IUI/IFV 40s

[Darlene]

Age 44

Second IUI test this morning was BFN.

First round was in December with the following:
Clomid
1 Follistim Injection
Trigger


Second Round:
5 days of Follistim @ 75 units
Trigger

I have 1 tube blocked which is my right, high egg count and husband has high sperm count. Because of these 2 factors, my RE is very comfortable with me being able to get pregnant, but just frustrated. Are there any other women in their 40s struggling with this? What has been your treatment? Would love to hear some positive results.

[Troy]

Sorry. It's always so hard. I hope your more aggressive plan going forward brings you better news.

[Darlene]

Thanks. I'm sure we will have success...it's just difficult.

What is your treatment cycle? Results?

[Troy]

I'm all done. When I was 42-43 (thereabouts) I did about six cycles in all, five IUI and one completed IVF with good response, all BFN. Eventually, I moved to donor when I was around 43 plus a few months. You really can't go by anyone else, though, because by the time you are over 40, it really comes down to individual response.

At this point, your doctor might be right. It could be that IVF potential is low enough that IUI is just as good. But I think you have to recognize that it's still low. GL.

[Darlene]

Thanks. Do recognize that it's low, but staying optimistic. Go to see my RE tomorrow for follow up and what the step will be.

[McGoo]

Oh, Darlene I'm so sorry! ((hugs))... m(success ment)

I was so hoping that you would be one of the lucky ones and be dancing around w/ a BFP! (((Hugs)))

I was hesitant to comment before, but now I'm just going to speak up because the clock is ticking. IMO - your RE is being almost ridiculously conservative. It's almost naive for any Dr. to say a 44yo woman with 1 tube open can expect to conceive easily, if at all, and an RE knows better (or ought to). Stimming w/ only 1 vial/day is really quite low (tho I do have a nurse friend who did that intentionally - w/ success but it took many, many cycles and several miscarriages). Also, 5 days is not usually sufficient to get good quality follicles.


Here's my condensed experience: I had high FSH, endometriosis, a uterine septum, and uterine polyps (none of which I knew about until I had a m/c at age 37).
At 38, after moving to an RE and discovering all my issues, having surgery to correct the uterus and zap some endometriosis, I started doing inj/IUI cycles. The 1st cycle w/ 2 vials/day, but was upped to 3 vials/day that cycle and stimmed for at least 7 days - sometimes 9. I stimmed until the largest follicle was around 18. The goal was 4 mature follicles - I triggered w/ anywhere from 3 to 8 on various cycles. The one w/ 8 mature was successful - pg w/ 2, 1 was a blighted ovum (scrambled egg) and the other is now 8yo.

At 40, I started w/ 3 vials/day, but was upped to 4 vials/day after the 1st cycle. I stimmed for 6-9 days (the 6 day stim cycle started out w/ my lowest ever cd3 FSH and my worst response). The cycle w/ my highest ever cd3 FSH was successful - pg w/ 1, she is now 6yo.

Everybody responds differently and maybe you are getting piles of beautiful mature follies on 1 vial for 5 days, but that would be extremely unusual.


I have many questions: What was your antral follicle count on each ovary each cycle? What was your cd3 FSH and E2 each cycle? How many mature follicles did you have on each ovary at trigger? At trigger, how large was the largest and how close in size were the others?


I don't want to be a downer by writing all this, but I think you need to be informed and IMHO - you need to push your RE to get more aggressive w/ your stim protocol.

fwiw - There are lots and lots of INCIID'ers in your city and they might be able to give you some insight about local RE's. I live in B'ham, but it's Spring Break this week so I happen to be visiting my sister in Alpharetta tonight - I wish I could swing by your RE's office tomorrow to have a "Let's get Darlene knocked up!" pep rally. Grow, follie, grow! Go swimmers!


Hoping a beautiful cycle w/ a BFP is in your near future!
Janet

[Troy]

I think Darlene also has one blocked tube, which also makes me question IUI versus IVF, because, basically, blocked tubes are why IVF was invented. But the reality is that a lot of REs, like mine, won't even consider IVF for someone over 44. But if that's the case, he should say so honestly.

[Darlene]

Ummmm....where do I begin. Thanks for the feedback. My RE is bumping me up to 150 units from 75 units. Yes, knowing that b/c I'm over 40 and a blocked tube, its going to be more of a challenge for me, but I'm going to remain positive that this can happen. "It's almost naive for any Dr. to say a 44yo woman with 1 tube open can expect to conceive easily, if at all, and an RE knows better (or ought to)". No, my RE and I are not naive of what we are up against, but I would rather exhaust my IUI possiblities first. If both of my tubes were blocked, obviously I would go straight to IVF, but it can happen with one tube. We all respond differently and based on my medical history, I'm comfortable with what my RE and I have both decided for my treatment.

I knew going in, this would be hard....I def knew the reality of this, but it's important for me to stay positive. My head is certainly not buried in the sand...although, I do feel like hiding at times.

(Follicles are growing & maturing...and swimmers are there, it's just getting them to meet).

I have to take March off b/c of a cyst, so, we'll start again in April.

So, just want to get that off my chest. I do appreciate the feedback. It is nice to hear what other women are going through...and what they have experienced. The body is a weird and amazing thing.

Have a good hump day.

[McGoo]

I'm so sorry what I wrote didn't come across as I intended. m, ...

I certainly didn't mean to imply that you were naive (and I doubt your RE really is, but why on earth would she say something like that???). I don't think your head is buried in the sand or you wouldn't be here on INCIID. You seem to be determined and focused on the goal and that is right where you need to be.


I think this is the part of your original post that got me going -
"...my RE is very comfortable with me being able to get pregnant..." So many OB/GYN's are guilty of this sort of talk to their patients - telling women that they have all the time in the world and they will get pg w/ no problems (mine did it to me all thru my 30's). I have friends in their early 40's who are still being told this nonsense by their OB/GYN's. Half of them are most likely already in peri-menopause and don't even realize it. Excuse me now I will step off my soap box.I guess it is a hot button issue for me.


As far as IUI vs. IVF goes - I, personally, think everyone (with at least 1 patent tube) should do a round or two of inj/IUI before doing IVF. It would allow the patient to get comfortable w/ the inj. process and allow the RE to see how someone stims before using the big guns for IVF (possibly making the IVF more likely to be successful), and there's a chance it might work, making IVF unnecessary.


I sure didn't mean to imply that there is no hope for you. There could be lots of hope! The truth is that nobody knows yet. I was very, very glad to read that your RE is finally putting you on 2/vials per day. That is wonderful news! IMO, your next cycle will be the first time you get a good shot at finding out how well your body responds. I will be crossing everything in hopes that you stim well and get lots of nice fat mature follies on your good side.

Peace,
Janet


fwiw - My FSH #'s in my late 30's were like what someone in her mid-40's would have, so while it was possible that my egg quality was that of a late 30's chick, they probably were more scrambled like those of someone in her 40's. My left ovary was covered w/ endometriosis and that side never responded as well as the right.

[Darlene]

Hi McGoo,

No worries on my end. I think we all have our hot buttons when it comes to our treatment and why something is not working. Our medical history is different and we're going to respond differently. I'm glad I"m bumping up my meds too. I hope I don't over stim and they need to stop the cycle, but I'm willing to go for it. I do feel good about my chances, but we'll just have to wait and see. Although I'm in my 40s, I've been responding as though my eggs aren't in their 40s. I would have thought my egg count would have been a lot lower, but it's not. So, I look at that as a big positive. I just have that dang tube that's closed. I really do hope that IVF is not needed.

(I never mentioned, when I m/c last year, I got pregnant while on the pill. I think this is the main reason why I feel hopeful).

You said that you have 2 children and you're going for a third now? What's your next treatment cycle?