Which procedure to go for?

[Celen]

Hi All

If you're thinking of going for help to conceive, how on earth do you choose which procedure to go for? What made up your mind? Are there 3 main ones (assuming you do need eggs or sperm donated) ie IUI, IVF and ICSI? And then how do you narrow it down?

Where can I find this information as I'm finding it all so overwhelming and I need it explained in laymans terms before I can decide what to do

Thank you

Hello I don't think people are generally presented with a 'choice' of procedures as such - it's more a case of following the usual processes for diagnosis and this will then determine the treatment(s) offered. How long have you been TTC and have you had any tests or been given a diagnosis?

The consultant decides for you is pretty much how it works I believe.

Perhaps someone will come along now and disagree lol

I was put on the long protocol and that fresh cycle failed along with a failed frozen.

Now undergoing my 2nd fresh cycle under the antagonistic protocol.

The change of protocol was partly his idea and also my prompting. wanting to try something different this time, to see what difference it made.

The discussion thread I'm on in fact all seem to now be on a similar short protocol after failed first attempts.

Having said that, two ladies in my group got their positive result to only sadly mc shortly after.

I decided I wanted to change protocol coz I was told i have a Very good AMH level but still only got 11 eggs from over 20 follicles. Out of those eggs 7 fertilised and 2 good quality B grade eggs were transferred and two poor quality were frozen.

Hoping this time I will have many excellent quality and higher numbers. Seeing as I have been trying for 4 years and 6 months.

We have had to pay for ICSI so i don't know if treatment on the NHS is the same in terms of influencing their decision.

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Intra-cytoplasmic sperm injection (ICSI) differs from conventional in vitro fertilisation (IVF) in that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg.

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Make yourself an appointment.

They'll want to check key information before giving you a recommendation IVF or ICSI or donor, same with regards to protocol.

With regards to the IUI we decided with the consultant not to do this option due to the sperm needing to travel up one of the tubes and i have one that is believed to be partially blocked. So wanted to eliminate that as a potential stumbling block for us.

At a later date is was also decided that this was probably a good decision. Due to poor sperm mobility and low numbers and perhaps IUI would be a waste of money. Not suitable due to the tiring journey the little guys have to make, as apposed to the man I'm the lab picking the liveliest little fellow.

First thing before treatment is the diagnostics to identify any you aren't getting pregnant, as this will help determine what's best

Day 3 bloods - FSH, LH etc
Day 21 bloods - are you ovulating?
Semen analysis - how are your partner's swimmers
HSG / HyCoSy - are your tubes open?
Laporoscopy / hysteroscopy - are there any issues in the uterine environment (eg endo / polyps)

If you're not ovulating then ovulation induction with clomid and possibly injectables will be the first port of call

If your tubes are blocked you'll need IVF

If your partner has mild male factor then IUI might be an option, as long as your tubes are open

If your partner has severe male factor then you'll need IVF with ICSI (ICSI is just a different IVF technique - IVF they just chuck the egg and the sperm in the petri dish and let them do their own thing, ICSI they inject the sperm directly into the egg)

If you're 'unexplained' after all the above investigations then IVF will generally be recommended, although the criteria for NHS funded IVF varies by area

My consultant doesn't generally recommend IUI unless you're using donor sperm or have very mild male factor. He says that an ovulation induction cycle with timed intercourse (follicle tracking and trigger shot) has pretty much the same success rates as IUI, so cheaper to deliver the sperm via a shag than a catheter

If you have mild male factor then IUI might be helpful to help the swimmers along.

NHS often bypasses IUI and goes straight to IVF for the above reasons

So treatment depends on what the problem is and what the Dr recommends

Hyland and bananafish your posts are so helpful thank you!!

I guess I was thinking that IUI is the less expensive option (or seems to be unless I'm reading the info wrongly?!) and therefore more attractive one! Off hand, do you know the general success rates IUI vs. IVF anyone?

IUI success rates aren't much different to natural conception via timed intercourse

All its doing is delivering the sperm to the egg through a catheter directly into the uterus, instead of at the cervix via sex

IVF success rates obvs vary according to your age and clinic

Many NHS trusts won't fund IUI as the cost / benefit ratio is so low

IUI is less expensive than IVF because it's got much lower success rates

A fairer comparison for IUI would be to compare the cost of IUI with the cost of a clomid or injectables ovulation induction cycle. They're roughly the same success rates

You shouldn't be worrying about this. The consultant will make a decision based on infertility diagnosis, age, and possibility of pregnancy outcome.

The thing is ItslikeRain, as we have to go private, I want to be as informed about choices beforehand as I'm concerned about being offered somethin we may not necessarily need? Plus it's an overwhelming situation to be in when you're "new" to secondary infertility.

I'm having IUI at the moment. My research told me that it takes on average five attempts at IUI to get pregnant. Having said that, I got pregnant on both my first and second attempt (the first ended very quickly as chemical pregnancy), which shows that it can be an effective method if you get your timing right. Having a good feel for when you ovulate make a difference in this, so a few months' tracking your cycle and taking notice of how your body feels around ovulation is invaluable.

I've been having IUI in Denmark for a cost of £650 per treatment which includes donor sperm. This is far cheaper than IUI at a UK clinic.

But, it will all depend on what might be causing you to be unable to conceive. IVF bypasses more potential issues than IUI does so it might be that you end up going straight onto IVF, where I think (but I don't know - it's ages since I did all my research) are more like 50% success rate per cycle.

IVF is more invasive and involves more medication with difficult side effects than IUI (which can be done without medication if your ovaries are producing good follicles on their own).

I need new shoes - you mention donor sperm?

Do I take it therefore that TTC via intercourse isn't an option for you?

In which case it makes sense you're going for IUI, but success rates for IUI aren't much different to TTC naturally...

Celen I would echo what banana has said. And bear in mind that while IUI seems cheaper, in reality if you're having to do multiple attempts (which is very likely though obviously not always the case) then the cost will add up. Not only financially but in terms of the emotional battering, possible stresses in terms of coping with work, travelling to the clinic etc - in other words all the shit which goes with fertility treatment, both in a medical sense but also more broadly in terms of how you cope. If IVF is deemed the way forward, it's sort of the same IMHO. The most expensive cycle is the one that doesn't work. Age is something you'll (sadly) need to factor in here, if time isn't on your side then that might well change things. Wish you all the best

Oh and as others have said, IVF versus ICSI won't be something you would decide, it would be a clinical decision usually based on sperm quality.

Yep - I'm single.

The only difference between iui and natural conception is that with iui (done properly at a clinic) the sperm is put directly into your uterus so there's slightly less to go wrong. With natural conception slightly fewer sperm probably make it through the cervix and it will be somewhat reliant on the quality of mucus available for it to travel up.

Yes exactly new shoes. But that's why the success rates are only marginally different

If a couple who are ovulating, have patent tubes and no sperm issues, are not conceiving after months of regular unprotected sex, then IUI which just puts the sperm a bit closer into the uterus isn't going to make much difference.

That's why my consultant doesn't recommend it unless you are using donor or frozen sperm where sex isn't an option. Or if there's very mild male factor where the sperm wash and reducing the distance the sperm have to travel, may make a difference

I struggle to see the benefit of IUI outside either of these situations when the odds of two months of sex are greater than one cycle of IUI