# Query following first consultation



## Pepstar (Jul 6, 2009)

Well we had our first consultation on Friday and we have come out of it feeling somewhat disappointed.  We were hoping to start next cycle but have been told that it is standard procedure to have counselling first and also a hycosy scan.  We realise these are both a good thing but it doesn't help when we want to start now!

Our doctor also didn't send through the results of the viral blood checks so I had to have this done again.  They have also raised a query about the donor that we have already chosen from the ESB and it looks like we might not be able to use him - this is despite us talking this through with our gp prior to purchasing.  AHH!  

Enough of that!  I was hoping though that people may be able to share their experience of deciding what IUI treatment to have.  We were hoping to do natural cycles (as to all intents and purposes there appears to be no reason why I should have fertility problems) but the doctor is very keen for us to use Chlomid as I have slightly irregular periods (in as much as the cycle varies from 28-35 days).  

We are a bit concerned about the increased risk of multiples with using chlomid which we discussed with the doctor.  She mentioned that on a natural cycle they might need to bast me twice in one cycle and this would obviously cost more in terms of the 'precious' sperm (her words, not ours).  She also mentioned that on a chlomid cycle we would have to be scanned every other day but on a natural cycle we would probably use OPKs to monitor the cycle.  One of our concerns that we raised was the impact on working times as I have a job that requires me to travel nationally but she still seemed to indicate that medicated was best.

Feeling a little bit   right now and was hoping that people could share their experiences with us.

Thanks,

Cat & Fi


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## leoaimee (Jun 3, 2008)

hi cat and fi

sorry to hear abotu the delays.  

i know different clinics have different ways but as there are some similarities between us ill tell you how it worked for me.

your cycles would be considered pretty normal ... my cycles were between 25 and 33 days and that is def in normal range.  i had natural cycles WITH scans ... i just paid for scans extra.  but i only needed about 2 or 3 this is because OPT werent too accurate for me.  subsequently i have found that testing several times during the day can help around ovulation time because a few hours might mean missing the surge.  i also used a digital monitor over several months to get a btter picture of my ovulation, and by about 18 months of monitoring i cld almost tell when i was most fettile and ovulating.

there is a girl here, kelz who is preg with triplets after a medicated iui ... so it does happen.

your clinic will get more money for scans and drugs ... if you dont want clomid go with your gut feeling.  you can change your mind if you dont get your bfp and wnat to change procedure later.

i dont knowo ESB ... so cant help on the sperm.

if you can pick up your ovulation on opk there is no reason why you cant just pop into the clinic on the day and have the basting ... really cutting down times to come into the clinic.

have you been using them?

all the best aiemex


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## lmb15 (Jun 12, 2009)

Cat and Fi,
You're clinic don't sound too helpful?!! They are right in a way - stimulated iui is more successful than natural iui but also has drawbacks. If you consider the 3 main options for "infertility" and weigh up the pros and cons for each, it may help you decide what to do. Here's a brief run down:

*1)* *natural iui* - you monitor yourself at home with ovulation predictor kits, or measuring your temperature, or whatever method you choose. When you think you're about to ovulate, you go to the clinic and have iui. Most clinics bring you back 2 days later as well so that you've got a better chance of the sperm and egg meeting.

pros - there's no drugs or scans involved, you only need to attend the clinic twice, it's the cheapest option.

cons - statistically it's less likely to work. it'll be difficult if your cycles go a bit awol, which can happen at the best of times, let alone when you're stressed about conceiving!!

success - about 10-15%
cost - £500-£900 excluding sperm

*2) medicated iui* - you take clomid/whatever stimulation drugs your clinic uses (some use the ivf drugs) to stimulate your ovaries so you get more follicles and therefore more eggs. The clinic monitor your response and when they think you're ready, you'll generally have a trigger injection (again depends on the clinic) and you go in for insemination (usually once, can be more)

pros - they monitor you so know when you should ovulate, you'll almost definitely release an egg (or a few) because of the drugs, so is more successful than natural iui.

cons - you're taking medications that have side effects and risks. There's a risk of ovarian hyperstimulation (can be fatal if severe) though if you're monitored properly this shouldn't be an issue. You'll have to go for frequent scans. The scans and drugs add to the cost. There's an increased risk of multiple births. If you end up with more than 2 follicles growing at the same rate, to avoid the risk of multiples some clinics will abandon the cycle - though you'll still have to pay for your drugs and scans up until that point. Some clinics won't do iui at weekends, so you may miss your ovulation.

success - 10-30%
cost - £600-£1,500 excluding sperm, dependent on clinic and drugs used

*3) ivf* - you inject/inhale drugs daily for about 2 weeks to put you into the menopause. You have a scan and blood test to make sure your system's shut down. Then you inject daily to stimulate your ovaries (like in medicated iui). You get scanned every 2 or 3 days for about a week or so. When you've got enough big follicles, you go in for egg collection. This is done under sedation or general anaesthetic. (amount of eggs varies person to person but usually 8-18 eggs as a rough guide). They mix the eggs and sperm together in a dish to fertilise. Between 2 and 5 days later you have the best looking embryo/s put back in. This is with you awake, bit like a smear test. From starting drugs to embryo transfer is about 4 and a half weeks.

pros - most successful option. You have an actual embryo put back in, and don't just hope the egg and sperm meet and like each other. The eggs are being artificially removed so you won't miss ovulation if they're not open ovcer the weekend.

cons - the drugs. You'll basically be injecting yourself for 4 weeks. Drugs have side effects (like in medicated iui), and you need to be scanned and have your bloods taken every other day for about a week. Some clinics will scan at 7am though so it doesn't impact on work as much. This is the most invasive out of all the procedures. Egg collection also has risks, eg making a hole in your bladder/uterus/bowel but are very unlikely to happen in experienced hands (less than 0.5%).

success - 25-60% dependent on clinic
cost - £3,000 - £5,000 excluding sperm, dependent on clinic and drugs/any additional intervention used

nb. if you egg share (give away half your eggs when they're collected) you either get massively reduced or free ivf. You get cheap/free drugs too
costs would be more like £500 - £1,000 excluding sperm

If you don't like the idea of putting drugs in your body, go for natural iui, just accept the lower success rates. However, it works for 10-15% of people and there's no reason why you can't be one of them. It can work 1st time, as with all the options.
If you're not averse to drugs but still want it relatively "natural" go for medicated iui, but beware of the added costs and inconvenience with scans etc, also the risk of multiple births.
If you want the most successful option and are happy to take the theoretical risks involved, go for ivf. It is the most invasive, but also statistically the most likely to succeed. If you're scared about multiples, just have 1 embryo put back.

We went for egg share IVF. The treatment, including consultation fee and HFEA fee, cost £690. (£140 consultation and £550 drugs). We bought a batch of sperm which lasts for about 5 rounds of IVF, which cost £1,500, plus £350 to store it for 10 years. So total cost was £2,540. However, our next cycles if we egg share again will only be £690 as we'll already have the sperm.

Our decision was based on the fact that we wanted the most cost effective way to get pregnant. To be fair, the consultant did try and steer us towards iui, but i was adamant i wanted ivf because it was 4-6 times more successful, and i wasn't concerned about the side effects/risks. Plus, if we egg shared it would cost the same as natural iui. We were lucky and it worked 1st time, and i'm now 14 and a half weeks pregnant with one baby (had 2 embryos put back, but one shrivelled up!).

It's a very personal choice though. Some - like us - will jump straight to ivf, others do AI at home or iui at a clinic, and some go inbetween and do medicated iui. Weigh up the pros and cons of each, and go with whatever you feel most comfortable with. Don't let the clinic push you into something you don't want to do.

Best of luck!! 

Lisa x

ps, sorry, that turned into a mammoth post in the end!


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## leoaimee (Jun 3, 2008)

what a comprehensive reply lisa!


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## nismat (Mar 7, 2005)

Hi Cat & Fi, 
Obviously you've had some pretty good answers already! But to add my two-pennorth, it sounds like you really want to try natural cycles, and I would say to be strong and insist on this with your clinic, even if you do it as a sort of "compromise deal", e.g. say that you want to start with natural IUI cycles initially, but will review after 2 or 3 cycles and then consider medicated.  
I did 2 natural IUIs, then moved on to medicated (Clomid initially, followed by injectibles x 3 cycles), and finally to IVF. For me, moving to medicated didn't increase my chances at all, because I didn't respond to any of the drugs (in terms of producing any more follicles than my normal 1). Possibly the IUIs were slightly more accurately timed, because the timing was based on follicle size/maturity rather than ovulation testing (although I don't think this was true for me). 
If you have to travel a lot, then the inconvenience of having to be scanned every other day could well outweigh any slight statistical difference in success rates. 
My advice would be to get familiar with your cycle in advance of actual TTC (if you haven't already done this) if you're planning on doing natural cycles. Temperature charts are useful, but only for confirming ovulation, not for predicting it. For that, using a combination of examining cervical mucus (it turns egg white texture during your fertile period - when it turned to egg white, that is when I then started using ovulation test kits until I got a positive), plus ovulation test kits to pinpoint the rise in Follicle Stimulating Hormone that indicates your egg will soon be released. 
Other points: I wouldn't worry that much about the variation in cycle length; I don't think that the Clomid will really help with that anyway. Oh, and Kelz, who had medicated IUI, was on injectible drugs rather than Clomid (which further increases the chances of multiples, as being stronger drugs you are more likely to have 2+ follicles).
I've rambled a bit, but basically, go with your gut feeling as you start treatment; you can always go more medicated at a later stage.


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## motos (Mar 14, 2008)

Just one other thought to add - you can have a monitored cycle without stimulation, which I what I did the first time - there was no basis to think that I needed stimulation (I was ovulating) but they wanted to maximise accuracy of the insemination, so I was scanned - once or twice, I can't remember - and then told when to take the HCG shot and inseminated 36 hours later. Actually, I tell a lie, i did have stimulation, but it was Letrozole (which makes sure that the egg matures) rather than Clomid (which produces more eggs) - but the principle is the same, I didn't need to have the letrozole, I could just have had the trigger shot.


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## leoaimee (Jun 3, 2008)

ps - i didnt have a hycose either .... there was no reason to think i had blocked tubes ...


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## TerriWW (Mar 8, 2007)

Hi

Just scanned your post (wriggly baby on my lap!) I would say.. why would you need the hycosy scan? Maybe in a few cycles if you're not successful but why start with it? There's no reason you should have fert probs is there? I would definitely question this - in fact I wouldn't have it done unless I was unsuccessful on a number of attempts.

Secondly - my clinic point blank refused to give me clomid, they said if was for people with ovulation problems and I used FSH medication. I have read people who have used clomid for a few cycles and it has caused them problems as it can thin the uterus lining. Again, I would not use this.

As for natural cycle v med, I'd probably try a couple of natural cycles and then move on to FSH (which worked fo me). Some of the clinics treat us just as they do the women who have had trouble conceiving and so have come to them. They shouldn't!! They should at least start treating us as thought there are no fertility issues.

Sorry this is a bit direct. Just wanted to get my info down before Romy wrestles the keyboard from me!

good luck!

Terri


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## leoaimee (Jun 3, 2008)

hay terri!


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## Pepstar (Jul 6, 2009)

Thanks for your comments everyone and apologies for the time taken to reply - problems with our internet and then a brief time away for our third cp anniversary to Barcelona  

All of your posts were very helpful and have helped us make some decisions about what we want and also that we weren't/aren't going crazy for the way we felt after our initial consultation.  Terri - your post pretty much sums up exactly what we are feeling so no need for apologies about being direct.  

We have made the decision that we our going to refuse to do a hycosy test in the first instance - if we are unsuccessful after a few tries then we will consider whether this is something that needs to be done.  If the clinic refuses to let us do this then we will go elsewhere.  We haven't been able to discuss this yet with the clinic as they won't discuss our treatment properly now until we have had our counselling session (Ah!!).

The counsellors are apparently very backed up at our clinic and although they contacted us they helpfully told us that they booked three weeks ahead and that they wouldn't be able to tell us until some point in the future when our appointment would be and that this was likely to take a number of months (just to get an appointment date!).  After a lot of to and fro we have finally got to the point where they have agreed that we can use an external counsellor - but only the one that had just left the clinic as her contract had come to an end.  Helpfully she has just set up her own private business  

In terms of the medicated vs non medicated we will discuss this with them when they finally agree to talk to us properly about our future treatment.  My partner is away this week for work so our counselling appointment is Monday evening.

We have considered going to another clinic but this one is very handy as it is close to home and on the way to and from work for the both of us.  We are also hoping that once we have got these initial bits out of the way that things will start to go smoothly.  If they don't then we will go to another clinic.  Seems like the initial try is still a long way off


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