The Saga of Becoming Fruitful

Posts Tagged ‘IUI’

Consultation re IVF - STATS AND RECOMMENDATIONS (Part 3)

STATISTICS
DrH said that normal (fertile) couples chances of getting pregnant are 20% in 1 month, 50% in 3 months, 75% in 6 months.

She said that an infertile couples chance of getting pregnant is still even less than that with IUI - which I have seen different numbers from various websites ranging for 6-17%.

DrH showed us national stats on live births, miscarriages, own vs donor egg  - all by age ranges. She believes though that 40 year old stats are closer to the next age range of 41-42 (than with 38 where it is in the same age range).

She said that their clinic’s stats are generally much higher than the national stats, except for the advanced maternal age where they are still higher than national stats but not much higher.

(I’ve actually seen their stats from SART so I knew what she meant when she made relative comparisons of their stats to the national stats.  Their clinic is by no means the highest in the US though…)

IT TAKES ONE GOOD EMBRYO
DrH mentioned 2 successful advanced maternal age cases.
- One was 45 years old with 20 retrieved eggs that resulted to 19 fertilized embryos. PGD on all embryos showed that only 1/19 was normal and that was transferred. Now that patient has a daughter.
- One was 40 years old who had 1 failed IVF (without PGD). She went for a second IVF and out of the retrieved eggs and fertilized embryos, there was one lone embryo that tested well in PGD and was transferred. The lady’s beta is now being monitored.

OTHERS
DrH echoed back that some studies showed acupuncture to help but she would stay away from herbs.

She said that the meds would have no effect on my breast cysts.  (I still am not 100% on that.)

POSTMORTEM ON RECENT IUI
DrH said that our recent IUI (second Follistim stimulation) was perfect according to her - but it still did not succeed.

Regarding the first Follistim stimulation which got cancelled due to OHSS (did not push through for IUI)… DrH said that it could not be converted into an IVF anymore since that decision should have been made in Day 8 so that antagonists are prescribed in order to convert into IVF. We were already past Day 8 when the impending OHSS was suspected.

DrH also clarified that they make calls until 6pm (only their incoming phones are turned off at 4pm so that they can do their housekeeping and return calls within 4-6pm). So I would have received a call re my results by 6pm.

She also said that she typically has post-mortems after failed cycles.

RECOMMENDED NEXT STEPS
I am on Day 50, so DrH said that when we are ready…. She would give me
- Provera to induce a period
- Skip the usual birth control pills (since I have irregular periods)
- Start me with Lupron
- Then proceed stimulate.

If IVF failed despite high fertilization rate, DrH said that she would not not recommend another cycle of IVF.
If IVF failed and there was low fertilization rate, she would say 2 things - 1) go for PGD or 2) go for donor eggs.

DrH recommended that we go through the IVF Seminar which is scheduled on Oct 8.

LASTLY…
DrH hugged me! I did not expect that but it felt good that she had no qualms on hugging.
DH thinks that mentioning the hug in this post is sooo trivial.  Man, are men clueless…

Well … that’s a lot for now… more data, getting a clearer picture, still need to dig more on specific topics.

Then need to digest info, step back, reflect and weigh, pray and decide.

My Feelings About IVF

In-Vitro Fertilization - I never thought we’d get this far.

I knew IVF was a possibility for us even we started TTC’in in 2004. Of course, I placed it in the backburner because there were still many protocols “below” (less invasive, less costly) that we could try before we needed it. By that time that we need it, I thought it would be straightforward to move forward with it since we would have been prepared by the previous protocols.

I’m finding now that DrH has recommended IVF as our next step, that it is not as easy for me to move forward with it. When K from the clinic told me that, I was downtrodden. We were sort of hoping, it would be another IUI round. I think I was in shock that I could not drill more questions any harder - as if my mind went blank. Blind-sided.

Perhaps because at first we thought we are going to have a child naturally (don’t we all?). Nope!
Then ok, maybe with clomid. Nope again!
Then, ok, maybe this time with injectables and IUI…

And we were really hopeful on the first IUI last month because:

• Now, my ovarian cysts are gone, gone, gone
• IUI will be more “precise” than doing it naturally.
• We have conceived naturally in the past

But Nope! Negative! Denied one more time.

Although, we have not decided on what the next steps are for us. I was more ready to give IUI another round because of:

• 2 reasons above (cysts are gone and we have conceived in the past)
• SA was low on the first day IUI (when I think the egg had the most chances of being fertilized)
• My research showed that IVF at my age was about 11-25% vs the 20-25% that DrH mentioned for IUI (of course, she mentioned the usual disclaimer “it depends upon the egg quality”).
• Much less cost than IVF

So there I was not knowing what to think, not knowing what to do next. I just knew that in about an hour, I had an appointment with the ladies from the church for a dinner at a nice restaurant.

What I Don’t Like About IVF
I was rebelling against the thought of IVF. I was marinating, stewing, boiling even… So much money for something that is not going to guarantee success! So much money for something that does not have a more significant chance for success! Hmpph! So I thought…

I was thinking already that we only have a budget for 1 IVF. What if it fails?

Then we will be eating up our Emergency Fund. What if the 2nd IVF fails?

Then we will be tapping into our retirement and investment money. What if a 3rd IVF fails?

Assuming we even have the emotional fortitude to go through 3 IVF cycles, I am thinking that at that point, we should stop.

Researching the Stats AGAIN
It’s amazing how after sulking, pouring out and surrendering to the Lord all my concerns, issues, questions, pleas - He gives peace and clarity.

I was prompted to research the IUI stats again and guess what? I saw what I was blind to see earlier. The limited self-published IUI data from a couple of clinics were 6-12% (for a 35 yo woman).

It was NOT 20-25%. Somehow that number which DrH mentioned during the IUI cycle stuck in my mind. So even if I was reading the same reports last Wednesday, the other numbers of 6-12% were not registering. This is a real case of “I was blind, but now I see”.

Conclusion: IVF is about 2x more successful than IUI.

So this all boils down to my conjectured reasons and money.

All that Anxiety for Naught….
I did all the research, all the math, all the fist shaking. And all I needed was a clear and peaceful mind that comes only from the Lord. He showed me once again that “Who of you by worrying can add a single hour to his of life?” is so very true. It’s a lesson that He’s constantly teaching me specially on this saga of becoming fruitful, this infertility journey.

So, what is the worst case scenario? If we don’t have a child of our own blood by the 3rd IVF, then we would have $45K less (which could have been used for “better” use), be another year older and be potentially a lot more pounds heavier.

I look at this now and it does not look too bad, actually.

Ask me again tomorrow.

Conversation with DH on Pathforwards

Last Thurday, I was reading LifeSlurper’s blog for the first time after she left me a comment. My tears were falling silently when I came to the Stiching Up the IVF Game post.

That’s when DH arrived from work. Came into the bedroom, saw me in bed with the laptop open and asked me how I was, how my day was, etc. Then he noticed that I was crying.

I told him that DrH recommended that our next cycle be IVF, instead of IUI. That’s when the dam broke even further. Waaahhhh … I could not contain myself. So there I was a crying and sobbing mess. And my DH just hugged me.

Why God?
When I was a bit more pacified, I told him that I was asking God, “Why can’t we not conceive naturally?” “Why did that first IUI cycle not work?” “Why can’t we have another IUI cycle?” Why? Why? Why?

“Can we not conceive with ‘just’ IUI instead of IVF?” Please, please, please?

Money Matters
I also told him that I was so averse and repelled to the idea of having IVF and pay a lot of money for something that was not guaranteed and had no significant edge over the much cheaper IUI.

Will You Still Love Me?
I asked him if he will still love me even if we don’t have a baby? He said, YES! And that as children of the Lord, we are different from the world as they view and react to this situation.

He said what would comfort me deeply - “You are my baby.”

I Want a MiniMe
But I said, “I want a minime, a miniyou.”

And he said “Don’t ask from me what I am not able to give. It is the Lord who gives us a child.”

“So what do we do?”, I ask.

“That’s simple.”, he says, “We pray to God to give us wisdom and guidance to make the right decisions and do the right things.”

WOW. I can’t help but feel so blessed to have him. I just praise God for giving me a beautiful husband who loves me, comforts me and helps me keep my perspective. I can’t ask for more in a husband (aside from wiping the toilet bowl, separating his colored vs white clothes, bringing in his lunch boxes, taking the trash out - all without reminders) No, really. I’m so very glad he is whom I married.

Yet, I feel sad that I can’t produce us an heir who we can raise to be beautiful as well. So I still keep on asking God.

What’s Next?

Yesterday after getting the beta-hCG result, my headache went into full blast. Torture to the MAX! (Typically, I just sleep a headache off, but this one needed tylenol!)

Could it be hormones crashing? Or perhaps thermal cycling going in and out of the car into the heat and then into the airconditioned stores? Or perhaps 4 hours without food? Anyhow, it made me indulge in some self-pity…

I was thinking I was tired of trying
…of having to take the injection shots
…of having to ride the stirrups and probed
…of having to induce Miss Flo with provera
…of having to look up the clock to see if it is time to take a BBT, to take the levothyroxin, to take the shots, to take the prenatal vitamins
…of wondering will I ovulate? will we get pregnant this time? if I am pregnant? are these pregnancy symptoms?

Many questions. No answers. I’m tired.

Well …the wonders of rest and sleep is that it can give you back perspective. DH woke me up when he got home from work and I told him of the results. Cuddle. Comfort. Wow. What a great husband I have. Thank you, Lord!

DH saw the book on our bed - “When the Cradle Is Empty“. And he read to me the following excerpt from the When Is It Time To Move On chapter:

Don’t make a hasty decision. Infertility testing and treatment involve a long, intensive, expensive process that’s bound to produce anxiety and frustration. Understanding this and preparing yourselves for it can help you avoid the “early dropout syndrome”. If you quit before you’ve really made an honest and thorough attempt to achieve a successful pregnancy, the two of you may regret it for the rest of your lives. (Emphasis is mine.)

That made me realize that this is “just” our first IUI and that there are many women who’ve had multiple IUIs and even moved on to IVF. I could not say with all honesty that we’ve had a “thorough” attempt already. So that encouraged me.

Meanwhile prior to the actual IUI, DH and I discussed a bit on Plan B. I suggested that we do Follistim cycle #3 with BD, instead of IUI. He said though that he’d rather have another IUI since the probability is supposedly higher. I thought that was mighty brave of him considering he had some technical difficulty in herding the boys!

Today, we’re not sure if that is the best next thing to do.

Anyway, we will meet with DrH when Miss Flo arrives to do baseline and at the same time discuss our next steps. Sounds like it is either another IUI or move on to IVF. I will have to do some additional research on the probabilities on either options.

The challenge with these probability information is that there is very litle IUI data that is published. But will make do with what is available and will surely share what I learn from them.

Meanwhile, maybe some of you can share what your thoughts were in making a decision on whether to try another IUI or to go forward with IVF. Appreciate it much!!!

Waiting for Ms Flo
Maybe I should get a job… instead of blogging my thoughts away!

The 2-Week Wait

So I had my 2nd IUI for this cycle this morning…we started with the ultrasound to see if the follicles ovulated and if so, how many of them did that. Looks like I ovulated 1 on the right and 2 on the left.

But… I have no sonogram because I forgot to remind Dr H to print one. I was telling the medical assistant later as I was checking out and guess what she said “You don’t want those. You want the “real” ones in the next 2 weeks.” I told her “this is real as well”. Hmmmpph!!!

So “worst” case, triplets? For me, 1 is alright, 2 is better, 3 is a stretch but I think still good. Well, we will know in 2 weeks.

Did anyone notice that I did not mention the SA results yesterday? Well, I intentionally did not mention that so as not to pressure DH (who reads this blog) on it. We however talked about it later, so now I can tell you about it.

My DH’s last SA was done late 2005 with good counts (71M) and motility (53%). What was below normal was the 4% morphology. When we asked Dr H last Sunday, she was not very concerned about the morphology and that she was after the motile concentration instead.

The post-wash SA yesterday for the first IUI was not very good with 4M motile concentration only. Perhaps it was because DH was nervous that he was only going to give a few millions. Perhaps because he was a bit sick. Perhaps because of the lack of lubrication. (I learned later that he did use s teeny weeny bit ) Anyway, Dr H said that maybe if we “stage” it better tomorrow.

So today, we used the recommended lubricant “Pre” from the lab that did the SA. The frontdesk person in the clinic actually said any non-spermicidal lubricant can be used. Here’s the front and backside of Pre containers:

… and we “staged” it. “Stage” - interesting word… let your imagination work. And we got way much better post-wash SA today at 19M motile concentration! (The desired level is 10M.)

Dr H was feeling good about my girls ovulation and my DH boys’ improved motility concentration.

So, the 2-Week Wait starts today and hopefully ends positive on August 5. Meanwhile, I will use Progesterone VS starting on 7/25 Thursday.

The time starts now!!! (tapping fingers…). So how do you “occupy” yourself in the 2WW? Any suggestions are welcome!

COST: $530 (180 ultrasound, $170 IUI, $180 SA/wash)

So That Is What An IUI Is…

I’ve always dreaded the thought of “artificial insemination”. Maybe I guess because it sounded like I was a cow.

Maybe that is why all this time, we have always opted for timed BD.

With the more expensive injectibles, we researched and were adviced that the probability of getting pregnant was higher if intra-uterine insemination (IUI) was done, instead of timing it. Also we have been timing that for 4 years, so we needed something more precise and effective because we’re not getting any younger, you know! It was then more prudent to go the IUI route so that we can maximize our chances with the more expensive injectibles.

Its a good thing that I was adviced by some forum posters that it’s not really a big deal so I did not obsess too much about it.

DH submitted the boys for washing early in the morning and I had the IUI appointment later in the morning.

Truly, it lasted shorter than a normal RE consult - done in less than 5 minutes. The waiting after the procedure was even much longer at 10 minutes.

It was like a pap smear in the sense that a speculum is used to create a passage way. Then a very thin plastic catheter (carrying the post-wash boys) is inserted through the cervix and into the uterus. The boys have avoided the harsh environment they would normally have to journey to get to the uterus, so they should be there either trying to meet the girls now or just hanging out and waiting for the girls to come down. They’re having a party inside of me!

Dr H showed me the catheter labeled with our last name and informed me that the labeling was done to make sure that we get what we submitted :). Just imagine an Asian couple like us suddenly getting a child that looks different from us. Not funny at all.

There’s a bit of discomfort but really, it is very tolerable. What I did to help in the discomfort was to relax my pelvis, breathed deeply and huffed open-mouthed a few times. Before my overactive imagination can take over, it was done!

Dr H set the alarm clock for 10 minutes. I was left laying down on my back with my feet planted on the bed. (I read in a website of one of the fertility clinic that there really is no need for this since the boys are in the uterus, above the cervix already, so they won’t flow down. Anyhow, doesn’t hurt to do it. Maybe it can also aid the boys to swim upstream ) 10 minutes passed by fast, then I was up and ready to go.

Anyway, we go back for another IUI tomorrow. (The same website above mentioned that there’s really no medical study conclusively pointing to 2 inseminations to be better than just 1. The key was more of how well-timed the insemination is done versus when ovulation occurred.)

Meanwhile, I still do not have my ultrasound image of the leading follicle because the sonogram procedure was not done today. Will get that tomorrow, promise!

COST: $350 ($180 for the boy’s wash and $170 for the IUI procedure)

CD13: Follistim Day 9 Response (Cycle #2)

The leading follicle last Thursday really grew and it is ripe for the picking!

I don’t have ultrasound image to show today though because in my excitement, I forgot to remind Dr H to print it for me.

Endometrial Lining = 7.1 -> 10.2 -> 10.5
Right Ovary = 10: 7, 6/3, 5/5, 4 -> 6: 11, 10/3, 8, 7 -> 5: 16, 15, 14/2, 10
Left Ovary = 9: 8, 7, 6/4, 5, 4/2 -> 5: 14, 10, 9, 8/2 -> 5: 20, 15, 13, 11/2
Estradiol = 91 -> 380 -> ?

(For those who are new here - You can go to Follistim response in the top tabs to see the tabulation of all my stats summary from both cycles.)

Dr H said she’ll print an ultrasound image tomorrow. Maybe, it will not show up as big anymore though since I injected Ovidrel this afternoon. She also mentioned that the other 3 next biggest would be candidates too. So potentially I will ovulate 1-4 eggs. Yaiikkks -potentially, quadrups?

So… we will be going in for our very first IUI tomorrow !!!

When I asked Dr H about the probability of conception for IUI, I initially got the “it depends on the quality of the egg”. I eventually got some quantity: 20-25%. This is about the same as the IVF success rates (live birth) they have for my age range.

We then asked about what the effect of SA low morphology to this probability and she said that post-count wash count was more important that morphology. The desired level is 10million count. I better go take care of the boys now.

Meanwhile, say a prayer for us!