# IUI or IVF/ICSI which is best for over 40's?



## Kazzie

apologies if this has already been asked (I do try to search first)...if I had to choose one treatment (I'm only just 45) what should it be? I ask this this because I had one go at IUI which failed & the con said it wouldn't increase the odds by having IVF or/and ICSI so I might as well try IUI again. But surely ICSI increases the odds because my understanding is that conception is literally made to happen (or 'forced') - so surely you have a better chance with a fertilised egg than leaving it up to nature (which isn't likely!!) But someone else of my age was told the opposite! I'm confused.....
Kazzie


----------



## Ms Minerva

It is my understanding that IVF/ICSI is considerably more successful than IUI if you are over 40. Not sure what the percentage success rates are though. I'm sure that it must vary, depending on your particular problem.

As we age, the shells on our eggs can harden, making it harder for the sperm to penetrate - ICSI overcomes this, and assisted hatching helps the embryo to break out and dig in to the walls of the womb. None of this is possible with IUI.

I had 3 failed IUI's on the NHS using Clomid and a clapped out scanning machine. They think that I didn't ovulate during at least one cycle, despite having the hcg shot. 

Jules
xx


----------



## *Kim*

Hi Kazzie

When we went for our consultation we were offered 1 cycle of IVF or 4 cycles of IUI. Because of my age i decided to go for the IVF as they could actually see what was going on. It took us 21 years before i got pregnant by my 2nd cycle so thought the IVF was the best way.

Thats my personal opinion but it has to be your own decision and what you feel would be more beneficial to you.

Good luck with whatever you decide on though.

love kimx  xx


----------



## Ellie.st

Dear Kazzie
I guess it depends on your personal history but I was certainly told that IVF would give me a better chance of success than IUI.  Mind you, the odds of success I've been quoted even for IVF at 40+ are pretty low (5% perhaps?).  Doesn't mean that it isn't worth trying, however. On the other hand, IUI is less invasive and you could probably try more IUI cycles than IVF ones.  Good luck whatever you decide.

Best wishes

Ellie


----------



## ULTRA

Hi Kazzie,

When I went for my 1st consultation ever on fertility treatment I wanted to go for IUI as it is much less invasive.

The statistics at the Lister we were shown changed my mind: in 5 years they had no woman of my age (44) achiving a "take home baby" of I believe 80 attempted cycles, whereas IVF+ICSI had a 4.8% chance of a "take home baby". No choice really if you want that end result!

Although my attempt failed I have the feeling I gave it my best possible shot.

-ULTRA-


----------



## madison

Hi Kazzie,

I am not over 40 ( i'll be 38 beginning of April )  but I dont respond well to drugs & I have had  2 FAILED IVF/ICSI attempts.
  To answer your question about the icsi being injected into the eggs would maybe give you a better fertilization rate.. I thought the same but it dosent , I had ivf first & icsi second, Both times I got 4 eggs both only 2 fertilized.

Good luck in whatever you decide to do,

Love Katy. xxxx


----------



## Joan

Hi Kazzie,

i wud say ICSI. although my first cycle just now i only had one folly and they said to cancel, but we went ahead with IUI, just incase it was the last ever folly and we wud have never known. We are 42/44, 

with ICSI you bypass the fallopian tube potential problem; the blunt sperm problem; the hard eggshell  problem, but, it can damage the eggs injecting them in, so you might have lovely eggs and then they are spoiled by the injecting process.

I didnt know it was only 5% for us oldies. Depressing, but then not, Challenging! we are all going to conceive.
Good luck to everyone.
Joan


----------



## AlmaMay

Dear Kazzie,

Without a doubt I would go for ICSI.  I don't know what you consultant was thinking when he said that because ICSI is definetly more successful than IUI.  You can have a look at the HFEA 'league table' results and compare the success rates for IVF and IUI.  I think they have IUI success rates included otherwise your clinic will be able to provide their IUI and IVF success rates for your age group.  I had 8 IUIs and I got a BFP with one but miscarried.  

I wish I had gone for ICSI sooner.  HUGE regret that I didn't.  I thought it would be much harder than IUI but it wasn't really.  Egg collection isn't as scary as I thought, in fact it was fine.  The big advantage of ICSI over IUI is that they can tell you the quality of your embryos and you know how many you have.  With IUI you have folicles but you never know if there's an egg in them and you don't know if they have fertilised.

We are unexplained and had our first treatment in Spain where they do ICSI as a matter of course.  ICSI has a better fertilisation rate about 80% compared to natural IVF which is 50%.  At our age I don't know why people just don't go straight to ICSI.  

I was told by my consultant that I had a 10% chance of success trying naturally or a 25% chance with ICSI.  If you think about it you increase your chances in four goes with ICSI by a huge amount.  

BTW - If your clinic is quoting you the same rates for ICSI as well as IUI I would really question it or move to a clinic that has a better ICSI success rate.  

Sorry if any of this sounds harsh but I wish someone had told me this over 4 years ago.

Good luck,
Almamay


----------



## Essex Girl

Hello Kazzie

At your age (sorry if that sounds insulting!), success with your own eggs will depend entirely on their quality and you will only know that by going through IVF/ICSI.  That way, you get to see how many are produced, fertilise, divide etc.  If they are no good (and I have to say that my clinic says that they have not got anyone PG with their own eggs over 43 although they will treat you up to 45), you will then know and can consider other options.  If the eggs fertilise OK on IVF, then future treatment by IUI, with drug stimulation, is an option your clinic may suggest, especially if cost is an issue.

I hope that helps.  Do IM me if you want more info. 

Essex Girl


----------



## fluffy57

I am 41 and have just stepped onto this rollercoaster.  I have had two consultations and have been left very confused with the process. Like with most things I like to do plenty of research so I have adequate information to make up my mind and form and act on a decision. All recommendations have been for IVF or GIFT and no mention of any other type of stimulants or treatment.

One clinic said the shut the puitry gland off and other said definitely not and on asking calling a third clinic by phone and speaking to a nurse she said she never heard anything like it.  One starts the treatment on day2 the other starts on day 21/22.  The reason why I phoned was because I couldn't get onto their openday this month. She also told me they don't do over 42s which is slightly disconcerting and they only put a max of 2 eggs in at a time. The other clinic says 3 (that was back in June not sure if it changed since) and another clinic i found says they can put all the eggs in as its GIFT.

Part of me think this is a very lucrative business for the healthcare professionals and part of me whats to reach over and grasp whatever helping hand is around. I also get the feeling that its a very cut throat business as the second clinic wouldn't accept the results from the first. Both consultations felt distant with no real warmth, just a declaration IVF or any proper explanation of the treatment - just telling me I don't have time and its all a gamble anyway.  

Its really  a massive gamble with very low odds and no way of knowing whats going on inside of the body. I have got a couple of quiet low temperatures like  96.0 or with my new temperature its 36.0 I wonder does this have anything to do with my hormones.  Also one clinic said they do an ovarian stress test and I asked was this FSH test and I was told no its a test that we conceived but yet it was linked to the FSH level... hmm no wonder its taking me so long to move forward.  any advice recommendation gratefully received.


----------



## Anne_7

Hi Ladies,

On my last cycle Ishack who was 42 got a BFP on her first IVF tx.  Hope this gives everyone some hope.

Love, Anne X


----------



## Lorri

Fluffy - If you are over 40 you can have a max of 3 embryos put back, under 40 its 2. I am not sure what GIFT is, but if they can put more than 3 back then I doubt its embryos, maybe its unfertilised eggs and sperm. Different clinics do have different tests, criteria and methods, you have to find the one that suits you and has best success rates for your treatment and age. Starting tx on cd21 is long protocol and cd2 is short I believe. Short is usually better for oldies or poor responders. I have done short both times. Some clinics have an upper age limit lower than others, as this can affect their success rates on the HFEA tables (check out www.hfea.com). It is a massive gamble, and the odds are against you, but as someone else said, you have to be in it to win it !  I am at ARGC as their success rates are the best in UK for ICSI for 40+ ladies (I think their success rates are best full stop). They are in London, but they do work out more expensive due to the extra testing. 

Kazzie - Though no expert, I agree with all the others, the success rates for ICSI are far higher than IUI. If your clinic's success is no better, then I would question their embryologists skills. With IUI you don't even know if your sperm ever gets to your eggs or if your eggs fertilize. With ICSI you get embryos put back and so its down to quality of eggs/sperm and your body's ability to implant etc.


----------



## oldest woman in the world

Hi there ladies - 
I really hope you don't mind me posting - I have only just seen this section - and have already posted most of this on the ARGC girls (under ICSI)

Re your question on IVF or IUI: 
My story is: I was 42 when I started ttc. Because I'd had one natural prgnancy at 39 (without trying even, how sickening is that? My little girl is just 4) and have no other probs except my damned age (why oh why did we let it get so late) they suggested IUI. So I did 3 cycles clomid IUI, BFN x3. Sad, depressed, decided to give up. Then woke up a month ago and thought can't let this go. ONE LAST TRY. I'm 44 next month and really feel time is running out (Lorri - I would kill to be 41 again.) Got unbelievable FSH (9.7 - yes, that's unbelievable for me) so set out on IVFthinking it would give me best chance. When I produced only five egss Dr said after age of 42 I had as much chance with IUI, in fact possibly MORE!!!, so I switched at last minute. Very despondent - felt he was saying i may as well try the cheaper option because I'm not going to succeed anyway. But at 11.00am today got BFP!!!! HCG 129. Not off the scale HCG, but not too bad. I'm a medical impossibility. I know it all seems confusing, and to be honest I don't understand it - but I can really reccomend Dr tarranissi at the ARGC. I do now believe what he says.

Hope I don't sound gloating (Chances are I'll miscarry,) but look, if I can get pg in the last month of my 43rd year then EVERYONE on this board has a chance. Don't give up!

Good luck to you all.
Clare


----------



## fluffy57

Hi oldest women in the world.  Congratulations.  I would really hope that you keep on the board as your success gives me hope. I just don't understand why my consultants are not giving me any other options other than IVF. The reason why I haven't gone ahead is that for women over 40 with high fsh the success rate seems low.  Sounds like your consultants did good by you. Did you go to many before deciding?

Hi Lorri - thanks for the post it makes so much sense   I just wonder why I cant get a better explanation from the consultants and why the IUI or ICSI has not been put forward to me.  It seems so hard to get all the info to make a decision and while I am trying to figure it out I am conscious that I don't have much time. I have high FSH 12, but everything else seems to be working - its just down to time factor.  GIFT apparently has a higher success rate than I think around 20% if you have at least one tube unblocked - but it costs more and its invasive - you need to have an op and a day bed in hospital.

Any way I have given up smoking and caffine, I go to Pilate's regularly and have started to watch my diet in the hope of pushing back the ovarian clock!  

Iam really glad that I found this forum as I feel more comfortable with people same age


----------



## nuala

Hi,

Fluffy - When I decided to seek help I was just 44...  I was shocked to find out that most clinics would not even see me, let alone treat me.  The only ones I found who would were The Lister and The ARGC as they both seem to specialise in the over 40's.

I think clinics push IVF or ICSI (ICSI is usually offered only if sperm count is low or you have problems with fertilisation) as they have statistically the highest success rate.  The flip side to this is once you are over about 39 your statistical chances of getting pregnant are low.

On my second IVF cycle I responded poorly (first time around produced 4 eggs and all fertilised but got a BFN) and produced only 2 follies.  When I discussed my options they told me that my chances of success with 2 eggs was equal to doing IUI so I opted for IUI but got another BFN.  

OldestMum:  your story inspires me  but the one factor that is different for me is I have never been pregnant and as I have only been trying to get pregnant since I married my DH last year aged 43 they just cannot tell if all of my systems are 'speaking' to one another.  Apparently your chance of success with any IF treatment is much greater if you have already been pregnant.

On the other hand statistics are always being challenged and who knows which of us might just be the person to break their stats wide open 

For us we're having a 2 month break and will resume this journey in Jan.

Nuala


----------



## fluffy57

Thanks Nuala for the info. I have been finding it very hard to grasp the whole thing. Its being a wierd experience so far and I can equate to your experience - because this whole situation is not what I was expecting.  I dont think its unheard of to get pregnant later in life with no record of previous pregnancies.  Theres no guarantee that a previous pregnancy means you will have a child later on in life. 

Has anyone had high FSH and conceived through intervention means?  or are those only successful with low FSH?


----------



## oldest woman in the world

Hi everyone, thank you so much for your lovely encouraging replies. There is something so comforting about meeting people who are going through the same awful feelings. For a long time i felt I was the only person in the world who knew what it felt like to have time slipping through their fingers. It is SO SO difficult to find anything else to replace the longing for a baby - and I have to admit I still haven't come close to finding it (and I speak as someone in a great relationship with a great fulfilling job and great social circle). But for everyone who's considering DE and or adoption....... it took me a long time to get my head round it, then I found a little post from a 40 something woman (I can't find it again whatever search string I put in, more's the pity) She said that she was unable to conceive so after trying and trying and years of heartache she adopted a little girl from China. She said that now she couldn't love this little girl any more, and that she couldn't believe the time she had spent (I think she even said 'wasted') trying to have a birth child because now it all seemed so alien to her when she looks at her fantastic daughter. I know that doesn't much help, but I can understand what she was trying to say - that sometimes our perspective can change in ways we can never predict. Does that make sense or am I waffling?

For all of you who admit to feeling jealous about other pregnant women - God, have I ever been there! I want their eyes to fall out, their ears to rot, worms to grow in their brains. I wish them all a slow slow death. I can smile and pretend to be happy for them but in my heart I'm sticking hot pokers under their nails(especially my sil, by the way. There should be offshore colonies for pregnant sils) I said this to some of the women at the ARGC where I was being treated and they thought I was insane. Then I clicked - it was because they were encouraged by success stories because they knew it increased their chances. As goldies we know that our chances are already low and that each month decreases our chances. Without being too morbid, it's the closest thing to death we'll go through without actually dying.

Fluffy, in answer to your question about treatment, I would so reccommend the ARGC. Yes they have downsides - it is incredible stressful and the clinic is SO busy you can wait in line for 15-20 minutes just to ask one question. But even though you feel like a number, actually they are keeping a close eye on you and their results speak for themselves. They'll have you back for 2 blood tests a day near triggering - so you have to be prepared esp if you don't live in London. (I am a 3 hour drive away so you can imagine it wasn't easy.) Also - yes, it's phenomenally expensive. This cycle my drugs alone cost over 3k. But unless you're prepared to travel to US i think the best shot you can give it is ARGC. But they will only do IVF under FSH 10 (although I think they're a tiny bit flexible).

Jules - re your IUI. Someone has just told me that Clomid can thin the womb lining - since that is a big problem for us mature ladies it could be worth asking about other drugs. This cycle I was on Puregon - (they started me for IVF, short protocol). Womb lining was fine. Now they're giving me heparin to thin blood and progeterone to keep that wee babby in its place (fingers xxxed).

Nuala: Thank you so much for your encouragement. But just because you haven't been pregnant doesn't mean that you _couldn't_ have been, since it sounds like you didn't try much in your 20s, 30s (?) I think the success for previously pregnant women is more about proven compatibility of DH sperm + your egg than your ability to carry a child - and you have no reason to think you and DH's sperm won't love each other. (But that's just my understanding.) And people still get pregnant by accident at 45. Did you know the highest number of abortions are given to over 40s who have given up birth control thinking they weren't fertile, and suddenly......... lalapalooza. Quelle surprise!!!! Also don't forget IVF stats for over 40s include those who are infertile for reasons other than age and would have needed ft even in their 30s.

Wish me luck - I spend hours on the net trying to calculate my chances of a successful pregnancy (not good, as we all know). I hope that my story is encouraging. But if you want to gouge my eyes out I will understand too. (just do it quickly and efficiently, ok?)

Love to you all

Clare


----------



## oldest woman in the world

And PS Fluffy
I've heard of pregnancies through IUI at FSH 12.7.

Clare


----------



## druzy

Just to say that I'm in the same boat.  I'm 40 (and a half), 41 in May, never been pregnant.  FSH 11.6.  Although my clinic also tested Inhibin B which was "good" - this seems to be a new one that "they" are apparently more keen on than FSH now.  1st IUI last Oct - failed, 2nd IUI day 12 today and have brown "spotting" (not sure why it's called spotting doesn't look like a spot to me) which is normal precursor to AF so am just about hanging onto 2nd level of delusional thinking ie oh it won't turn into a real period but pretty sure it will.

My cons seems keen on IVF really and I think that if he agrees I'll probably do this next rather than squeeze another IUI out of him which he probably would reluctantly do.  I know there seems to be evidence and stories about one being better than other at an older age but I think that the fact that with IVF they can see the quality of the eggs and if they fertilise etc it's probably better to do this sooner rather than later before one gets even older.  

Clare's description of what she wanted to do to other pregant women did make me laugh, very well put, and made me feel better especially for not being the old woman in the world who doesn't feel positive all the time.  Get so sick of people telling me to be like that.

Ah well, must get back to growing older.

Druzy


----------

