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Ask Dr. Marc.....When should we move on to IVF

By on June 28, 2013

I live in Costa Rica and have been seeing my OB/GYN for fertility treatment over the past 3 years.  We were fortunate to get pregnant after AI 3 years ago, but now we are trying for a second baby and have not had any luck.  So far we have tried 6 AI’s since my delivery.  A couple other things you should know is that I have a history of endometriosis, 2 spots which were removed during surgery last year.  Also I am 20 pounds heavier now than I was when I became pregnant with my son.  Should I move on to IVF.  What if we just try naturally?

Thanks,

Trying in Costa Rica  

 

Hola Trying,

I am sorry that you have had such a string of bad luck, hopefully we can straighten some things out and get you on the right tract for the future.  Lets address things one at a time:

1. The fact that you became pregnant through intrauterine insemination (IUI) or artificial insemination (AI as you said) previously, bodes well for you now.  Importantly, we need to figure out why insemination worked for you in the past.  Was there an issue with your husband’s sperm?  If so, that issue may now be worse.  Just because they have used his sperm for inseminations recently, does not mean that they have performed a complete evaluation of the sperm, know ans a semen analysis.  You should have your husband’s sperm evaluated completely.

2. Your history of endometriosis is important.  We know that endometriosis can contribute to infertility.  Although it sounds like your endometriosis was not severe in the past (only 2 focuses) it may have progressed.  With your history, it may justify another laparoscopy, or at least an HSG (hysterosalpingogram) to be sure that your tubes are still open.  I would do this before any more treatment.

3. Weight can be an issue.  We know that it is harder to get pregnant for women who are significantly over or under weight.  Ideally your BMI should be between 20 and 30.  To check you BMI you can go to (www.nhlbisupport.com/bmi/).

4. IVF is the best bet for you now.  After 6 inseminations with 4 to 8 eggs each time, you have exhausted the usefulness of insemination.  As for cost, IVF is more expensive than IUI, but it is not more expensive than multiple IUIs.  From that point of view, it is probably more cost effective to not do any more IUI and save up for IVF.

5. Natural pregnancy is always a possibility!  To that end I want to share a story of one of my recent patients.  She had gone through multiple IUIs over a 2 year period and never conceived.  Subsequently, the couple resigned themselves to IVF and took off a year to save up enough money.  She was supposed to come in this month with her period to start medication but her period never came!!! Low and behold, she was pregnant!!

The point is that you should not give up! Formulate a long-term treatment plan, save up for IVF and while you are getting prepared for the treatment, continue trying the old fashioned way!

Good luck,

Pura Vida,

Dr. Marc 

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