# Views on medicated vs unmedicated IUIs for the over 40s?



## winky77 (Nov 27, 2007)

Hello, 

I was reading the posts on the other strands earlier and interested in all the comments about medicated IUI being higher odds than non medicated.  When I saw my consultant at LWC she said that the odds would not be that much different at my age.  She seemed to be saying the drugs don't have as much effect in the older age groups (even tho I have an AMH of 17 which I did tell her ....LWC don't test this but I had had it done up here in Scotland) .  What has anyone else in the 40 plus age bracket been told?  I will ask the consultant again but I'm really interested in other people's views as I want to make the right choice for treatment! 

Response much appreciated....I'll post on the ttc over 40 strand too! 

..Di


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## anna the third (Jan 15, 2008)

obviosuly med will produce more follicles, especially if your AMH is so high (age of 41 would indicate much lower than your 17) - however, the first line of med is Clomid which has side effects which can be v unhelpful to natural conception eg as it is an anti estrogen, it reduces cm a lot.  for IUI, though, i'd do med as i don't see much downside. with highish AMh though you might have to watch overstimulating because if youdo, you would probably have to consider converting to IVF....


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## daisyg (Jan 7, 2004)

Research has shown that results for medicated vs natural iui cycles in over 40s are significantly higher. I think your consultant is wrong. Over 40 you need to maximise your chances every cycle and the only way to do this is to increase the number of eggs for potential fertilisation through injectible meds.

I would say that the most effective stim protocol would be to use an ivf meds protcol (ie. fsh meds like follistim/gonal f without clomid starting day 2 of your cycle). Using a high dose of fsh meds. you will stand a higher chance of stimulating your ovaries to produce more eggs. You then need to be constantly monitored by bloods and scans and then have a trigger injection in order to properly time IUI insemination and max. your chances.

Over 40 the stats. are relatively low - but of course who knows your individual chances. You obviously need a fairly good hormonal profile (i.e. good fsh and E2, prolactin, LH etc) and it would be interesting to see your antral follicle count at the start of your cycle.

You may want to consider a second opinion at another clinic, as I think your consultant is not doing you any favour suggesting natural iui... I would ask her what her live birth rates are for women your age at her clinic with medicated vs natural cycle....

You do not have time to waste on treatments which are less successful. I would also (if you can) investigate other issues which may impact on your fertility. e.g. HSG/hysteroscopy to check your uteruse for fibroids etc., thyroid levels, antithyroid antibodies and other autoimmune issues, clotting factors, bacterial infection, etc etc. These are things your GP can check and it is worth looking into if you can as you do not want to find that you have these issues when it is too late to do anything about them.

I would not spend too much time on IUI without thinking about moving on to ivf in order to maximise your chances. However, it is obviously something to discuss and maybe get a second opinion on your best way forward. Your first IUI cycle will give info. on how your respond to meds etc.

Best of luck,

http://www.cababstractsplus.org/google/abstract.asp?AcNo=20053000213

http://www.fertilityplus.org/faq/iui.html

http://findarticles.com/p/articles/mi_m0CYD/is_24_37/ai_95792126

Daisy
x


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## winky77 (Nov 27, 2007)

Thanks Anna and Daisy, 

Anna ....I think you are right about watching out for over stimulation with my AMH that high.....alto a bit scary on my own I'd still love twins but any more than two would be seriously scary and risky! 

Daisy......Interesting what you say about research (do you happen to have a link or a reference I could follow up?) I will definately talk to my consultant to find out more about her rationale. I don't want to think that she is wrong but I obviously need to understand more about what is behind her recommendation. And yes I am having all the other stuff you mentioned tested out too.  The fibroid is an interesting one. When I had the big one removed 12 months ago the smaller one was left because it was deemed to be not significant and not likely to affect fertility. An internal scan at a Scottish clinic in December also indicated the same.  But at LWC scan a month later they were a bit more reserved so I'm having an echo scan at same time as hycosy to get another opinion.  I'll be gutted if I need more surgery as that will just lose me more time! 

ta for you input...x


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## Damelottie (Jul 26, 2005)

Hello all

I'm not quite 40 yet! I had my first IUI when I was 35 I think. To be honest, it never even occured to me to go unmedicated! Sounds odd I know but with money being such a issue I just didn't have to waste on lower odds of any kind. The consultant didn't try to convince me one way or the other - but I guess thats because I didn't ask too much. Having tried only 2 iui's I'm going straight for ivf now. As I said - I just don't have the money for the potential 6 iui's. I just didn't feel the rates of success were anywhere near high enough to throw money at it. Just my opinion tho     

Love
Emma xx


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## anna the third (Jan 15, 2008)

IVF can be diagnostic as it also casts light on some more of the things that can go wrong as we age (i'm 39) 

the price we pay is financial (of course) and in terms of increased intervention which I personally started off not wanting at all. BUT at some point you say: i need the better odds. 

good luck girls


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## daisyg (Jan 7, 2004)

Here are just a few of the research articles I found for further reading!!

http://www.medscape.com/viewarticle/488142_2

http://humrep.oxfordjournals.org/cgi/reprint/12/9/1865.pdf

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=12095486&cmd=showdetailview&indexed=google

http://www.medscape.com/viewarticle/488142_2

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=12095486&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1

The first ones are interesting, then obviously you could go on forever reading this stuff!! I feel though that just intuitively, it makes complete sense that medicated cycles are going to give you a better chance than natural especially over 40.

In ivf for example, research has shown that more live births are achieved the more oocytes that are produced and the more embryos replaced etc etc. so it makes sense. Chances of multiples also declines with age, although there is some risk obviously if you are producing more than one egg (however, even one egg can produce twins...). It is a balancing act between a lower chance of pregnancy and a possible but pretty low risk of multiples...

Best of luck to everyone.

Daisy
x


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## anna the third (Jan 15, 2008)

I agree with Emma - IUIs are ridiculously overpriced for what they do for you. Mine was agony too at chelsea and west.... gggggrrrrr


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## Betty-Boo (Oct 14, 2007)

Hi Di,
I've decided to go straight for IVF, even though there isn't anything wrong with my fertility - apart from no sperm!!!
The odds are higher than the IUI, plus I totally agree the IUI is over priced for what it is!  
Good luck with your decision
Take care
Rachel x


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## ♥Jovial♥ (Feb 25, 2007)

Ooh Rachel, good for you making your decision .... decisions are something I am terrible at!  Any idea when you are likely to be starting tx?  I think i'm right you have already chosen your clinic  , what's the next step?

Getting exciting round here!
xx


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