IUI vs. IVF

It's been a tough week already and it's only Wednesday. I'm still having some pain and cramping from the saline ultrasound yesterday, and I know it's all my fault because I'm the one who asked for the bubbles! Last time I had the saline u/s, I didn't have much pain at all. And it seems I've only confused and stressed myself out by even bringing the possibility of another IUI to the table.

Here's what's going on in my head. It's like a ping pong game, haha. I'm trying to weigh the benefits of IUI first before we move forward with IVF and also thinking about timing.

Benefits of the IUI first:

• Much less invasive to just do another Clomid w/ IUI, which I've been through before.
• Much less expensive than IVF, which would help us buy lots of cute baby things!
• A little less chance of multiples.
• Conception would take place inside my body rather than in a lab and this might be ultimately better for our baby.
• Feeling like we did everything we possibly could before moving on to the more invasive IVF.

Those are my initial feelings on the benefits. Here are the drawbacks:

• Only 10% chance of it working as opposed to a 60% chance with IVF.
• We've done it twice already and it didn't work, so would I just be setting myself up for more disappointment?
• Timing. We don't really have the chance to pursue a fertility treatment until October because of my writing. That would mean IUI in October if we decide to do it, which pushes IVF back to November or even possibly as late as January depending on how well my ovaries recover from the clomid. If we push IVF back to Jan or Feb, I might have to redo the saline ultrasound and the bloodwork. Again.
• If it works, obviously there is no drawback, but if it doesn't work, I wonder if the disappointment will hurt my chances of going into IVF with a positive outlook.
• Using part of our insurance benefits for a procedure less likely to work, which could mean more out of pocket expense for the IVF round.

I just go back and forth with so many thoughts and doubts. I wish I had a crystal ball that would tell me which way is the right way. If someone would just tell me what will work! Of course, I would much rather we be able to create our child as naturally as possible. Since it's such a low chance of that ever happening just with timed intercourse, IUI would be the next best thing. Still, with only 10% success rate and already 2 failed IUI's, IVF really does seem to be the best chance we have. When we're holding our little baby in our arms, will it matter that they were created in a lab? I mean, the embryo is only outside of my body for a few days. After that, the baby actually grows and takes shape and develops inside my body.

TTC is such an emotional rollercoaster! How are we supposed to deal with all this information and decide what is best for us and our family? George of course wants me to do whatever I want or think is best. He's definitely on board, but is not exactly in decision mode. My therapist thinks I should follow my instincts, but her two cents is that I've emotionally prepared myself already for IVF in October and that might be best for me. Then, if IVF is not successful, we can always do an IUI next instead of IVF again. It will still be our choice. She definitely has a point.

Here's the other thing about the timing. If I get pregnant in October, I would be about 11 weeks pregnant when we go to visit my family back home in Georgia for Christmas. (give or take a week depending on how the timing works out) In my mind, I just have this incredibly happy thought of how amazing it would be to announce our pregnancy to everyone at Christmas. I also think that if it doesn't work, I'd have at least a couple months to deal with it emotionally before I had to go visit family with all their babies and pregnant bellies and kids and such. If we do IUI in October, I still might have that successful pregnancy story, but it's 50% less likely. Then, if that pushes IVF back to November, it puts me in a tougher situation during the holidays. If successful, the pregnancy would be really new and more fragile in the first trimester. I wouldn't be ready to announce it, but I might also have a hard time keeping it a secret (and my belly might show a little since IVF can make you bloated, lol). Also, if it didn't work, it would be really raw coming out of a failed IUI and IVF both and having to be smiling and around family and babies and such.

See where my mind is right now? I know I'm repeating some of what I said yesterday, but I'm just trying to work it out in my head. I don't even know what my gut feeling is right now. I'm just trying to work it all out. In the meantime, I'm supposed to be writing the final book in my YA series, lol. Needless to say, that's not getting done right now. Ugh. I am hoping once I make a decision and feel good about it, the writing will flow again like it needs to. I need to learn to give myself some time and space and get out of the stress zone. 

Saline Ultrasound Results

Today was my saline ultrasound plus bubbles, and let me tell you, the bubbles added PAIN. I remember the last saline ultrasound not being so bad. I mean, of course it's not the most comfortable thing in the world and it hurt while it was going on, but it was fast. This time, since I was the genius who wanted to get a look at my tubes, he added the bubbles and then spent a heck of a lot more time in there (even adding more saline) showing me exactly what was happening.

Here's the basics. My uterus and my tubes are both totally clear. No problems at all. Yay! Er.... wait a second. If my bloodwork is fine, my uterus and my tubes are clear and healthy, then why the heck am I not getting pregnant? Suddenly, all these emotions just slammed into me. Where is the real obstacle? What's going wrong?  And if the tubes are clear of any scar tissue, is IVF really the right next step? Did we try hard enough with the IUI's?

When the doctor was done and I had to get up, I got woozy because this time there was blood. Also, this sharp pain shot up my right shoulder and I felt like I could hardly breathe. Gas from the bubbles? I'm guessing that had to be it. I toughed it out and went to the consult with the doctor. He asked what we want our next step to be. I expressed my doubts about why the previous 2 IUI's didn't work and he basically said it's never a guarantee and if we wanted to do one more IUI w/ Clomid before we move on to IVF, we can.

Wow, after all the confusion of the last week and all the emotions, that just really hit me hard. How do I know what the right thing is to do now? George doesn't want me to do IUI and Clomid next cycle because I'm working on my fifth book and my plan was to finish it and get it published before I moved on with any more fertility treatments. Basically, he thinks there's no way I'll finish this book in time if I'm also doing an IUI. So, his suggestion is to substitute the IUI for the IVF in October's cycle. Give it a chance and if it doesn't work, move on to IVF in November.

But then I look at the calendar and just don't see how this is going to work. Let's say we do the IVF in November and it works. That would mean a 16 hour drive to NJ to visit George's family in early December when I'm only a few weeks pregnant. Then, another 8 hour drive there and back to Georgia to visit my family for Christmas. All that driving and traveling in the first trimester of a PCOS pregnancy, which is already high-risk for miscarriage? I'm just not sure that's the best idea. Of course, if IVF doesn't work, I'll be a mess the entire holidays and having to be around people and their kids isn't going to be fun either.

Of course, George then says that maybe we should just wait and do IVF next year. And this is how it happens. Things always getting pushed back and never working out the way I think they will. I feel like such a mess right now. I would much rather do the IUI and have it work without having to go through the injections and emotional rollercoaster of IVF, but we've already done two with no luck. Who is to say this time could be any different?

So, the saline ultrasound answered some questions and brought up a heck of a lot more than I was ready to deal with. I can't even imagine what it must be like to have a conversation with your spouse that decides you're ready to start a family and then a few months later, you're pregnant just from having sex and being a normal couple. That must be the best feeling in the world.

My First IUI

Today was the big day! Our first IUI - Intrauterine Insemination. Here's how the procedure went:

*At 8:30 we checked in at the doctor's office. DH went straight in to a room in the back to give a sperm sample. He said the room had magazines and video and such to "inspire" haha. I can imagine that having to do that in a doctor's office and collect it in a cup would be really awkward and tough, but he did a good job. When the results came back, it showed that his sample had 105 million sperm! Of those, 31 million were high motility. Very good results that mean our chances of having a successful IUI are just that much better. The nurse said that they look for anything better than 10 million, but that 20-30 is ideal. We were just above ideal, so that's awesome!

*At 10:00 we were called back into the examination room. I stripped from the waist down and laid down with my legs in the stirrups. Our regular doctor was not available today, so another doctor from the sister OB/GYN office came to do the IUI. It was a little awkward because we'd never met him before, but he was very nice. The procedure didn't last long at all. He inserted the speculum, which is very much like what happens during a pap smear. It was uncomfortable, but not too bad. Then, he put the catheter inside, threading it through my cervix and up into my uterus. I only felt just little bit of a pinch, and then it was over.

DH held my hand the whole time and I was glad we were there together. After the doctor left the room, I laid on the table for 15 minutes. I felt a little bit of cramping right from the start, but they weren't as bad as what I usually experience with my period. After 15 minutes, we were able to leave. I spent the rest of the afternoon in bed relaxing. There was a little bit of blood when I went to the bathroom and a LOT of cervical mucus. I have read that the cervical mucus comes from so much of it releasing when the catheter opens the cervix. I also had a lot later this evening. I'm also still cramping a bit. Nothing too bad, though.

I am so excited and nervous to see the results of this IUI. I know that for a lot of people, IUI works the very first time. I really hope we are one of those success stories! The two week wait is going to be the toughest one yet, because I know this is our best chance. Some websites say that IUI with Clomid and a good number of sperm in the sample has up to 26% chance of resulting in a pregnancy. I had 3 healthy, mature follicles and the sperm sample was good. It's exciting and I know we've got a good shot. Now, I have to just relax and keep stress out of my life for the next few weeks. I can reasonably test on February 16th. I don't even know how it will feel to get that BFP!!! Amazing!

Second Ultrasound

This morning I had my second follicle check ultrasound for this third medicated cycle. My follicles are definitely maturing. I had one 22mm follicle, which is big enough to trigger. But I also had two others that were at 17 and 16 mm's. The nurse said that there is still a good chance the IUI will work with only one mature follicle, but having more than one does increase the chance of getting pregnant without significantly increasing the chance for multiples. So, I had a decision to make. I could either trigger today with one follie or I could give it a day and allow the other two medium follie's to mature.

The only problem with waiting a day is that there is a possibility I could ovulate on my own tonight or tomorrow with the one mature follicle. If that happens and we don't catch the surge, it's possible the IUI could be too late. I've been taking OPK's every few hours, and there hasn't been a surge yet. I'm hoping the bigger follie will hold on just a little bit longer. Tomorrow, I will go in to the doctor and get my trigger shot. Hopefully, I will then ovulate within the next twenty-four to thirty-six hours.

Our plan is to go in for the actual IUI on Thursday, which should be exactly right. I hope. If I release three good, healthy eggs this cycle and we get the washed sperm into my uterus within 24 hours of the eggs releasing, I should have a really good shot at getting pregnant this cycle.

There is definitely a little bit of fear that we might end up with twins. I think I would be okay with it. Sure, it would be twice as expensive and probably twice as tough, but I think it would still be fine. It's three babies that bothers me, and the chance of that happening is extremely rare. I am so nervous about entering into the 2-week-wait. It's the worst time of the month, because it's so incredibly difficult. And since this is our best chance at having a successful cycle, I have a feeling it's going to be particularly tough.

Even though I'm not technically in the 2-week-wait just yet, I can feel it getting closer. I want to be ready with some ideas on how to stay centered so that I don't go crazy over the next few weeks. I will either get my period or get a positive pregnancy test by February 17th. I hope it's a BFP! How exciting would that be? It would be such a dream come true! I will think about the different ways I can keep stress-free over the next two weeks and hopefully post a new blog about it in the next few days. I will also blog about the IUI and what it was like.