IUI question

[amc80]

Hi all! I thought about posting this in the TTC forum, but figured it would get more visibility out here. A friend of mine is TTC. She is 28 and her husband is 45. He has 3 kids from previous marriages and had a vasectomy. He had a reversal about 14 months ago. They have undergone two medicated IUIs, both unsuccessfully. For the last IUI, his count was about 9,000.

I, in no way, claim to be an expert in this stuff. The only things I know are those which I've read online. From what I've read, a washed count of 5-10k is considered to be low, and they really want something over 10k, with numbers closer to 30k being ideal. Am I wrong? Another friend and I were talking about it, so she mentioned this to the girl doing the IUI, who said her RE told her that 9k is a great count and that there's no reason it shouldn't work.

Is 9k a great count for IUI? It seems really low to me, but, like I said, I'm no expert.

Apparently their game plan is to try two more IUI cycles and then switch to IVF. I looked at the clinic's website and they have a shared cost IVF program- It's $17k, and if no live birth, free FETs as long as you still have some frosties available. And if it still doesn't work, you get all of your money back (that fee doesn't include meds and some other things). If it were me, I'd probably jump to IVF and not spend the money on the next two IUIs, since the IVF option basically guarantees you either a live birth or a refund.

Thoughts?

 

[LtlFirecracker]

Just a quick search and my first question 9k or 9 million? Everything I am seeing is in million. I am seeing conflicting articles on what is acceptable, with some quoting numbers as low as 5 million. If the counts are truely in the thousands, disregard everything I am about to say. I am sure it is not just count, but the other factors that come into play such as the motility when determining what is an acceptable sample. One thing I have learned from all this, is that the literature has changed in the last 5 years. So you may be looking at a different article than her doctor is looking at.

My RE doc just told me that he is not doing an IUI on me because in the case of normal sperm counts (our case) an IUI does not significantly increase your chances. So that would lead me to believe that an IUI is an appropriate first step in a case of a lower sperm count. I think back, even a few years ago, everyone who was on clomid got an IUI, but they seem to be moving away from that.

There are a lot of factors you friend needs to consider if she wants to go to IVF. I have been looking at low cost IVF options (I am no where near that, but just in case), and most programs require a minimum workup, and trial period of other stuff before they let you into the program. IVF to me seems to be a risker procedure than IUI. I know that it requires lots of medications, surgery ect. I can tell you as a pediatrician, many pregnancies from IVF end up becoming high risk pregnancy and some of them with some very serious complications for the baby (that may decrease since there is now a movement to implant less embryos). And as I alluded to it before, her doctor may ask her to do a couple rounds of IUI's before he lets her into the program. This may not only be for cost reasons, but because as a doctor who is always looking at the risks/benefits of what he is doing, he will probably want to ensure he has at least attempted the safer method before moving to something that is higher risk.

Me personally, I really want to try to get pregnant the least invasive way possible, and will do IVF if necessary, but really want to avoid it. I think after 3 rounds of clomid HCG, I will approach my doc about trying something different. But your friend and doc really need to work together to decide what is best.

 

[amc80]

Just a quick search and my first question 9k or 9 million? Everything I am seeing is in million. I am seeing conflicting articles on what is acceptable, with some quoting numbers as low as 5 million. If the counts are truely in the thousands, disregard everything I am about to say. I am sure it is not just count, but the other factors that come into play such as the motility when determining what is an acceptable sample. One thing I have learned from all this, is that the literature has changed in the last 5 years. So you may be looking at a different article than her doctor is looking at.

Nope, I'm retarded...it's million. Must have gotten my units confused when talking about sperm counts versus dollars!

 

[Laila619]

9 million is a little low, yes.

I think most REs want to see at least 20-30 million, post wash.

 

[amc80]

Firecracker- thanks for sharing. I mentioned the IVF programs to her, offered by her clinic, and she didn't know anything about them. I found them on the clinic's website. I guess it just seems odd to me that all of her options (present and future) weren't laid out at either the initial consultation or once initial testing was done. Something like "you are a good candidate for IUI, so we will try x many rounds, and then after that you can consider IVF. Here are our programs..." Maybe it's standard RE procedure to not discuss what could be down the line before you know if you'll need those options?

Her clinic does look legit, and her doctor is well credentialed, so I'm sure she knows her stuff.

 

[amc80]

9 million is a little low, yes.

I think most REs want to see at least 20-30 million, post wash.

That's exactly what I thought!

 

[Laila619]

My RE doc just told me that he is not doing an IUI on me because in the case of normal sperm counts (our case) an IUI does not significantly increase your chances.

Hmm, that's interesting! My DH has a very high, Superman sperm count but they still recommended IUI for me when we were first TTC. The reason was that when infertility is unexplained, it could be that some women might have hostile CM or anti-sperm antibodies, which can kill healthy sperm. IUI would bypass that.

 

[LtlFirecracker]

My RE doc just told me that he is not doing an IUI on me because in the case of normal sperm counts (our case) an IUI does not significantly increase your chances.

Hmm, that's interesting! My DH has a very high, Superman sperm count but they still recommended IUI for me when we were first TTC. The reason was that when infertility is unexplained, it could be that some women might have hostile CM or anti-sperm antibodies, which can kill healthy sperm. IUI would bypass that.

My RE doc actually wrote an infertility book for patients. In the book he stated that theory was controversial. Just read it last night, and I have not been back to work to actually do the lit search. It would be interesting to put your RE doc in a room with my RE doc and hear both sides of the story. I am sure an IUI is down the road for me if this does not work, I think his approach is least invasive first than most invasive. When I did my rotation in med school, everyone got an IUI, but the doc could not give me a good reason for it. When I asked my current doc explained to me why he was not doing an IUI on me he did say "we just can't keep doing procedures anymore without being to justify it..." Didn't ask him for specifics, but I thought that was interesting. I can tell you my doc does NOT like to talk about future options with me. He really wants to take it one step at a time. I am sure from his point of view, it is not an efficient use of time to talk about a procedure, that in reality a very small percentage of his patients need, until it is time.

 

[stephbolt]

Has your friend asked for your opinion on what she should do next or if her numbers are good? Of course, I don't know either of your or your relationship, but this seems like a very personal topic for you to be questioning her doctor and her planned course of action on. I understand as her friend you want her to have the best chance at a successful pregnancy, but I'd probably offer her support and cheer on the decisions she's made rather than try and second-guess her doctor and say what you would do in her shoes, unless she has directly sought that opinion.

 

[amc80]

Has your friend asked for your opinion on what she should do next or if her numbers are good? Of course, I don't know either of your or your relationship, but this seems like a very personal topic for you to be questioning her doctor and her planned course of action on. I understand as her friend you want her to have the best chance at a successful pregnancy, but I'd probably offer her support and cheer on the decisions she's made rather than try and second-guess her doctor and say what you would do in her shoes, unless she has directly sought that opinion.

Yes, of course. Another friend and I have been helping her from the beginning with charting, opks, etc. She shares her plans with us and asks our opinions. I've never given her anything but support, nor have I voiced any concerns about her process. I'm really asking these questions for my own knowledge. Like I said, her doctor seems to be very qualified. I was just curious and looking for information on a few things that seemed odd to me. Like I've said more than once, I'm no expert, just looking to learn.

 

[monkeyprincess]

That count is on the low-side, but I think I remember my NP saying that they like it to be at least 5 million if they are going to do an IUI. I'm sure other clinics have different cut-off points. I feel so lucky that our first IUI worked because I'm sure it gets more and more stressful each time you have another failed attempt. Wishing your friend success however she chooses to proceed.

 

[amc80]

That count is on the low-side, but I think I remember my NP saying that they like it to be at least 5 million if they are going to do an IUI. I'm sure other clinics have different cut-off points. I feel so lucky that our first IUI worked because I'm sure it gets more and more stressful each time you have another failed attempt. Wishing your friend success however she chooses to proceed.

Thanks

 

[BrightSpot]

Just saw this. Ditto to what mp said-my RE also likes to see over 5 million post wash for an iui. And, as much as I'd prefer a what-if plan for all contingencies, my RE likes to take things one step at a time too.

Best of luck to your friend!