# IUI or IVF at 41??



## saskia100 (Mar 28, 2011)

Hi

I am 41 and have recently decided to try to have a baby on my own.  I have had one round of IUI at the Maigaard Clinic in Denmark last month, but it didn't work.  I am not sure what to do now, whether to continue with clomid 100mg, try the injectables or go straight to IVF.  Some sources indicate that IVF gives the best results, while others indicate that the eggs are too fragile for over 40s so IUI is better! I have been pregnant before with my ex, but unfortunatley had a miscarriage.  I did have several tests afterwards and they all came back negative.  

Also has anyone had IVF at the Maigaard Clinic.  Bit scarey doing this on my own.  

Many thanks for any advice,

Saskia


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## ksf (Mar 16, 2010)

Hi Saskia,

Just to give you some hope - I was 40 when I started ttc and 2 years later I was lucky enough to have twins by c section, they are now 6 months old and are a constant delight!

I had 3 rounds of stimulated IUI. The 1st 2 cycles I only had 1 follicle which was just big enough to make it worthwhile continuing and I didn't get pregnant. On the third attempt I had significantly higher doses and I was lucky! I had injectable drugs. I was advised to have 3 rounds of IUI and if that didn't work to then try IVF. 

I'm not sure about the relative success rates of IUI vs. IVF in the over 40's, but IUI seems less invasive to me so I was happier trying this first.

I too am on my own and was scared and apprehensive - it was worth every sleepless night and I feel very blessed.

Good Luck

Kate x


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## alexine (Jun 8, 2010)

Hi Saskia, 
I'm single, had IVF at 40, now 41, and was very fortunate on my first go...I am now almost 36 weeks pregnant. I went straight to IVF as I understood it gave me the best chance...however I know a lot of ladies do IUI first and are also successful.
Hang in there!   
xxA


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## saskia100 (Mar 28, 2011)

Dear Kate and Alexine,

Thank you very much for your words of encouragement and many congrats for your babies / pregnancy too.  Knowing I am not alone on this path is reassuring.  

I think I will try one more round of IUI and then move on to IVF if that fails.  Probably mentally and financially that is the best plan.

Thank you again,

S xx


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## daisyg (Jan 7, 2004)

Saskia,

I personally would try a bit more investigation before continuing.  What miscarriage tests did you have?  I would eliminate as many causes of failure as possible before continuing.

These would include, checking uterus and tubes (blockage/polyps/fibroids)
Thyroid (TSH should be between 1 and 2)
Clotting factors
Infection
Autoimmune testing (ANAs, RA, lupus anticoagulant etc)
Karyotype for you

The best chance at your age is either IUI plus injectibles (basically using exactly thesame injectible protocol and doseage as an ivf cycle including orgalutran etc) plus trigger and double insemination if poss.  You may want to add something like femara at beginning of cycle.

I would steer completely clear of clomid as it is not well tolerated by over 40s and extended use can cause more problems than it solves.

If you do not have success after an IUI, I would move on to IVF at a very good clinic which has had live births with women your age.  

The fact that you have been pregnant before is a very good sign, but the miscarriage may have been bad luck or something that can be fixed after testing.  Your GP can carry out many of the necessary blood tests.

Finally, what is your hormone profile like (FSH, E2, LH prolactin, AMH)?.  This will give you a bit more info. about potential for stimming and what kind of protocol the clinic will use.  

Best of luck
Daisy
xx


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## Jue jue (Feb 26, 2011)

Hi Saskia,

  I am 41 this August and had 1 round of  natural iui.  

  My progesterone is at 29.1 and awaiting fsh day 3.

Asked my doctor only yesterday about meds and she prescribed clomid and hcg shot so will take these with next treatment.  however did not know that clomid for older women not a good idea so will look into that first.

I did not consider IVF and think will just give iui a shot, if it doesnt work i dont think i would go for ivf due to it being so
invasive and so expensive.

Have you got bloods back yet and what are the doctors recommending for you?

Jue


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## urbangirl (Jul 28, 2010)

Hi, I am doing a combination of IUI's and ivf now.  I'm 43 and in hindsight if I'd known what I know now I would have done a couple of ivfs when I was 41, because the stats are so much better than for a 43 year old.  The IUI might work, so good luck if you stick with that, but I think it's good to have a plan B for a few months time if it doesn't.


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## Jue jue (Feb 26, 2011)

HI Urban girl,  May I ask what you know now that you didnt know then to have brought you in another direction?

Jue


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## TamsinT (Nov 25, 2010)

When I asked about IUI v IVF, my consultant said that the chances of success were much higher using IVF


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## urbangirl (Jul 28, 2010)

Jue jue, so many things, a big one is amh though - mine has plummetted in the last two years which means my chances at ivf are really reduced, I would have had a much better possibilty to get pregnant when I was 41.  Also, in the last 6months I've had lots of investigative tests done which showed up a few problems, if I'd known about them I would have had a mix of ivf and iui, like I am now, because my chances at IUI and natural ttc are less than people's who's reproductive 'bits' are in good shape.  Basically, the more information you can get sooner the better- because consultants aren't all as good as they should be- I worked out most of what's wrong myself.


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## Jue jue (Feb 26, 2011)

Urban girl 

I fully understand what you are saying, you have to be very proactive.

I seem to be directing my clinic each step of the way.


Jue


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## Jue jue (Feb 26, 2011)

HI Saskia,


Wondering how you are getting on?  Have you decided to stay with iui or go with IVF?  

Jue


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## saskia100 (Mar 28, 2011)

Hi Jue,

I have decided to do 1 more IUI this month and then move onto IVF next month as statistics seem to indicate a slightly better chance. I have a wonderful dad, who obviously wants to be a grandpa, as he has offered to help out with some of the costs for IVF. 

Daisy, do you know what it is about the clomid that is not good for over 40s? Just started to take them this month (tho did have some negative side effects last month).

Saskia


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## Jue jue (Feb 26, 2011)

Hi Saskia,

That's nice about your Dad, great you can share this with him.  

So you are doing one more iui with clomid and injection?

Daisy will have more info re clomid.  Over the last few days i have been reading about it and much says it just does not work , not a jot of difference and it can thin the lining of the womb.  cannot say whether this is true as it seems to be opinion.

Jue


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## MaisieCat (Sep 9, 2010)

Hi all,

I just spotted this thread and thought I would join in as I am facing a similar decision.  As you can see from my signature, I went to a private clinic and had some tests about a year ago when I was 40.  They found my FSH to be about 7 (I can't remember the exact figure) and did a HyCoSy to check by tubes etc. which they said was all fine.  They recommended trying naturally for a few months - they said that the flushing action of the HyCoSy sometimes clears the tubes a bit and 'does the trick' - and then to try one or two IUI cycles and move onto IVF if that did not work.  Unfortunately by the time we went back to book ourselves in for the IUI there was a long waiting list so we had to wait another 3 months to have the IUI, by which time I'd turned 41.

The IUI failed, and we immediately booked ourselves in for another IUI after a 1 cycle break and and an IVF cycle after another 1 month break (they let us do this because of the original delay and my concern over my advancing years).  However,  none of that actually happened because I fell pregnant naturally before even having a period after the IUI.

Unfortunately, that wasn't the happy ending we were after.  We paid for a scan at 8 weeks because we needed to reassure ourselves quickly and know whether or not to cancel our booked treatments.  That scan found a sac but no fetal pole or hb and we were advised to wait another week and have another scan.  At that point I had already been to my GP and had my first midwife appointment booked for the afternoon of the scan, so I called the midwife to explain and she arranged for an NHS scan 2 weeks later.  We were still hopeful that it was a slow developer or that dates had been messed up by the IUI, but that we not to be.  2 weeks later I had the scan and was told it was a 'missed miscarriage' and was given the option of having the womb contents removed by ERPC or to wait for nature to take its course.  I could not bear the thought of an ERPC and was afraid of damage being done during the procedure so I elected to wait.  It took a further 2 weeks for anything to happen and after it had, my GP booked me for another scan to check that everything had gone, but it had not.  I therefore ended up having to have an urgent ERPC over a month after the 'missed miscarriage' diagnosis.

This was mid-January and I'd missed my chance for the IVF that had been booked, so we were right back to square one.  Looking back on it now, perhaps I should have had the procedure straight away as, on top of the trauma of having a miscarriage, I now face the fact that several precious months have been 'wasted' and my 42nd birthday looms in June.

We are now really stumped as to what to do.  DH seems convinced that we should be able to concieve naturally now that we've done it once, but I am not so sure - I think the pregnancy may have been due to residual effects of the drugs I had for the IUI.  We are now in the middle of our second cycle of trying naturally again and just don't know what to do about having more treatment and, if we do, whether to go for IUI or IVF.

Sorry to 'hijack' your thread, Saskia, but I was hoping that any answers I get may help you too.

Best of luck with you IUI this month.

A-M
xx


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## saskia100 (Mar 28, 2011)

Hi A-M

So sorry to hear your story. When I had my miscarriage (at 12 weeks) I had it at home and they advised not to have the D&C after as only a little remained, but it took about 4 months for my body to recover and expel all the tiny bits of tissue, so my homones took ages to get back to normal.

I don't really know enough yet on the drug implications of IVF, however I think for me I don't want to waste any more time with IUI if it doesn't work next time.  However, I am making this decision on my own.  If your hubby wants to try naturally it could be a better way, and obviously cheaper.  Have you had the AMH test to check the status of your eggs?  I had this done 2 years ago and it was ok, but I have decided not to have it re-done as it wont change my course of action, but it may help you decide?

Saskia


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## saskia100 (Mar 28, 2011)

Hi Jue,

I am gonna do one more IUI but have decided to reduce the amount of clomid.  Last month I felt pretty rotten because of it - headaches, cramps, tired, blurred vision and edgy.  In addition I don't want to overload my body with drugs this month, as if I do the IVF next month I will have to take a lot then.

Are you going to do another IUI shortly?

Saskia


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## MaisieCat (Sep 9, 2010)

Hi Saskia,

That's a good idea about the AMH test.  I wonder if we can get things like that on the NHS?  I had assumed not because of my age, but have read a few posts on here with older ladies getting some investigatory stuff done through their GP even though there's no funding for IVF for us.

Perhaps I'll get a GP appointment and ask - unless anyone knows the answer?

A-M
xx


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## Jue jue (Feb 26, 2011)

Hi ,

What exactly is the amh i believe it costs around €300 

Jue


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## MaisieCat (Sep 9, 2010)

Well I assume the AMH test is a blood test like they do for FSH, but I'm not sure.  I can't remember what it stands for, but I know it's another way to check your fertility level.

A-M
xx


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## Jue jue (Feb 26, 2011)

yes it is a blood test alright but my clinic dont do it they say there is no evidence it prooves anything etc etc


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## urbangirl (Jul 28, 2010)

Hi, you can't get amh on the NHS, it costs about £100 privately, though you can get it done cheaper.  Saskia - you need to get your amh done anyway if you want to have ivf because they will use it to decide your protocol.  The meds doses for someone with a good amh are far lower than for someone's who's amh is low. It's a really useful figure to have.  You will need all your day 3 tests for IVF as well, for them to decide whether to treat you even- some clinics won't treat with high fsh for example.  The more tests the better, you'll be closer to finding out what's happening inside.


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## saskia100 (Mar 28, 2011)

I have informed the clinic in Denmark where I had an IUI that I wanted to move onto IVF, and they have agreed. Though I will have all the blood work and scans done here at a local clinic. It's strange, I pretty much feel I have to get to grips with understanding everything, as neither clinic is that forthcoming in giving me information. I guess there is a language and distance issue with the Danish clinic, and my local clinic here probably feel I am not a "proper" client as I am going abroad for the IVF?? I don't mind, I just need to make totally sure I do understand the whole process so nothing gets overlooked!

I did have the Anti-mullerian Hormon test (AMH) done a few years ago and it was ok for my age, but as you say Urban Girl if its needed to determine the level of injections I will have to have it done again.

This is a good link giving an overview of what the AMH is:
http://www.advancedfertility.com/amh-fertility-test.htm

Has anyone had acupuncture to help balance their hormones, and found it effective? I want to try every little thing than can swing the odds in my favour, but obviously money is an issue and I don't want to waste it on unncessary things.

Saskia


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## urbangirl (Jul 28, 2010)

Saskia, my amh was also fine a couple of years ago, now it's in the 'very low/ undetectable'  range. Keeping an eye on it helps to focus the mind - I moved alot faster after I got my new result.  I use Chineses herbs a lot by the way, and my hormone levels have stayed fine, thank goodness, one less (very big) thing to worry about.  I can't say for sure that it's due to that but since everything seems good while I take them i'm continuing!


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## MaisieCat (Sep 9, 2010)

Thanks for the answer re AMH test on the NHS, urbangirl.  I'm coming to the conclusion that I really need to stump up the cash to get my levels checked again.  AMH was never checked originally - maybe because FSH was good, but that was a year ago...

I have not had acupuncture myself, saskia, but someone on my local thread has, and is very positive about it.


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## urbangirl (Jul 28, 2010)

I think if you are in your 40's and your amh etc is good don't be complacent, make the most of it and give it your best shot, because when your levels of amh, fsh etc etc deteriorate it makes everything a lot harder. Good luck to all of us!


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## MaisieCat (Sep 9, 2010)

You are so right, urbangirl.  Complacency is what I think my DH is suffering from.  He seems to thank that 'cos we got a natural BFP last year, we can do it again without help.  I'm not so sure.

It helps so much to mull things over with others for support on here.

A-M
xx


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## urbangirl (Jul 28, 2010)

Hi Maisie, I think the reality is that if we left our men to organise everything nothing would get done.  My partner is equally complacent but thankfully he allows himself to be swept along by me with a good grace. I got pregnant so easily the first two times, but the last time took so much effort plus with miscarriages we lose so much precious time. Also, when you start going down the road of extensive testing that also takes time. It's taken me the last 10 months to methodically complete nearly all the tests I need to do (I got a lot of informatio regarding those from this site) and to start to deal with the issues that came up- for that reason I really wish I had a year back now!  I would follow your instincts and try to make more progress.


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## Jue jue (Feb 26, 2011)

HI guys,

just got my day 3 fsh back after many calls to the clinic over the last week. it is 10. 1 . Any thoughts?

Jue


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## Jue jue (Feb 26, 2011)

Am answering my own question now

i just found this info

9 - 11 Fair.  Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.

is there anyway of increasing it , i guess not.  does it fluctuate i wonder?

Jue


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## Jue jue (Feb 26, 2011)

Sorry for this should have posted all together.

it seems  there is an fsh and lh ratio

so my lh was 4.9

Jue


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## daisyg (Jan 7, 2004)

Jue Jue,

You also need your E2 measurements as high estrogen can falsely suppress FSH numbers leading to a misleading interpretation.

Your FSH level is not unusual for a woman your age (providing your E2 is also normal).

FSH can only give an indication of how you may react to stimulting meds. in an ivf cycle e.g.  It tells you nothing about the quality of your eggs, but at your age, quality is a big factor as a large proportion of eggs may be abnormal.

FSH does fluctuate from cycle to cycle, and it may be worth taking another FSH/E2/LH reading next month to see.  However, I wouldn't wait around for a lower FSH, as you need to get a move on now.

Has anyone ever had a look via scan to see how many antral follicles you have?  This can be another diagnostic tool to see how you may respond to stimulation.

Daisy
x


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## Jue jue (Feb 26, 2011)

Hello Daisyg  


          Yeah I can have an antral follicle test done if i wish.  Went to a fertility specalist this week and he is  is recomending

2 cycles of stimulated iui and then if nothing ivf.  He is also recommending amh but said nothing about oestradil.  Think the drug is tamoxilin, the cousin of clomid  along with fsh injection as advised on here, but bad news they cannot get
the sperm for another 2 months!!

Cervical  polyp not removed as yet, hospital not keen to say they would rather not. still waiting to hear from them following their contact with the clinic.  

think will stay with first clinic for next month cycle and do the clomid and hcg as this is all they can offer they donot do fsh injections.  
how are you and where are you at?

Jue


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