Should I consider another IUI?

iVillage Member
Registered: 01-18-2008
Should I consider another IUI?
7
Wed, 08-08-2012 - 12:56pm

It may seem strange that I'm considering this since I've been griping about how long it's been taking to get to IVF.  However, in light of my recent high FSH result and re-reading the insurance rules for IVF cycles, I'm wondering if I should try an IUI cycle with injectibles as kind of a test run for IVF.

My fear is that I won't get to try more than one IVF if I don't repsond well the first time which is entirely possible with this high FSH.  The insurance criteria for them to authorize subsequent IVF cycles reads like this:

"Results of prior IUI cycles must be submitted with the initial IVF request, and results of subsequent cycles must be submitted with each request to demonstrate an adequate response (i.e., at least 3 follicles >12 mm diameter for FSH/IVF, and adequate embryo numbers and quality for transfer)."

I remember reading the part about having to produce 3 follies before but I missed the part about adequate embryo numbers and quality for transfer.  What if my eggs don't fertilize or the embryos are poor quality.  To me this says that if I don't make it to transfer, I won't be able to try again(at least with my own eggs). 

At this point, I have not tried any injectibles and have no idea how I'll respond.  I'm wondering if i should try an IUI with the same meds thay planned to use for IVF to see how i respond. Do they use Gonal-F and Menopur for IUIs?

My other concern is whether or not I'll have IF coverage next year.  I would hope that my employer would keep it, but I know it's expensive and I could see them trying to drop it for next year.  So, I would like to get 2 IVF attempts in this year if possible.  As it stands now, I have time, but I'm not sure I will if I do another IUI. 

I'm going to talk to the finance lady to see if I'm understanding the criteria for extra cycle right and see what she thinks.  Then I might ask for a phone consutl with my RE to talk about it too.  I haven't heard what he thinks about my high FSH result yet.

Any advice or opinions?

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iVillage Member
Registered: 08-27-2008
Wed, 08-08-2012 - 1:39pm
That is such a tough one! I think that in a perfect world an IUI with injectables would be nice since it would give you a pre-view of how you might respond. They do use FSH meds with IUI's - I did Menopur with my 3rd IUI. With that said it's kind of a crap shoot...for IUI they will put you on a very low dose. For me I produced 4 follicles in my IUI cycle that used Femara + Menopur but one took over and was a dominate follicle, not allowing the others to mature. Not sure it told us a lot about how I would stim for IVF.

My biggest question for the doc at this point would be, is there any therapy that could be done to lower FSH and potentially increase egg quality? Is DHEA therapy an option? DHEA therapy is suppose to be done for 12 weeks though so it would push out your timeline for this year for sure.

Really when you move on to IVF it's a leap of faith. You have to hope for the best. My doc was also concerned about the number of eggs and quality of eggs we would get. I did DHEA for 12 weeks. We came out with 12 eggs, 11 were mature, all 11 fertilized, 10 made it to blast, 2 were transfered, 4 were frozen and 4 weren't high enough quality to be frozen. All in all a very successful cycle for someone with my AMH, FSH and antral counts.

Not sure that helped at all...

Caryn
iVillage Member
Registered: 01-18-2008
Wed, 08-08-2012 - 3:48pm

Thanks for the insight Caryn.  I know they use lower doses for IUI, so you're probably right that it might not be a good indicator of IVF success.  I'm just nervous that I'm only going to get one shot at this if I don't respond well the first try.  Personally I think you should get to try at least twice.  I think the first one is a learning experience for everyone.  They shouldn't punish you having bad luck on the first try.  I guess it is a leap of faith.  I really wasn't nervous about it until I got that high FSH result.  Hopefully since it's my first one, I still hve a few good eggs in there. 

I think I will at least ask to get it rechecked on day 3 after BCPs.  I'll also ask about them testing my AMH and doing an AFC.  Then maybe we can wait a cycle if the numbers are still bad, if not then start stimming.  The insurance counts the cycle start when you fill the prescriptions, but I don't know how long you have to get to ER/ET after that.  Most women get the meds before they start their protocol so hopefully, if we wanted to wait a few weeks for my next cycle, it wouldn't be a big deal.

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iVillage Member
Registered: 08-04-2008
Wed, 08-08-2012 - 8:15pm
I don't know what to do if I were you. A phone consult sounds like a good idea. I would be afraid to do any drugs this cycle in fear of it messing with AF again. If you really want to wait for another cycle I'd just do a natural cycle and see if that lowers your FSH. I think its the drugs that made it double in such a short time. But who knows. Again ask your RE.

Elizabeth (31) DH (36) TTC #1 since July 2008

iVillage Member
Registered: 01-18-2008
Thu, 08-09-2012 - 9:34am

Thanks, Elizabeth.  I think you're right about drugs messing up my hormones in the first place, although I don't doubt that I might be moving into DOR/POF territory because of my age and also having an auto immune disease.  Hopefully, I'm just at the early stages and will still be able to pull out a enough good eggs/embies when we do IVF.  I probably would be setting myself up for more delays by doing another medicated IUI cycle.  I guess I'm just scared that I'll only get one bite at the IVF apple. 

Of course, I still have not been called back by the financial lady.  Very annoying.  I'm sure she's busy, but I've called twice in 3 days.  Unfortunately, she works at the main branch in Mass so I'm sure she's busy with all the insurance claims for the patients down there since Mass has the IF coverage mandate.  It's just that I know the insurance company will approve/deny within 2 business days, but they can't approve it until it gets submitted.  I was hoping to have an answer this week so I can get meds ordered etc. next week.  I don't want to have to take an extra week of BCPs because she couldn't find time to get submit my claim in a timely fashion.  I'm worried about getting over suppressed if I have to take the BCPs too long.  If I don't hear from her today, I'll call my RE's office and ask them to give her a kick in the pants if they can.

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iVillage Member
Registered: 11-13-2011
Thu, 08-09-2012 - 12:27pm
Sheesh that lady needs to get her stuff together and call you back! Hope you can get in touch with her today.

Britty  & DH (both 30) TTC since late 2008

iVillage Member
Registered: 08-27-2008
Thu, 08-09-2012 - 1:04pm
That really stinks that they haven't called back. Even if it's just to say "I'm busy but will file it by the end of the week" or something. Sounds like you're leaning toward just going through with the IVF cycle?

If it were me I might lay out the options you have thought of and ask you RE to make the call on what s/he thinks would be the ideal way to proceed.

Caryn
iVillage Member
Registered: 01-18-2008
Thu, 08-09-2012 - 4:40pm

I called my RE's office and said I've tried to get a hold of the finance lady and haven't been called back.  Someone called me back and said that's because they're waiting to hear back from the insurance company(I missed the call).  I can't see any new authorization requests on the insurance website.  I only see the 3 IUI requests and one IVF request from March(which was denied).  The only reason it wouldn't show online is if they didn't submit it electronically.  I don't know why they would submit all previous requests electronically but not this one.  If they faxed or mailed it, I will be pissed.  I'm going to call the insurance company and ask if they have any pending prior authoiraztions.  If they don't, I'll be calling back tomorrow and asking why they lied to me.

I guess what pisses me off the most is that this lady can't make time to return my phone call.  I always get my calls returned promptly from my RE's office, but she can't be bothered?  If she's that busy, perhaps they need to get her an assistant or something.

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