Terra arrived for the pregnancy test for her 2nd IUI cycle. She had fought the temptation to test on her own and came in with an open mind, although she confessed she felt a little more bloated this cycle than last, for whatever that means. When the blood test results rolled off the machine, we were all saddened again. Another negative. She and her husband requested a face-to-face meeting the next day.
This is what I told Terra and Miles. "Our goal is to help you get pregnant in the easiest way possible. For someone of your age and your situation, most likely you will get pregnant with either IUI or IVF. Whether it will happen easily with just IUI or require the power of IVF is unknown. However, each unsuccessful IUI cycle leans us closer towards choosing IVF. Also, each successful IUI cycle reinforces our confidence in IUI. For example, prior to doing any treatment, I would strongly urge trying IUI first. Let’s pretend that you did get pregnant on the first IUI cycle, but had a miscarriage. Then I would be more persistent about sticking with IUI, even if the next two didn’t work, because we now know that you CAN get pregnant with just IUI. On the other hand, let’s say as an extreme example, that you did six IUI’s and they all failed, and let’s say that you made more than six eggs each time, then it would be pretty convincing that it was time to move on to IVF, because it would mean that something else was wrong, something that wasn’t being helped enough by the IUI procedure. Maybe the sperm is totally incapable of penetrating the eggs. Maybe the eggs are just not getting picked up properly by the tubes, or they are surviving poorly because of something like endometriosis."
So based on the two failed IUI cycles, I still felt that the evidence pointed towards trying one last IUI cycle. Many patients have failed 2 IUI’s and then got pregnant on the third IUI. However, if they wanted to move on to IVF, I wouldn’t dissuade them at this point. We spent the next half hour going over the details of an IVF procedure including the pros and cons, the risks and the benefits and all the variations of decisions. I did a baseline ultrasound and my staff gave them the medication instructions for both IUI and IVF. They were to go home and discuss it tonight. If they wanted to start IUI #3, they would take the medications again. If they wanted to do IVF, Terra would start taking birth control pills.
Miles called the next day and said they were ready to proceed with IVF. I generated a schedule for them and had them to come back in two weeks for the next step — the trial transfer. Meanwhile, Terra continued to take the birth control pills.
