New here- weighing DS IUI vs. ICSI

iVillage Member
Registered: 10-19-2004
New here- weighing DS IUI vs. ICSI
12
Mon, 05-21-2007 - 3:21pm

Hi everyone I am new to this board. My DH has severe male infertility and we are dealing with time pressures, as I am nearing 39 and we want 2 kids. DH is being for prostatitis with anti-inflammatories, and had 2 weeks of antibiotics. We don't know if that helped yet. He also has a varicocele that he got a sono for today. Unfortunately the surgery for that can take many months to be effective and there is no guarantee it will even help, so we are feeling like we can't afford to wait for that.

I had yet another talk with DH about our options and he brought up the idea of using donor sperm again instead of IVF/ICSI. He asked how much it cost and I said I didn't think it was that much, definitely much less that IVF/ICSI, but realized I really don't know. Can anyone tell me how much this cost them per cycle (do cost decrease after 1 with donor sperm, as you've already selected a donor?), and how many cycles it took to get pg?

I love my DH so much he is so sweet. He adores all kids and I know he will make a wonderful father. I want to know he is really OK with this option and he seems to be fine with it, as he's brought it up several times. He said once I'm pregnant he doesn't think it will matter how we got there, and it doesn't seem to matter to him if it is his DNA or not. I asked him what would be the deciding factor as to what to choose (donor sperm or IVF/ICSI) and he said whatever get you pregnant faster. Of course $$$ is an issue, especially if the IVF/ICSI didn't work on the first cycle.

Does anyone know if IVF/ICSI is cheaper the second cycle if you can use frozen embies from round one, and by how much??

I guess I am coming around to the idea of using donor sperm. It's difficult for me to get my head around because I know using my own eggs is a priority for me, but I know not everyone feels that way. If I could not get pg with my own eggs I would be open to donor eggs, but only after I'd given my own eggs a good chance. I would like to have my husband's bio child but honestly that is not as important to me as it is to use my own eggs, as long as it is not a priority for him.

I know DH is concerned about the cost as well, and I think IUI with donor sperm would be cheaper. My FSH is excellent and HSG showed no problems, so I could be quite fertile still. DH's motility has only been at a 1.5 on a scale of 1-4 (no rapid forward movement/incapable of fertilization), so getting pg so far has been impossible no matter how fertile I am.

Another option would be IUI with donor sperm and the varicocele surgery, in the hopes of being able to get pg naturally or with IUI with DH's sperm for baby #2.

I feel like these are such big, irreversible decisions it is hard to know what is the right choice for us. I don't want to have regrets. I really think my DH will love and feel connected to our kids no matter where the DNA comes from. I worry if we use donor sperm his family won't love our kids as much as his sisters, that are bio children. Is that crazy?

Has anyone here made that choice, between donor sperm and ICSI? What did you choose and are you happy with the decision?

- Jenna

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iVillage Member
Registered: 03-26-2003
Mon, 05-21-2007 - 5:39pm

ICSI was not an option for my DH as he is azoospermic, meaning he makes no sperm...ever

If your DH has sperm in his sample even w/a variocle I personally would go for the IVF/ICSI

BUT that being said...

Donor is MUCH MUCH MUCH cheaper...a normal unmedicated cycle should cost less than $400
Medicated can go $500 - $1200 per cycle, depending on how many you are doing.

Also you do have a time limit...and you can GREATLY reduce your costs if you get any frozen embryos to save for later (totcicles I like to call them)

A normal IVF/ICSI cycle is $15-$20,000

Freezing an embryo is around $1200 per year

Having a totcicle deposited for #2 is maybe $2000 at the most (they just put it in there)

IMO - if money is NOT an issue go for the ICSI/IVF and ask the doctor about a TESE (its a search and destroy mission looking for spermies in the testes themselves...sometimes the better soldiers are in there). If you DH EVER made a sperm, EVER...they can find it with a TESE

Also check your clinic at the CDC...all must compile their success rate...and research the ICSI doctor

Ask your doctor several things...

If you do IVF/ICSI and have a succesful follicle production how many embryos will they put back (any doctor that says more than three...beware)

Is your doctor open about Selective Reduction?

If you did Donor would your doctor medicate you?

How do they monitor you when on medication?

Would you be willing to do a shared cycle - donating some of the embryos to another couple - to help with the cost

How many IVF's will your clinic do? What about clomid for an IUI, how many cycles will they do? (beware any that says more than 12 in a lifetime and never more than six in a row)

Good luck and what a great dh!

Also - the reasoning behind your DH's issues..would it be genetic? If there is a risk there are you willing to pass it on?

Even if my DH had had ONE spermocidial cell they could've used ICSI now...but so then we would've passed on the infertility to our child perhaps?

And I'd never EVER wish this on a soul









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iVillage Member
Registered: 10-19-2004
Mon, 05-21-2007 - 6:27pm

Wow! Thank you so much for such a thoughtful, helpful and informative response.

I had been leaning towards ICSI myself, though it is sounding to me like my DH is leaning towards DS. I do worry about passing on infertility to our children, we don't know it is not genetic, though they have found 2 non-genetic possible causes. I've read there can be a genetic microsdeletion on the y chromosome that can cause severe motility problem, but right now testing is extremely expensive and only done at research centers. My DH was also suspected of having autism when he was a small child, and though he turned out not to I know he is worried that he may carry a risk for that that could put our kids at risk. From what I've read genetically at-risk kids test differently than normal, and so there may be something to his worry there.

My Dh's counts fine, over 50 mil, but his motility is only 27% and those that are moving are barely moving. I think we would need ICSI as from what I've read if sperm's motility is that damaged they usually aren't capable of fertilizing an egg.

Money is not a major deciding factor if we can get pg in one cycle or with toticles. I didn't realize that implanting the frozen ones was so "inexpensive". However it would be much harder for us to afford 2 fresh cycles. It would be ideal if we could get lots of fertilized eggs and keep some on ice to create baby #2. My FSH is still only 5.6 so I'm hoping that means my egg quality is still pretty good and will respond well to stimulation.

As for a shared cycle, I don't think anyone would want my 38-39 year old eggs, and besides we'd want to keep any extras on ice for baby #2. I wouldn't go for implanting any more than 3, and would have hesitation on implanting more than 2. I do not want to have to do a reduction and the risk to the babies of triplets is too high for my comfort. A friend of mine had a reduction and the other 2 babies were premature at 5 1/2 months and both died.

We have a consultation appt set up for the 6th. I asked on the phone if they do unmedicated IUI's and they said they usually don't as there is not much of a better chance doing that than a natural cycle. I don't know if it would be different for donor, when the reasons for not getting pg so far could easily be 100% male factor. Since there may be nothing at all wrong with my fertility I am tempted to try 1 unmedicated cycle first if we go for donor sperm.

Well I need to go to the hospital now to get my blood drawn for a progesterone test. Before I go though may I ask---

Did you do donor sperm? Did it work? Medicated or unmedicated? How many cycles?

- Jenna
iVillage Member
Registered: 03-26-2003
Mon, 05-21-2007 - 7:26pm

I am a BAD example for donor...my son is now six...we started ttc'ing right after we got married in 1990

We did three natural cycles with one IUI

then I had the hsg and we did three more

For the next two cycles we added 50mgs clomid, unmonitored

Cycle #8 we did 100mgs clomid - unmonitored

Cycle #9 we did things radically different - and how the SHOULD have been done from the beginning.

We chose a different donor

We did 100mgs of clomid with ultrasound monitoring at day 7

I used baby apsirin

When follicles were ready we used the HCG trigger to force ovulation to go with IUI

I had IUI #1 12 hours after hcg shot and then IUI #2 24 hours after that

I've no idea if that's why it worked or if it was because IUI #2 was on my favorite sister's birthday. Or because it was my LAST try. We did 8 more IUI's exactly the same way and didn't succeed albeit with a different donor.

You'd also be surprised about the shared donor cycle...if you are willing you might want to ask...if it saves enough to pay for the totcicles or what have you it might be worth it.

If DH is against the ICSI but willing to go for the donor ask your RE about doing 1-3 cycles of donor with EXTREME measures making it the BEST effort. Do the meds, the monitoring, 2 IUI's, etc...while you wait for the IVF to be ready.

Also ask if the guarantee the IVF...some clinics do now

I've been on this board since 1999 and I think the average for donor IUI is running about 4 cycles for a positive. IVF USUALLY works the first time if you respond well.

And remember that most of the posters on ivillage find the boards after many losses or failures. I know women that have had 3 IVFs fail and some that #1 created 28 totcicles. I know women that reduced from 4-2, women that lost twins or one of the two and women that have had four born at 32 weeks.

"Normal" women don't usually post to boards which is sad....

But congrats on coming this far and loading yourself with questions...every question you get answered on your first appt gets you one step closer...right?

And I know its hard to be positive. You want to talk about it all the time but most DH's don't. We are always here and you can email me if you ever want to.

But mind you...I am open to a fault, perhaps too honest. But I place a high value on my friends, maybe even my online ones more so.

There's a poster here that I swear I pestered into not giving up...and now she has beautiful twins!

It is a hard hard hard road full of broken dreams and shattered hopes...but in the end, it is worth every teardrop and stupid hpt's.

**big hugs**









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iVillage Member
Registered: 01-17-2005
Mon, 05-21-2007 - 7:32pm
I was in a very similar situation. My husband's motility was also 1.5, but his count was only 10,000. ICSI was an option, but we discussed it and decided it wasn't important what the genetic make-up was, we just wanted a baby. Finances played a big part, as well as the injectible protocol, whar to do with extra embryos, how many to implant, etc. I am very pleased to say that after 4 cycles, 9 ultrasounds, and 2 inseminations with donor sperm, (about 3,000 dollars total), I have a beautiful daughter. We were very pleased with the overall process and we have 6 vials on reserve for our next try! I highly reccommend it, it is stressful, but so worth it when you look into the eyes of that precious blessing! -J
iVillage Member
Registered: 03-18-2007
Mon, 05-21-2007 - 8:04pm

Hi there and welcome to what has been a very supportive board for me!

My DH and I have gone through most of the options you are considering. I was 29 when we started this journey two years ago. All my tests have always come back fine, including bloodwork and the HSG.

My DH sperm parameters are low on all aspects ... count (anywhere from 1 - 8 million), motility and morphology. He had a varicoclectomy in December 2005. The urologist said that he was a great candidate for the surgery to help enough to make IUI possible for us. He had 3 varicoceles removed with the one surgery. There was no discernable change from the varicocelectomy. His best SA came from after the surgery (8 million), but so did his worst (1 million w/ only 100,0000 post-wash).

Then we did an IVF/ICSI cycle. All the numbers for me were coming out great. The cost was about $13,000-14,000. They had 14 eggs retrieved, 11 mature eggs. But, only one of the eggs fertilized. The others didn't activate at all. So we transferred that one and didn't have any to freeze. Though the embryo developed beautifully (Grade A 8 cells at 3 days), it didn't implant. If we had been able to do a frozen cycle, it would have been about $4,000.

Now we have moved on to DS IUI. Our cost per cycle is about $800-1000. This is with the sperm cost (about $400), a small amount of medication - Femara/Letrozole and an HCG trigger shot (about $100), the IUI itself ($125), and 1-2 ultrasounds ($150-300).

My DH has come to terms with not being a biological father. It's definitely a grief and loss process that a man should go through in order to truly be ok with it. He has been a big part of the DS IUI process - he did the majority of the selection of the donor and he pushes the plunger each time to inject the sperm. So ... he's the one that puts the sperm into me each time, even though it's via an unorthodox method. That really means a lot to him.

We just did IUI #3 and are hoping that the third time's the charm!

 

iVillage Member
Registered: 01-11-2007
Tue, 05-22-2007 - 12:31am
You've got lots of good advice above and I don't think I have anything much to add, especially seeing as I'm in Australia and it's all different here anyway, so probably not as useful to you.

2010 OC sig


iVillage Member
Registered: 10-19-2004
Wed, 05-23-2007 - 6:59pm

Thanks again for responding. I had thought maybe it might make sense to try unmedicated IUI first if we go for donor sperm, so my body could at least be given the opportunity to get pregnant on its own... I am aalittle worried about what all those drugs do to your body and future fertility. But I can see the logic in giving it the best chance. I din't realize it may take an average of four cycles for donor sperm to work if the woman haas no fertility issues---though I suppose my age alone could be an assumed issue. I've just always felt I would be very fertile, and so many of my freinds older than me got pg on their first or second cycle trying naturally or by accident.

But I don't want to waste time, I feel the pressures of my bio clock so strongly right now. I just want to get pg. Even though we are moving forward with the neccessary tests and making the neccessary appts I feel that we are just treading water and wasting time until we have something concrete scheduled that has a chance of getting me pg.

I guess we'll get the info we need to make a real decsion in our consukltation on the 6th. Though I still need to get a sono after that to see how many follies I am naturally producing. The tests seem endless...it's had to understand why I really need all these tests when I haven't even had a chance at getting pg with DH's sperm.

- Jenna
iVillage Member
Registered: 10-19-2004
Wed, 05-23-2007 - 7:03pm
Thanks for sharing your experience- that's wonderful you got your baby fairly quickly! If we could get pg with only $3,000 for ART I'd feel lucky- things here seem much more expensive. We've already spent over $2,000 on just tests and consultations.
- Jenna
iVillage Member
Registered: 10-19-2004
Wed, 05-23-2007 - 7:12pm

Thanks for sharing your experience. I guess that is my worst nightmare- tahat we would spend a tom on the surgery and ICSI and it wouldn't take. It's stories like this that make me want to go straight to donor sperm. I need to ask if damaged sperm make it less likely for ICSI/IVF to work than if his sperm were healathy---if so that would also push us to try donor sperm first.

That is a nice thing that your DH pushed the plunger. My DH seems comfortable with Donor Sperm already. It is starting to sound more and more like the sensible choice, I am getting used to it. I would hate to spend our savings on ICSI with nothing to show for it.

God, it's still such a tough decision. But hearing your story helps me know what questions to ask and prepares me for what the outcome can be. So thank you! I really hope the third IUI is the charm for you and you get your much deserved BFP. Good luck and sending P & PT's you way.

-Jenna

- Jenna
iVillage Member
Registered: 10-19-2004
Wed, 05-23-2007 - 7:16pm

Thanks Belinda- after jearing on an unsuccessful IUI it is good to hear the other side of the coin, where those didn't work and IUI did. Mayb e trying donor IUI first and then moving in 3-4 cycles to ICSI if it doesn't work is a good plan...

It is also good to hear that once your child arrives it doesn't matter how he got there. I guess not having the option to use your DH's sperm took the guesswork out of it- and the secondguesswork. But still it is what I want to hear, that once the child is born there are no regrets.

Thank you Belinda!

-Jenna

- Jenna

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