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WEEK OF FEBRUARY 9, 2009

It is so interesting…we got home and said, Okay, let’s take the week to determine what to do, IVF or IUI. But I think we both knew right away that IVF was the way to go. Like I said, I tend to get all the info and have the ability to make a decision immediately. The hubby? He ruminates. I get it. And then I don’t get it. At the same time, it did feel a little strange to meet one time with a doctor and then make a major life altering decision. We decided to do the following:

  • Talk it over with our parents
  • Review the financial ramifications of trying IUI first, then moving on to IVF if IUI was unsuccessful.
  • Complete a list of unanswered questions to email to Dr. F.

IUI

To begin, we learned more about the IUI process. Most people we know call it “The Turkey Baster.” I guess this is the way they can make is comfortable to talk about. {Maybe this is something I’ll talk about later, how much people DON’T want to talk about this, even your closest friends.}

IUI is defined as the process by which sperm is deposited in a woman’s uterus through artificial means. From what I have read, many IUI candidates are those who have male fertility issues and can use assistance getting the “good” sperm separated and inserted past the cervical mucous.

Process

TheAdvanced Fertility Center of Chicago has a good description of the process in my opinion:

  1. The woman usually is stimulated with medication to stimulate multiple egg development and the insemination is timed to coincide with ovulation – release of the eggs from the follicles.
  2. A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
  3. The semen is “washed” in the laboratory (called sperm processing or sperm washing). By this process, the sperm is separated from the other components of the semen and concentrated in a much smaller volume. Various media and techniques can be used to perform the washing and separation, depending on the specifics of the individual case and preferences of the fertility doctor and laboratory. The sperm processing takes about 20-60 minutes, depending on the technique utilized.
  4. A speculum is placed in the vagina and the cervical area is gently cleaned.
  5. Then the separated and washed specimen consisting of a purified fraction of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in to the uterine cavity (intrauterine insemination, IUI) using a sterile, thin and soft catheter. Intrauterine insemination has a better success rate than intracervical insemination. Therefore, it is the preferred method at the large majority of fertility specialist centers.
IUI Insertion Example

IUI Insertion Example

After reviewing this option, my husband is REALLY, REALLY wanting to do this. He feels like it is more natural, in so much as those procedures that need assistance. He is getting pretty upset that our baby may be made in a petrie dish. I keep joking we can name the baby Pete. Apparently, not so funny. I think it is. The other consideration here, this is MUCH LESS invasive and emotionally and physically demanding on the woman. My husband did not want to see me go through this.

IVF

I thought I knew a lot about this process. You take some hormones, they harvest your eggs, they fertilize them, re-implant them and you are pregnant. Yippee! I DID NOT KNOW. I JUST DID NOT KNOW. Every situation is quite personalized For us, we were starting from a poor baseline. Let me take you through the process of IVF, later I’ll talk about follicles, eggs, etc.

IVF has many steps, and is much more complicated to explain than IUI. In short, the goal of IVF is to stimulate more than multiple follicles {as opposed to one} into multiple eggs for retrieval and fertilization in a lab. These fertilized embryos will be implanted into the woman’s uterus anytime between 2-5 days after fertilization. Two weeks after implantation you will know if you are pregnant. I will go into MUCH greater detail the IVF process in a later post.

TALKING TO OUR PARENTS

This just didn’t go so well. My hubbo isn’t that close to his, so we went to talk to mine. I just started to cry. I startled myself with this. They just didn’t think it was as “bad off” as we said. My dad, the doctor, was convinced that our test results were wrong. Bless them, they just didn’t want to see us in pain.

OUR LIST OF QUESTIONS

  • You quoted us possible success rate of 35-40% with IVF. Is this per embryo implantation per cycle, or per cycle only? And, is this rate based on our specific case?
  • How many eggs will you aim to retrieve? What is a normal retrieval?
  • How many eggs do you recommend implanting per cycle?
  • What is the increased percentage of multiple births?
  • What is the risk for miscarriage?
  • What are the common complications we need be aware of?
  • Is it possible that our future bloodwork and/or tests could change our eligibility for IVF treatments? Are there key tests we need to be aware of?
  • Are there any genetic defects and/or development disorders that have been associated with / attributed to IVF?
  • Given our inclination to move straight to IVF, do I need the laparoscopy, or can we wait?
  • I have recently gained about 15 pounds (normal weight is 160-165lbs). Is there benefit to waiting a couple of months to lose the weight prior to starting treatment? I am concerned about being too heavy during my pregnancy.
  • Is there weight gain associated with the fertility drugs I will be taking?
  • Are there any lifestyle modifications that might help my condition and increase my chances of getting pregnant? What role do the following play in getting pregnant: weight, exercise, prescription drugs, stress, acupuncture, etc?
  • What is the full array of programs/services the Center for Reproductive Health offers?
  • Will any of our fertility conditions worsen over time, improve, or remain constant?
  • What further tests do you recommend? Are there any risks associated with the testing? Does my hubby need additional testing?
  • Follow up: In your practice, how often does this/these treatment(s) result in pregnancy? How many of these pregnancies result in live births, miscarriages, etc. (percentages?)
  • How many cycles of treatment on average does it take to see positive results?
  • Can we begin treatment immediately? Do you tailor treatment to individual couples, or is there a set protocol?
  • What type of monitoring and interaction can I expect from the center? Ultrasounds, blood work, general communication? How available are people for consultation and questions via telephone?
  • What are the benefits to IUI v. IVF? What makes a good candidate for each treatment? Can we improve our candidacy for IUI?
  • At what point do either or both of us need to consult a reproductive endocrinologist? Does your center offer that service?
  • Do you provide fertility and ob/gyn, or fertility only? Do I need separate ob/gyn?
  • What does treatment cost? Does my insurance cover any of the medications, hospital charges, or doctor’s visits? If I must pay out-of-pocket, do you offer any special payment plans?
  • What is the procedure for getting questions answered between appointments? Can I call, fax, or e-mail and expect a prompt reply?
  • What is the standard callback time, and does it vary depending on the urgency of the call?
  • I understand that many of my questions can be answered with a callback from a nurse, but if I need to speak with a doctor how do I make that clear?
  • What do I need to know about scheduling weekend procedures?
  • What is the phone number for off-hours problems?
  • Is there a directory of phone numbers for office staff and doctors? (numbers for contacting a nurse, getting lab results, discussing billing issues, etc)

THE DECISION

By default, we decided to just go to the upcoming IVF orientation. We were pretty clear that IUI was not going to work for us. Had it simply been an issue of my husband’s sperm motility, it may have made sense. However, with my follicle count and FSH levels “drifting upward” we knew we needed additional help. At this point, I think it was really more a question of whether or not IVF would work for us.

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