Sunday, February 10, 2008

scattered - and long

I feel so completely scattered and unfocused. I can't seem to decide what I would like to do next, treatment-wise. In my mind my options are:

1. another round of fsh & iui
2. another round of fsh, but no iui
3. ivf
4. stop treatment (either temporarily, or for good & move on to adoption)

And, just to complicate things a bit more, option 5: either 1, 2, or 3 at a different clinic.

I am not convinced of the value of iui, statistically. I have been reading through a lot of abstracts online (and yes, as a person who has some experience in empirical research, I know the danger of relying on abstracts) and nothing has convinced me that iui's are going to be of enormous benefit to us, beyond the benefit of the fsh. On the other hand, they might be of slight benefit and at this point I wonder if we shouldn't grasp at every straw.

My personal experience of the iui was not entirely positive. First of all, we were in the office for three hours. Three hours. Obviously, this is a huge inconvenience. We were lucky that it fell on a day that Jack and I both were off of work. For a procedure of dubious benefit, this is a legitimate strike against it, since I only have so much sick/personal time and I am already devoting a good bit of it to monitoring appointments.

But my much greater concern with the timeline is that the length of time between obtaining the semen and performing the iui is negatively correlated with pregnancy rates. And the vast majority of our wait was between those two events, not waiting for them to call Jack in to do his part. I wish I could remember what time he was called back. I do know the exact time we first arrived in the office (I wrote it on the sign-in form) and the exact time of the iui (the nurse told me to wait 10 minutes afterwards before I got up, so Jack looked at his watch) and that those two times were three hours apart. I do know that the iui took place one hour and twenty minutes past the time it was scheduled to occur. I do know that we watched every single other patient in the waiting room come and go while we waited. Can you detect a little bitterness?

Honestly, it is not the inconvenience of the wait (though that was not fun) it is the fact that the wait may have substantially reduced the chances of the iui being successful. And not only reduced the chances of the iui being successful, but reduced our chances of getting pregnant (since we abstained for 36 hours prior to the iui). Which makes me doubt everything else about the way I am being treated by this clinic.

Third argument against iui is the cost. This is not covered, so we pay out of pocket. The cost of the iui is equivalent to our cost for a 300 cartridge of f-stim. Unfortunately, money is a limiting factor for us, so why spend it on iui (dubious benefit) rather than more rounds of injections (proven benefit)?

Finally, and I would not make a treatment decision based on this, but emotionally the iui just didn't feel good to me. It felt as foreign and invasive as anything else on this long journey has. And this is despite the fact that the nurse who performed it was as nice as she could be, and actually let Jack be the one to push the plunger and send his swimmers on their way (he gave me a card later that afternoon that said "thanks for letting me inseminate you").

So, to summarize, I am not convinced that iui is of much benefit to us beyond the benefit of the injections. The way my iui was performed (timed) may have diminished that already questionable benefit. Does what's left, in terms of the advantages of an iui, outweigh the disadvantages (time off work, expense)? That is the question, and I am having trouble finding an answer that feels right to me.

As for option 3 (way up there at the beginning of this post), I don't really think that we would move directly on to ivf from here. I haven't even discussed it with my doctor. But it's looming on my mental horizon. It's the obvious next step, assuming another failed iui or two (and right now I am having trouble imagining a successful iui). Frankly, we can't afford it. Which is exactly why I am thinking of it now. Why spend the money on two more doomed iui cycles, instead of starting our ivf fund with that money? (Here is where I start to feel crazy and scatterd and completely lose the ability to think rationally - because my next treatment cycle, whether iui or just injectables, isn't doomed. But I'm having trouble believing that.)

Then there is option 4. Option 4 is appealing to me right now. A nice, long break sounds good. I am starting to think more and more about adoption, too (which I used to think about all the time, but forcibly put out of my mind since we decided to actively pursue treatment). Thing about adoption is, it costs money too. I wish we could pursue adoption and treatment at the same time, but we can't. And when we reach the point of making a decision about ivf, it will probably be either/or, the big "how do we build our family" question.

And just thinking about that, my brain is so mushy that I can't even contemplate option 5. Which is probably the one I should be putting all my mental energy towards.

Sorry for this extremely lengthy post. I just needed to get this all out of my head.


swissmiss said...

Oh dear, those are a lot of options. For what it's worth, here's my assvice. We have a different diagnosis than you (we have very clear male factor issues) so we blew off the iui and went straight to ivf based on the assumption that with our diagnosis iui was more or less doomed so why bother? For us, iui would have been covered by insurance and the ivf wasn't and I still didn't really feel convinced that it was worth losing the cycle or two worth of time.

I agree that if you're feeling less than confident about your clinic that's something to think about.

It's a lot to think about. Good luck.

~Carrie said...

Sorry about the length of this. I don't even know if my ramble will be helpful.

First, I am sorry you are having to go through this at all.
I hear what you are saying about IUIs. Well first, making you wait three hours - inexcusable. I believe the washed sperm is still ok though - it's the time between actually collecting the sample and getting it to the clinic that is more time sensitive. (which you didn't have to do) I believe that once the clinic has it, it's ok for quite a few hours. (if I am incorrect someone correct me!)
However, you don't need the stress of waiting like that!!

Back to the effectiveness of IUIs.... I went through the same thought process myself b/c we were not dealing with any male issues. (I had 5 IUIs) In fact, one month I did just meds and not an IUI because my RE was going to be away at a conference. (he always did the IUIs himself) He said that my chances would not be significantly reduced by not having an IUI that month, since sperm count was not an issue.

I then thought, "Well, why do the IUI at all??" I thought through things very much the way you did!

I went ahead the next month with an IUI anyway, figuring that if it helped at all, I may as well try, especially since I knew it was going to be my last one. I did feel that same sense of doom that you do - it's hard to shake that feeling some times. Let me clarify though, that just because my IUIs did not work does not mean yours won't.

However, if cost and stress is an issue, (and again, you do NOT need any more added stress!) you may want to consider a medicated cycle with no IUI, though I would suggest getting a post-coital test (if you have not had one already) to make sure there isn't any issue w/ your cervical mucus that is keeping the sperm from getting though. If you do that, just make sure that you do a lot of BDing at the right time.

If you do another IUI, you should still BD right around that time as backup. My RE always told me to BD right before the HCG shot and then after the IUI. Again, this is if there are no male factors involved.

You may want to ask your RE about your chances as far as IUI vs no IUI.

The thing that stinks about IUIs is that it doesn't get around issues that the RE can't really diagnose (ex: tube issues that don't show on HSG or on ultrasounds) and unfortunately you don't really know until you keep having failed IUIs! It's maddening!

What you said about saving money on IUIs in case you need to go to IVF makes sense too. It's such a hard decision.

Taking a break isn't a bad thing either. That can help you relax and think more about your options, if you are not sure right now.