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11-14-2012 at 4:28 PM
GettinCraf...
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GettinCrafty is not online. Last active: 05-21-2013, 12:02 PMNewbie

DOR, OOP and conflicting advice from RE. WWIFD?

Here's our story so far:

DH and I are 100% OOP for treatment. In Aug. 2011 we were diagnosed with DOR and slight MFI. In June 2012, after about a year of hemming and hawing over whether we should pursue treatment with such low chances, DH and I decided to take the plunge and try an injectible IUI cycle. Then we tried another. And another. Two BFNs and a CP.

So we paid for a consult with RE to make a plan. He said we have 10% chance with injectible IUIs and 20% chance with IVF. Given that we got one CP, proving sperm and egg can meet, he said we're better off doing two more injectible IUIs. If those failed, he recommended BYPASSING IVF since our chances were "so low" and going straight to DE or adoption. So we tried another injectible IUI cycle. They missed my O, so I didn't trigger and I didn't get to do an IUI. I lost trust in them and began to feel like a number at their very large clinic.

I called RE office to find out what we might do differently next time -- how to better catch my O, whether to change up meds, etc. -- since it's potentially the end of the road for us. RE nurse tells me RE recommends IVF. REALLY? (Talk about feeling like a number and not getting personal attention! Didn't he just say it wouldn't be worth it and we should pursue DE? Are they even looking at my file?) She just called back to say yes, he really recommends IVF. That his prior recommendations were based on the fact that we're 100% OOP.

So now I'm torn, and I know so many of you ladies can understand. Hoping you can help me weigh the pros/cons...and to understand if 20% really is a low chance for IVF. 

My choices, as I see them: 

1. Do 1 more injectible IUI as RE initially recommended - 10% chance.

2. Do 1 round of IVF with current RE (our limit, at $15,000+ a shot) - 20% chance.

3. Switch REs and get a second opinion (resulting in either IUI cycle or IVF with them). I can get in at another nearby clinic (affiliated with a university) sometime next month for a consult.  

What would you ladies do? 1, 2 or 3? Or something else entirely?  

Thanks for any advice you can offer. <3 
TTC#1 since September 2010. Me: 35. DH: 37. Dx with DOR and slight MFI (8/4/11). 100% OOP for treatment.

Right now: IVF #1 (ER in early June)
10/2012 IUI#4 (Follistim, ovulated before trigger, missed IUI, converted to TI): BFN
8/2012 IUI#3 (Follistim/HCG trigger): CP (Beta #1: 4.61, Beta #2: 1.0)
7/2012 IUI#2 (Follistim/HCG trigger): BFN
6/2012 IUI#1 (Follistim/HCG trigger): BFN

6/21/11: First RE visit. Test results: 7DPO b/w: Progesterone = 11.3; CD3 b/w: FSH = 10.1 mUnits/mL, E2= 52.0 pg/mL, AFC: 6; SIS Ultrasound: Uterus great, tubes clear! AMH: 0.3


 
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11-14-2012 at 4:41 PM
baker916
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baker916 is online. Last active: 05-21-2013, 3:19 PMBronze
I'm sorry you're dealing with this.  If it was me, I would get a second opinion before proceeding.  If you've already tried three injectable IUI cycles, it is likely time to try something else.  Plus, it sounds like you don't necessarily love or trust your RE or his office at this point.  Initial consults are fairly low cost, so I would get a second opinion before making any other decisions.  Good luck!
TTC #1 7/10, Me (31)- Dx DOR (AMH 0.6); DH (30)- normal
BFP on Cycle #8. Natural M/C at ~8 weeks
IUI #1 and #2 (8/12, 9/12)- 50 mg Clomid + Ovidrel = BFNs
IVF #1 (EPP) 13R/10M/9F, 5DT 1-4AA blast, beta #1-148, beta #2-322, 5 frosties!
3/18/13 - It's a Girl!
4/18/13 - A/S- baby looks perfect, but partial placenta previa
Lilypie Maternity tickers 
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11-14-2012 at 4:44 PM
J&D2007
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J&D2007 is not online. Last active: 04-28-2013, 8:12 AMBronze
I am not usually one woulda would suggest changing Drs, but in your case, I would consider it. The 20% chance with Ivf doesn't sound right to me. What was your FSH? Your AFC? Your AMH? I certainly think if these numbers are reasonably normal, your chances should be much better with Ivf. What is your age? In your shoes, I would get a second opinion and go the Ivf route. With DOR, why not get the most eggs you can in one shot and see what happens? I know it's pricey, and I'm oop too, but I couldn't stand messing around with any more iuis. GL to you.

Me: 35, DH: 36, ttc: 3+ years, dx: unknown
10/11: after 2 years, saw a RE, FSH 5.4
11/11: BFP! (surprise after thyroid med & normal hsg),
12/11: missed m/c after 7 week u/s,
1/12: D&C,
6/12 IUI #1: clomid, 5 mature follicles, excellent sperm,= BFN,
7/12: IUI #2: clomid, 3 mature follicles, excellent sperm= BFN,
8/12: IUi #3: clomid, 5 follicles, = BFP!, C/P
10/12 IVF #1: FSH 5.4, estradiol AFC: 14, long Lupron 150/bravelle75,5R/5M/4F, all 4 made it to 5dt, 1 blast and 1 8 cell transferred. No frosties. BFN
IVF #2: AFC 21, MD lupron 12/25, 225bravelle/150men, 4R/4M/3F, 5dt of 1 blast BFN
IVF #3: natural start antagon, starting 3/30, ER 4/11, 12R,11M,10F
.
[IMG]http://i248.photobucket.com/albums/gg174/pixydust3084/April_V2.jpg%5B/IMG] 
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11-14-2012 at 4:47 PM
J&D2007
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J&D2007 is not online. Last active: 04-28-2013, 8:12 AMBronze

J&D2007:
I am not usually one woulda would suggest changing Drs, but in your case, I would consider it. The 20% chance with Ivf doesn't sound right to me. What was your FSH? Your AFC? Your AMH? I certainly think if these numbers are reasonably normal, your chances should be much better with Ivf. What is your age? In your shoes, I would get a second opinion and go the Ivf route. With DOR, why not get the most eggs you can in one shot and see what happens? I know it's pricey, and I'm oop too, but I couldn't stand messing around with any more iuis. GL to you.

Sorry, I didn't see your info at  the bottom of your siggy. I have seen women on here with higher FSH numbers and lower AFC have great Ivf results. I just don't like the negative vibes I'm getting from your post about your current RE 

Me: 35, DH: 36, ttc: 3+ years, dx: unknown
10/11: after 2 years, saw a RE, FSH 5.4
11/11: BFP! (surprise after thyroid med & normal hsg),
12/11: missed m/c after 7 week u/s,
1/12: D&C,
6/12 IUI #1: clomid, 5 mature follicles, excellent sperm,= BFN,
7/12: IUI #2: clomid, 3 mature follicles, excellent sperm= BFN,
8/12: IUi #3: clomid, 5 follicles, = BFP!, C/P
10/12 IVF #1: FSH 5.4, estradiol AFC: 14, long Lupron 150/bravelle75,5R/5M/4F, all 4 made it to 5dt, 1 blast and 1 8 cell transferred. No frosties. BFN
IVF #2: AFC 21, MD lupron 12/25, 225bravelle/150men, 4R/4M/3F, 5dt of 1 blast BFN
IVF #3: natural start antagon, starting 3/30, ER 4/11, 12R,11M,10F
.
[IMG]http://i248.photobucket.com/albums/gg174/pixydust3084/April_V2.jpg%5B/IMG] 
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11-14-2012 at 4:54 PM
darby17
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darby17 is not online. Last active: 05-21-2013, 1:18 PMNewbie

Hey Gettincrafty,

Sorry for all that you are going through. There is no right answer -  I think you have to follow your heart. But since you asked for input - I am thinking that I'd go to another RE and get a 2nd opinion before you rule out IVF.  I never like getting conflicting advice. If you feel like a number at your current office - and they made a mistake and missed your ovulation o5n your last IUI - you should at least talk to another RE.  Knowing how much injectable drugs cost - I would be so upset if that happened to me. 

How did you respond when you were on the injectables? Do you know how many follicles were developing?  I am DOR too, and have done two IVFs that resulted in Chemical Pregnancies. I am not ready to move onto donor eggs though.  My doctor thinks it is still worth pursuing IVF. We are currently "banking" my eggs. This means - I'll do 2-3 egg retrievals. They'll freeze my eggs and then fertilize them when we have a little bunch to work with. One benefit to this - is that we'd save on lab fees. Any little bit helps when you are OOP.  

I just don't think you should give up yet. I didn't have very good luck with IUIs, so I think I'd say go for the IVF.  You don't want to look back and say "what if?"  BUT - I would make sure you are with and RE that you trust and feel comfortable with. 

Good luck to you! 
Me:38 - TTC for 3+years - Multiple failed IUIs (w/clomid, femara,injectibles - all BFNs) IVF #1 - Jan 2012, CP -IVF#2 March 2012, CP - Went back to IUIs all summer. Multi-Cycle Egg banking for FET. Egg retrieval #1 October, 2 frosties. Retrieval#2 January 2013. 6 eggs banked - waiting to be fertilized in March, FET March! FET - cancelled because zero eggs survived thaw process. April IUI, BFP - Beta #1 - 43, Beta #2 - 78, Beta #3 dropped, another CP. May IUI with Femara. 
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11-14-2012 at 5:15 PM
GettinCraf...
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Joined on 09-30-2010
146 Posts
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GettinCrafty is not online. Last active: 05-21-2013, 12:02 PMNewbie

Thanks, ladies. I guess my gut is telling me to get the 2nd opinion, too. We were lucky to get Follistim donated through our current clinic, and that won't be the case at the new clinic. 

And, darby17, to answer your question about how I responded: RE says I've been doing well. I had 2 nice-sized follicles at trigger the first cycle, 3-5 (!!!) for the second and 2 for the third. Also had 2-3 ready to go for the fourth cycle, which never triggered. That's been on doses of no more than 100iu of Follistim. 
TTC#1 since September 2010. Me: 35. DH: 37. Dx with DOR and slight MFI (8/4/11). 100% OOP for treatment.

Right now: IVF #1 (ER in early June)
10/2012 IUI#4 (Follistim, ovulated before trigger, missed IUI, converted to TI): BFN
8/2012 IUI#3 (Follistim/HCG trigger): CP (Beta #1: 4.61, Beta #2: 1.0)
7/2012 IUI#2 (Follistim/HCG trigger): BFN
6/2012 IUI#1 (Follistim/HCG trigger): BFN

6/21/11: First RE visit. Test results: 7DPO b/w: Progesterone = 11.3; CD3 b/w: FSH = 10.1 mUnits/mL, E2= 52.0 pg/mL, AFC: 6; SIS Ultrasound: Uterus great, tubes clear! AMH: 0.3


 
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11-14-2012 at 6:05 PM
Sophistiki...
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Sophistikitty is not online. Last active: 05-21-2013, 11:02 AMBronze

Like you and many ladies on this board we are also 100% OOP.  Based on my experience, here are my thoughts & advice: 


  1. I would certainly have another RE look at your case.  It is amazing what a second set of eyes can see and suggest.
  2. I would hesitate to be overly optimistic with your response to 100iu of Follistim.  Yes everyone is different but at 100iu of Follistim, I produced 5 follicles, 4 of which were mature.  I don’t want your numbers to give you a false sense of security.  In my opinion, it would be much better to proceed with a treatment where you know that all of those eggs had their best chance of fertilizing.  Something that IVF offers over IUI.  As many of the ladies have said, statistically, after three IUI cycles the odds of success are diminished.
  3. From someone who has moved on to donor eggs I would say, it is a huge step to make that transition.  It can seem cut and dry in the beginning but it is a mind-boggling transition with a mine field of emotional issues that in order to surmount successfully you have to know 100% it is the right decision for you.  Personally I can say that the transition would have been incredibly more difficult if I hadn’t had at least one try with my own eggs.  I think if it is for no other reason but your future peace, the $15,000 is worth it.  I am quite sure that a second opinion would validate my view.


For what it’s worth, my second IVF I was told I had a less than 10% chance of pregnancy.  It was the only time I was ever pregnant in my life.  


I wish you good luck with your decision.
TTC #1
Dx = AMA/DOR, hypothyroid, submucosal fibroid, adenomyosis, mild MFI
IUI#1-3 = BFN
IVF #1 (EPP Antagonist); 3R, 2M, 1F; 3dt of one 12-cell embryo = BFN
IVF #2 (EPP MDLF); 6R, 4M, 3F; 3dt of 1-7 cell, 1-8 cell & 1-10 cell = BFP; confirmed C/P @ 4w2d
Genetic carrier screening negative (CF, Fragile X, SMA, Tay Sachs)
Karyotyping, autoimmune & thrombophilia panels all normal
IVF#3 (DE); 13R, 12M, 8F; 5dt of two “excellent quality” blasts = BFP
Beta#1 = 203, Beta #2 = 81, Beta #3 = 17; confirmed C/P @ 5w1d
Two frosties left
*PAIF/SAIF welcome*  
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11-15-2012 at 5:08 PM
IBackBevo
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IBackBevo is not online. Last active: 05-21-2013, 12:42 PMSilver

Hope I'm not offending anyone by posting on here since I have a LO. I was actually looking for the DOR check-in when I saw your post.  I had similar stats to you: FSH was 13.3 (but was probably actually higher as it was suppressed by high estrogen), AMH = 0.54 and was 100% OOP.  I also had a really short luteal phase. [And I still do - my first post-partum LP was 3 days!]  My RE gave me a less than 10 percent chance of conceiving WITH art, but yet I just had a little one.  The only issue we did not have was that you do is that we didn't have any male factor issues.  

Here is my thought - Have you tried any of the less expensive methods like just doing Clomid or Femara, or Clomid or Femara plus an IUI?  I think clomid is like $25 or something.  And even clomid or femara plus an IUI is alot less than injectables...I have a friend who has done clomid/iui six times and each time I think it costs her about $300. Mine was about $600 but I had an ultrasound that was IMO unnecessary and I think that was half the cost. The reason my DH and I went this route was because it was so cheap...you can do a whole lot of rounds of clomid or femara for the price of doing one round of IVF.  You can even do alot of clomid/iui for the price of one round of IVF. IMO, everytime one of us DOR ladies does a round of ART, it is just like spinning a roulette wheel. 

Another thing you might look into is some of the alternative treatments that are cheap for DOR that is supposed to improve egg quality/quantity like taking CoQ10 or doing chinese medicine.  If that didn't work, though, I think that IVF would be a good option. It will take out the male factor issues for sure.  If you go over to the Success after IF board, there are alot of women with stats alot worse than yours who have gotten pregnant with their own eggs.  And your AFC count was 6, right?  That is not a terrible count at all.  I would think that IVF with your own eggs could be a good potential option.        


DX: DOR & Fragile X premutation carrier
2011: FSH 13.3 & E 99; AMH 0.54 ~ 2nd FSH 6.2 E 40's AFC: 8
BFP from Clomid/IUI ~ Pre-e and IUGR during pregnancy ~ LO born 9/4/12
Feb. 2013: AMH less than 0.16 (undetectable) ~ FSH 6.8 (normal)
What is going on with my body? 
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11-19-2012 at 10:51 AM
GettinCraf...
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GettinCrafty is not online. Last active: 05-21-2013, 12:02 PMNewbie

Hey, sophistikitty, thanks for your insights. It's a good dose of reality to hear how you respond to meds, and to get a preview of what the transition to DE is like. When RE first mentioned DE to us, I felt numb. I can only imagine what that journey is like... Big hugs and FX for your January cycle! It's good to hear how helpful another RE's opinion could be for us. Thank you, thank you. 

IBackBevo, thanks for weighing in and offering some hope that lower levels of intervention may still be viable options. I'll certainly talk with the new RE about the pros/cons of multiple IUI cycles vs. taking the plunge and doing one IVF before calling it quits. The reason we moved forward with IUIs beyond the 3rd IUI was because IUI #3 resulted in a C/P and that gave RE hope that it could work. That seems to support what you're saying. All things I'll talk with the new RE about. 

After reading everyone's thoughts, and doing more thinking on my own with DH, I feel like we have a gameplan to see the new RE and take it from there. Thanks for being here! Hope I can repay the favor soon.

xoxo
TTC#1 since September 2010. Me: 35. DH: 37. Dx with DOR and slight MFI (8/4/11). 100% OOP for treatment.

Right now: IVF #1 (ER in early June)
10/2012 IUI#4 (Follistim, ovulated before trigger, missed IUI, converted to TI): BFN
8/2012 IUI#3 (Follistim/HCG trigger): CP (Beta #1: 4.61, Beta #2: 1.0)
7/2012 IUI#2 (Follistim/HCG trigger): BFN
6/2012 IUI#1 (Follistim/HCG trigger): BFN

6/21/11: First RE visit. Test results: 7DPO b/w: Progesterone = 11.3; CD3 b/w: FSH = 10.1 mUnits/mL, E2= 52.0 pg/mL, AFC: 6; SIS Ultrasound: Uterus great, tubes clear! AMH: 0.3


 
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