This is the 24th installment of Barren Advice. You can ask questions that are fertility or non-fertility related.
Barren Advice is posted each Tuesday-ish. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.
I am writing to ask about IUI along with Clomid. Does this ever work for anyone? My fertility doctor recommends a few attempts with this approach, but she says it has a 5% chance of working, which is less than the standard statistic of 10% per month for a woman over 35. In my quick review of the blogs on your blogroll, none of them were successful with this approach, only with IVF. Our insurance does not cover any fertility treatments, so we'd rather not waste $ and time on a 5% chance!
--Anonymous and Blogless
If your doctor told you that you would have a 5% chance doing IUI with Clomid, a 10% chance doing IUI with Follistim, a 30% chance doing IVF, a 60% chance doing IVF with donor gametes, and a 99% chance doing adoption*, it would make the most sense to go with adoption. Except that you want to experience pregnancy so then it would make the most sense to go with IVF and donor gametes. Except that you'd like a genetic connection to the child you're carrying which means you should do IVF. Except that you're paying out of pocket for every procedure, so it doesn't make a lot of sense to start with the most expensive so you drop back down to the IUIs and...well...you're back in square one staring at the statistics again.
The problem with success rates is that (1) you don't know which side of the percentage you're going to fall until you do the procedure therefore, looking at them is a lot like gambling and (2) success rates are not one-size-fits-all. You may have a 5% chance of an IUI with Clomid working, but another person may have a 30% chance of the same procedure working. Therefore, I throw all numbers out the window when making a decision because they're meaningless. Instead I look at the overarching facts associated with each procedure and what problems it can and cannot compensate for or overcome.
I'd look at diagnosis and age as your determining factors. IUI is great for a number of problems including mild male factor (not azoospermia), absence or acidic cervical mucous, and the ever dreaded diagnosis of unexplained infertility. It is not great for egg quality issues, high FSH, or uterine anomalies (though IVF can't overcome some of these issues either). This doesn't mean that IUI doesn't work if you have egg quality issues, but what I'm saying is that it isn't a procedure that is meant to circumvent that problem. Therefore, I'd take a look first at your diagnosis and consider whether or not IUI is being thrown at the problem because it's less expensive but it isn't truly the best fix.
The other thing I'd look at is age. I'm assuming from the wording of the question that you're over 35. What you would try if you were 25 is very different from what you'd try at 35, especially if you would like to have another child after the one you are trying to conceive. How aggressive I'd be would depend on how far over 35 you are (40? I probably wouldn't spend a lot of time with IUI. 36? I may give it more consideration) as well as the hormone levels on your day 3 blood work.
I think one problem is that the choices aren't (or shouldn't be) just IUI with Clomid or IVF. You could try a few combinations of injectable drugs with IUI, for example. Even with IVF, there are a multitude of protocols your doctor could follow--some more aggressive and more expensive than others. The protocol is chosen based on a host of factors.
I feel for you because we don't have coverage either so almost everything is out of pocket. You don't want to spend more than you have to and you don't want things to be more invasive than necessary. But at the same time, you don't want to waste time.
I guess this is the analogy I would use for making the decision. You dated a lot of people (I'm assuming) before you met your partner. And those past relationships not only gave you information that made your current partnership more successful, but they also were educated tries along the way. If you had known they wouldn't work out, you probably wouldn't have spent the time just as if you know a procedure won't work out, you probably don't want to spend the time (and money). But every cycle gives your doctor more information--from how your body responds to drugs to how your uterine lining grows. And that information may be what makes your first IVF successful vs. gathering some of this information with your first IVF cycle before you go on to the next one. Every relationship gives you information too--so those old relationships that didn't work out weren't truly a waste of time.
In other words, it is the difference between dating around with low stakes rather than jumping straight into marriage with the first person you meet and either having it work out or having to go through a messy divorce.
I will state this clearly here: sometimes, you don't have a choice with what you try first because diagnosis dictates a clear-cut solution (or a best solution). It sounds as if the playing field is open to you because you don't have a diagnosis that points in a single direction. Therefore, I'd always choose low-key over invasive. You may hear from people below that they have regrets that they tried the IUIs because they didn't work or you may hear from people who are ecstatic that they tried IUIs because they did work. Either way, their experience is their experience and not a prediction of your experience. You may not have regrets if you have some IUIs that don't work if they streamline your first IVF cycle. Or you may have regrets if you have limited funds and you spend them on something that has a lower success rate (IUI almost always has a lower success rate than IVF).
Regardless, it's a decision you're going to have to make because it is a very personal decision but my advice is to always take the path where you'll have the least regrets while, at the same time, holding yourself in check with the regrets department by remembering that a negative cycle doesn't always mean a waste of time.
No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.
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*all success rates are fictional. True success rates are based on a plethora of information and aren't one size fits all.