IVF, IUI, Adoption, Oh my!

sportychik'sHusband · 04-01-2009, 03:08 PM

Gentlemen (And lurking ladies),

My wife was diagnosed in September of last year with PCOS. She stopped taking OCA's around the same time and we've been actively trying since. Her endocrinologist put her on metformin and dexamethasone and she's been peeing on sticks for a while to figure out when to try. Now her endocrinologist has said that because she also has low ovarian reserve (lucky us) he doesn't want us to try too long (like more than 6 months) without help. His recommendation is to do 2-3 rounds of clomid followed by IVF. Apparently that's a rather expensive proposition. So, the question is, what do we do? We're concerned about spending money on clomid without success (not especially wealthy people) just to go on and spend 10-20k on IVF. Opposingly, what if we spend the 10-20k on IVF wihtout success? Then, no money left for adoption (option 3). And, do the hormones associated with IVF really turn your wife into a she-devil? Any info or experiences would be appreciated.

G-

jwitte311 · 04-03-2009, 06:31 AM

G~
Wow you sound like you took a page right out of our story. My husband and I have been actively trying to get pg for 4 1/2 yrs. Last Feb I was dx w/PCOS and we were faced with the same questions. Our insurance does not cover any infertility treatment and we are not exactly financially wealthy either. We were concerned with trying clomid then having to go to the injectables and not having money left for adoption at the end. We discussed the possibility of skipping the clomid and going right for the injectables as the success rate is higher. Our dr. convinced us to try a round of clomid first, saying if it worked we would be spending considerably less than the injectables or ivf. A little over $2000 later we did not get pregnant. The experience was pretty emotionally draining and we decided take some time to decide what the next step would be. We are currently in the process of adopting siblings through foster/adoption. This is different than traditional foster, the kids are already in foster care and have already had the parental rights terminated.

jwitte311 · 04-03-2009, 06:45 AM

These are the kids you see on the state websites and on adoptuskids.org. We live in MN and the state pays for the all of the fees throughout the adoption process, including our homestudy. On Weds. we finished our initial adoption application. The same day we got a call that I was a candidate for an IVF clinical trial. There is a IVF clinical trial for women w/PCOS I had found on clinicaltrials .gov (search PCOS). This might be something your wife could apply for depending on how close you are to the trial clinics. There are still fees involved, but it is around $7000 instead of $20,000-25,000.
We have two friends with PCOS, one did 6 rounds of clomid before having twins on her first round of injectables and one got pregnant on her first round of clomid.
If you guys have any questions about our experiences, you can e-mail my husband and I at jadonjadon @ hotmail.com
Good luck in your journey!
Alissa

myenzoorka · 04-03-2009, 10:47 AM

Lurking lady here. I'm probably going to say a lot of stupid things - but here goes.

I don't know much about the infertility treatments - we never had that kind of money (and husband was happy with the 2 kids we already had). And here I'll show my ignorance - but why, even with a low ovarian reserve, does the doctor want you to not try for more than 6 months? It also seems odd that the doc is so quick to "up" the treatments so quickly. Is the egg supply so low that this is truly such an urgent problem? Or is there another time constraint?

The reason I ask all of this is that there are quite a few of us who get pregnant (I did - and we were trying not to have a baby). And from the information you gave, it just sounds like the doc is rushing things an awful lot (but like I said - I know nothing about getting infertility treatments).

Please forgive me if I exemplified everything that is wrong with stupid people today and feel free to completely ignore this post if that is the case. In any case, I wish you the best of luck!

abbiedarlin1 · 04-05-2009, 07:31 AM

Just wanted to add in, you never know how clomid will go. I'm a heavy cyster and doubted clomid working....well, the 2 cycles I took it, it worked. And it kick started my cycles and I ovulated the following cycle without meds! Clomid is a cheap option. The meds themselves are quite cheap and the only monitoring required is a progesterone test 7 days after ovulation. Get your wife to start temping. The information on how to do it are on fertilityfriendDOTcom. It's a very useful charting site and that way your wife will be able to track her cycle and know when she is ovulating. The best thing you can do is research. Know everything about everything so you can ask questions and know what to do. I've found that researching has been the best tool. I definitely think clomid is worth a go. And if your wife isn't ovulating on her own, I think 6 months of trying would be a waste if she has low egg reserve. I personally would request clomid sooner rather than later.

myenzoorka · 04-05-2009, 10:16 AM

Abbie makes an excellent point. And my apologies for not clarifying better. I meant in NO WAY AT ALL to imply that you should not try clomid. I thought the quick jump to IVF was a bit extreme. Boy, I need to think more clearly when I post! Sorry. And thank you Abbie for helping me pull my head out of my, well, you know.

ducky · 04-09-2009, 05:05 PM

I was fortunate enough to get pg 2x's on met/clomid combo. As far as cost goes, our medical system is different, all I had to pay for was the drugs. The first baby cost us around $600 worth of drugs and the second about $700 - and not all at once. I was on the highest dose and was around $90/mth. The only monitoring was blood tests during the month. The fist pregnancy took about 5 rounds of clomid, the first 3 were to get the dose right and make me O, then once they had the right dose I got pg the 3rd time on that dose. The second time I got pg on the 7th round of clomid. That is unusual as they don't like to go over 6 rounds but my Dr had wanted some extra blood work before we moved on to injectibles. I feel we are very fortunate that clomid worked for us becuse injectibles cost so much more, never mind the cost of IVF.

You mentioned your endo doesn't want you to try more than 6 mths without help - is that before you start clomid or whatever treatment you choose? When we first started TTC - and I don't have a reserve issue, my RE said with PCOS they start treatment right away as it's much less likely to happen without help.

Lots of women get pg with clomid & met - and it seems the cheapest way to go. There is much less monitoring, and, if you do decide to go that way you might want to ask your DR about combining it with IUI's if you have such a short window.

sportychik · 04-11-2009, 02:53 PM

Thanks to everyone for the information. This is in fact the OP, but my profile doesn't work, so I'm using my wife's. The story with the clomid/reserve issue is simply that the RE is concerned that if we try too long without assistance that we may expend what eggs she has available. We think there's an O because of her tracking including peeing on sticks, but not 100% sure if that means that an O is actually happening. According to her RE, it is at least at times, based on past ultrasounds. As far as cost, everything is on us. Our insurance will cover PCOS stuff but as soon as it even smells like fertility they bail. The RE says he won't do clomid without before and after ultrasounds to determine multiple oocytes and to rule out ectopic from a positive pregnancy test. That makes each round of clomid between $600 and $900. You can see how these add up!! If we knew for sure that 6 rounds of clomid would produce the results, I'd have no problem spending the money. But the fear is that if they don't work then we're out of cash for IVF. The RE said he'd be down with either option, Clomid then IVF, or straight to IVF. He did not discuss IUI or injectables, except to say that he wouldn't recommend we do them. I think I mentioned in the OP that she is now taking Met at 1000mg, dexamethasone at 0.4mg (I think), sticking to a good diet, and exercising. Not sure if it's applicable to TTC issues, but she's also a "thin cyster". Again, thanks for the input and the clomid encouragement. Anything else you might have is greatly appreciated, so please keep it coming.

SportyChiksHusband

KAMsMOM · 04-11-2009, 09:00 PM

Clomid is a cheaper option. Wal-Mar Pharmacy has Clomid on their discounted meds list for 50mg 1 month for $9 and 100mg for $18. I wouldn't be so willing to give up yet.

myenzoorka · 04-12-2009, 10:06 AM

Well, I'd say the Walmart info was helpful!! I'd only like to add one thing. Try to make sure you're both relaxed. An awful lot of cysters get pregnant when they're not trying (I'm one of them). It seems the eggs prefer a calm environment.

sportychik · 04-12-2009, 03:11 PM

Quote:

Originally Posted by myenzoorka

Well, I'd say the Walmart info was helpful!! I'd only like to add one thing. Try to make sure you're both relaxed. An awful lot of cysters get pregnant when they're not trying (I'm one of them). It seems the eggs prefer a calm environment.

With any luck. We're trying not to think too much about it. Her next appointment is in June, so no decisions til then.

G-

Physicsdude · 04-21-2009, 05:07 PM

Sorry to hear about that...sounds like the boat that my wife and I were in a couple of years ago.

We were looking at the same situation, with putting out around 12K for IVF, and as you say, with no guarantee.

My wife ended up getting pregnant after we stopped the clomid...a huge blessing to us.

Hope things turn out well for ya...I'm pullin' for ya.

vablondie · 05-10-2009, 09:56 PM

Don't forget about the dreaded male factor IF. With IF, 1/3 of the time it is the female, 1/3 of the time it is male only, and 1/3 of the time it is both male and female. We were unfortunate to have both male factor and PCOS! I went of BCP in 1998, Started Actos and Metformin in 2000, and in 2006 still had no baby. It was not until we saw a reproductive endocrinologist and had a semen analysis at a andrology center that we realized how severe our male factor IF was. With male factor IF, IUI or IVF is definitely the way to go. IUI is definitely cheaper, and of the male factor is not too awful it may help. If the male factor is more severe, they can do IVF/ICSI and make sure the sperm fertilize the egg.

Just my thoughts...

vablondie · 05-10-2009, 10:06 PM

Male factor IF. If you have not had a semen analysis at an andrology center, it is definitely something to consider, just to make sure the little guys can get there. With IF, 1/3 of the time it is female only, 1/3 of the time it is male only, and 1/3 of the time it is both male and female. We fell into the male and female category. I have PCOS and he has very poor sperm morphology.

If you have severe male factor IF, IVF definitely is worth the money. If the male factor is not so severe, IUI may help. If your boys cannot get to the egg, medications for her will not make a lot of difference

We did several IUIs, both with clomid and with injectable meds, none of them worked. It took IVF to finally get us pregnant. Hopefully it will stick.

AvarraClover · 05-13-2009, 07:20 PM

A couple fo things... I got my clomid at rite aid. They did a proice match to Wal Mart and they used the prescription card program to make it cost really cheap. And I was on a rather high does.

Also, if you need to go onto more expensive drugs there is always this: https://www.caremark.com/wps/portal/...ER-PRICING-004 Caremark, an Rx insurance company, offers individual insurance for fertility medications. Its worth looking into if it means cheaper treatment.