IUI questions

I am thinking a lot about what comes next. Regardless of what it is, having a plan that I can follow makes the whole process so much smoother. There is of course the risk that the plans I make will get changed at the last minute, which seems to occur at nearly every junction. Yet, in the meantime, my anxiety is much more manageable when I can see our potential options laid out ahead of us.

Barring a miracle with this FNA MAP (which we scheduled for September 29th) we will be proceeding with donor sperm. I want to start working through some of the choices that I'll be faced with. Ultimately, I am trying to balance the emotional, physical, and financial components.  I am hoping that some of you who have been here/done that can offer your advice.

How do I choose a RE for dIUI?
There is one local RE who has a very small boutique practice. He is fairly new and only had one year worth of IVF results reported. (He'd only had 4 IVF patients and only one was successful.) It would be so much easier to have a local Dr, but I have a general distrust of our rural medical practitioners and worry about a 'one man shop' being the right fit for me. I would not do IVF with this Dr for those reasons. PROS: local, personal, less time off work, ML could be with me at all appts,  CONS: one man shop, I'd only do IUI with him

There is the big university hospital RE program in the City. I had an initial consult and ultrasound with the head of their program, they did my saline sonogram, and their geneticist reviewed our records too. It is a 3 hour drive each way to get to the City, which requires a day off of work. I trust their medical judgement and like the fact that although I'll have a primary RE, there is a team approach to every case. PROS: reputation, trust, team, consistent care if we move to ivf, CONS: travel, time off work, ML couldn't be there at every appt.

The other option would be to find a different RE in a nearby city. I might be able to cut an hour off the drive while still benefiting from the larger practice.

What questions should I ask the RE?
How much experience do you have with IUI? dIUI?
What can we expect as a IUI success rate with your office?
Do you have a preference for medicated vs unmedicated cycles?
What hours are you available? Evenings? Weekends? Holidays? Emergencies?
What lab do you use?
Where did you train/residency? Where did you work before?
What are the costs associated with dIUI? (actual procedure, monitoring, sperm prep, other?)
At what point would you recommend we switch to IVF?
What records / tests will you need from me? Do I need to repeat anything?
How quickly could we start a cycle?

How to choose sperm?
Oh My, this is a loaded question that deserves its own post.... but here goes.
Which sperm bank to use?
How do we narrow our choices and make a selection?
Are there cost differences between the banks and donors?
Which bank will give us the most information about the donor?
How do ML and I do this together? Will ML do this on his own?
Things that are important to me:
Open donor, not a CF carrier (full screening?),

What do we tell people?
Who do we tell?
What exactly do we say?
How much privacy do we maintain for the child to choose to disclose?
What kinds of reactions should we expect and how to best respond?

I think that this is a good start at organizing my questions. I am going to keep this post active and add to it as I think of other questions or topic areas. I really would love your wisdom and experience about all of this - comments, links to other posts that explore these questions, any resources that you know about!

Three cheers for the ALI community. Thank you for being here.



bibc said...

okay my friend, i didn't even get all of the way through your post. for me, the most sensitive part of this whole equation is the sperm, no? i suggest you take a look at SIF's blog. she is going IVF alone and recently went through the whole donor sperm thing. hopefully that will help you. i also read R's blog and she is pursuing donor egg. not the same thing, but im sure that you have some questions in common.

here's my thought on the whole doctor thing. if you end up needing to do IVF and you decide to stay closer, your husband could possibly feel more a part of everything. you will be going ahead with donor sperm most probably and if you are 3 hours away and he can't give you shots, come to appointments, etc, would he feel even more left out? food for thought i guess. in my opinion, it isn't so much the doctor as it is your body. if your body is going to get pregnant, its going to work wherever you are. just my two cents, and i hope it helps!!
looking forward to being here for you through this next step

bibc said...

p.s. i did get through the rest of your post, i just couldn't wait to comment!

Lily said...

Hey Foxy -

I don't have any good answers for you but just wanted to say I hope you get them when you need them. Take your time and handle each question as best you can - there are no clear & easy answers in this infertility game. And for my two cents - you don't owe anyone an explanation about how your family comes to be.

Lastly, I think you are very brave to put out these questions and I hope someone who has been there and can understand is also brave enough to respond.

Lily - The Infertile Mind

DeterminedDory said...

Oh my gosh foxy, I don't know what the FREAK Google is doing with my comments!!!! Delete those last ones, they were only the beginning to my response. It wouldn't let me post the whole thing, so I posted my response on my own blog. Here's the link:



Julie said...

Foxy, I can't help you with the doctor questions at all...I think we did a pretty lousy job at choosing an RE, since he constantly asked Jeff about his motility, even though he knew we were using DS.

The other two I might be able to help with...

Dory is exactly right in her assessment of California Cryobank. Jeff and I both found them really really creepy. We wound up going with Fairfax. We felt like we got more of a personal picture of the guys there, we liked that we could listen to parts of their interviews. The have open and closed donors. Their pricing is just silly. It's extra for open donors and donors with PhD's. I will tell you that if you want an open donor through them, choose early. They have a whole mess of forms to sign for that.

Jeff and I talked about what we really wanted our child to have that he would have passed on. We settled on hair color, eye color, and sense of humor. We both searched and came up with a lot of the same donors. While it seemed like such a big deal at the time, I couldn't tell you anything about the donor now, except that he had straight hair.

Who you tell is completely up to you, but I will say that I wish we hadn't told as many people as we did. (Seems to be a pattern with me!) We will make sure the baby knows as early as possible. It's not something we want to keep from him or her.

You're welcome to email me any time if you have questions. I'm afraid my comment is going to be too long, like Dory's. jc underscore winkler at yahoo dot com.

Kakunaa said...

California, Fairfax are the biggies. We went with Cryogenics Laboratories. www.cryolab.com. Cheapest :) We also couldn't afford ID Consent, so we went with the least expensive of the ones since that wasn't a factor. Hubby kinda helped, but he wasn't real into it...it's not easy. But in the end, YOU GUYS WILL BE THE PARENTS, not your donor. So it comes down to how much you want to spend...hugs

Kate said...

When it comes to picking your RE, only you and DH will be able to make that decision. My only thought is this... If we have to go through this lousy crap anyway...sometimes a 3 hour drive and an extra day off work are well deserved. My RE's office is about 25 minutes away and I actually look forward to the drive and time off work. I figured I'm owed some perks! And you are too!

Marianne said...

I have just as many questions as you! Good luck, I will definitely follow your journey!

Kristen said...

I don't think there's any "right" answers. My advice is to go w/your gut...find a doctor you trust and feel comfortable with, be honest w/yourself and your spouse in term of what you want in a donor and tell people who will support you through this process.

Bionic Baby Mama said...

About the RE: the biggest concern I'd have with a one-man shop is hours. You need a place that will do all procedures all days of the week. Ovulating on a Sunday is not a good reason to have to skip a cycle, you know? So I'd add that to your list of questions, and make sure you get a straight answer.

25% success isn't great, but 4 is too small a number to extrapolate from. So: See what you can find out about where the RE worked before/trained, what their stats are (see SART), etc. AND -- in fact, this might matter more -- figure out where his lab comes from. You'll probably need to ask directly. If they haven't come from a good program (at least most of them), I'd seriously reconsider. A good lab matters, maybe even more than a particularly good doctor.

Ultimately, if you have doubts about the local place, I wouldn't go there, even though the convenience is hard to pass up. All this business gives us enough to worry over and second-guess without concerns over the quality of the practice.

About donor sperm:

Quite a few banks do ID-release (called different things everywhere). Sperm Bank of CA and Fairfax both had a fairly good number of ID-release. Some places hardly had any.

We liked that Fairfax lets you listen to a snippet of an audio interview with each donor for free. (You can buy the whole interview.) In terms of assuring ourselves we'd done what we could to find a guy who might not be a jerk to a kid looking him up in 18 years, we thought *hearing* the donor was incredibly helpful. We decided we were willing to make a decision based (mostly) on what was available about the donors for free -- buying all the information about multiple donors adds up in a hurry! If that's not your style, I think it's Xytec that does a flat fee deal where you can look at lots of information about all the donors for a set period of time, which seems like a good deal. Friends who used Sperm Bank of CA say that the staff will be happy to tell you about the donors you're interested in if you call. (People love them.)

We didn't find a significant difference in price, once we compared ID-consent donors and considered all extra fees (shipping, etc.). We went with FF because they screen for HPV. They all screen for CF, Tay-Sachs, etc., though there is some variation in which donors get screened for what. I think FF lets you request (and pay for) extra screening, but I'm not sure. I know their test for CF mutations covered more mutations than I was screened for. They also have SMA results on file for some donors -- you can call and talk to the genetics department and they will give you more information than you'll find online.

Good luck, and feel free to email if there's anything else you think I might be able to help with.

Bionic Baby Mama said...

Oh, I meant to say, re: price:

Shipping adds up. You may want to crunch some numbers to see what it would cost to ship several vials at once and store at your RE vs. shipping only when you need them. Even though storing at our RE was more expensive than storing at the bank, we ended up storing with the RE because the shipping cost was so great.

With that in mind: I don't know where you are, but if any of the banks that seem reasonable are within driving distance (not the case for us -- especially without a car!), I'd give them extra points. You may be able to pick up yourself and save hundreds of dollars.

Also: talk to the andrology lab at your RE about what preparation of sperm they prefer. We started by buying ICI sperm, since it was cheaper and the lab would wash it for free, but once it was washed, the counts were so low that we had to do two vials per insem -- much more expensive than using IUI in the first place. When we did IVF, I asked first, which was great: the guy in the lab had previously worked in a sperm bank, so he was able to give me the low-down on what was better quality. (Basically: don't buy the IVF preparation.)

Jendeis said...

Hi, here from L&F. We got our DS from Fairfax after looking at both them and the California one.

For us, we talked about what was important to each of us in a donor. We too wanted someone who was ID-consent and we wanted someone who looked like DH and had the same ancestral background as DH. We picked out some favorites and compared them side-by-side on a spreadsheet.

With questions about dIUI for the RE, make sure to find out what kind of formulation your clinic wants - our clinic wanted unwashed samples since our clinic washed everything anyways. Some clinics want only one kind or the other, others just have a preference. Your RE will be able to explain what they want. Your clinic's preferred formlation may not be available yet for the donor that you picked, so you'll need to talk to the bank about it (sometimes they have vials in quarantine that are what you want, but they won't be available for a certain amount of time).

Process-wise, you'll also want to know how many inseminations the clinic will do per cycle and how those are timed. We did back-to-back dIUI's on the day after I got a positive OPK. So, positive OPK on Monday, then did a dIUI on Tuesday and one on Wednesday.

Our RE told us that the average time it took for a confirmed pregnancy with unmedicated dIUIs was 6-7 cycles.

I'll end my novel here, feel free to email me with any questions. Good luck!

Anonymous said...

I don't have advice for donor sperm, but I do have advice for IUIs. First, I think your list of questions is great. You are probably going to get the same responses about the success rates. In general, most clinics have similar success rates with IUIs (about 10 to 20% per cycle). If you end up doing medicated cycles, ask about what types of medication they prefer. Pills (Clomid, Femara) or injects. This makes a huge difference in cost. How many follicles are TOO many? (Meaning, at what point would they cancel a cycle because of too many follicles?) Also, make sure that it's the doctor who does the IUI. I know some women who go to clinics where the nurse does it. Trust me: you'd rather have the doctor in the driver's seat.

As for who to tell, that's entirely up to you. We told everyone. The plus side was that we had a lot of people thinking about and praying for us. The downside was that we had to let everyone know when the beta was negative. It's difficult enough to swallow a negative on your own, but to have to share the news with others is even more devastating. I found that most people had very positive and encouraging reactions to our procedures, and they were a big support during a very difficult time.

Good luck with your decisions!

Denver Laura said...

Here from LFCA.

I echo the comments above. I met the Dr. supposedly one fo the best in the country, but I have not seen him since the initial interview. The nurses did both IUI. We did not do donor, so I can't offer advice there.

I'd ask about the different medicated IUI options, and what protocols they suggest for you. Like if they suggest Clomid, what level do they start at, when do they choose to bump up the meds, what are their thoughts on HcG, when do they want to start monitoring for follicles. I have a late cycle and they started way too early causing me to pay for unneeded scans. Do they recommend generic Clomid or brand?

What is their holiday schedule? I had one IUI on Christmas Eve. They only worked a half day and I was one of only a handful of patients that got in that day.

If you do choose to transfer to another clinic if you have to move on to IVF, find out what tests you'd have to repeat.

I made my appoinements during the lunch hour so I could drive to the clinic during lunch and go back to work. I decided not to tell anybody outside of my mother. Most people don't get that IUI is different from IVF and explaining it didn't seem to matter. I don't tell people when I do "the deed" so I chose not to tell people about the IUI. It made it easier when they came out negative.

Oh, when I had one ultrasound for follies, the results on my bloodwork came back and I had to drive the hour from my home to the clinic to pick up the vial for the HcG. I worked 20 minutes away so I chose that clinic but the tests were done on a Sunday so there was no way to avoid the hour drive there.

Try to do something with the hubby after the IUI. Ours wasn't donor but it still felt weird with him going in that morning and a couple hours later I did my thing. As a couple, it felt so alienating. I wish now that we had gone to lunch afterwards or something...


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