's the most sensible option but hard to do when you become so irrational about it all!

I am hugely lucky to have one DS. But he is now 5 and I would really like a sibling for him. We went to a fertility clinic last year and were diagnosed with unexplained secondary infertility. My results, all good for 38 as I was at the time, DH results all good, no tube blockages....nothing that they could find was a problem. We have continued trying naturally but no luck.

Someone has suggested endometriosis?