Explaining the unexplained… or not?

A BIG THANKS to everyone who commented on yesterday’s post! 🙂

I used my brain, your feedback and Mr. Google to compile the following list of questions to discuss with our RE.

What is our success rate for IUI? Is there anyway to increase our chances? What is the possibility of doing 2 consecutive IUIs in one cycle? 

Our RE recommends 3-4 IUIs before moving onto other options. Success rates are at 10% per cycle. 1/3 of couples will conceive using IUI.

She doesn’t see the need to do more than 1 consecutive IUI per cycle as my husband’s counts are good enough to justify only needing 1 IUI.

What’s the game plan if the next IUI fails? 

With our demographics, sperm and follicle counts, she thinks we are good candidates to try IUI up to 4 times. If that doesn’t work, we can try IUI + injectables.

The success rate for IUI + injectables increases to 20% per cycle.

Many patients chose to skip IUI + injectables and move straight to IVF. That’s also an option for us, but she doesn’t want to push us to move to IVF without at least trying a few more IUIs.

What additional testing is available to dig into our “unexplained” diagnosis? Is there any way to rule out mild Endometriosis as a cause of our infertility? What about any uterine abnormalities? 

Our RE was not willing to entertain additional testing. She was really focused on the fact that studies are inconsistent in their results. She doesn’t want to make me have to go through more invasive procedures and face more risks if there isn’t conclusive evidence that the testing (example: laparoscopy) will solve any fertility problems or increase our chances enough to make it worth it.

She was also convinced that any major uterine or tubal issues would have come up already in my previous testing.

Yes, this would be my biggest red flag right now. Our RE seems VERY scientific in her approach. She’s all about the odds and the numbers. Statistically, she thinks we will conceive if we continue treatments. On one hand, I’m glad that it seems like she is looking out for my best interests. On the other hand, doesn’t that answer seem like the easy way out? I hear so many stories about couples who finally receive a diagnosis other than unexplained a couple years into the process. Doesn’t this mean there’s always more testing that could be done?

Does an explanation for our unexplained diagnosis really matter though? Isn’t getting pregnant more important than getting answers? I’m torn here. My husband thinks getting pregnant is all that matters. I am an answers kinda person. Why does my curiosity always get the best of me?

Can we do immune testing (for natural killer cells, etc)?

No, our clinic does not do immune testing or treatment. Once again, she referenced inconsistent studies. She stated that it’s not overly common in Canada to pursue immune testing, but it’s more popular in the States.

Once again, I’m not convinced. Looks like Mr. Google and I have another date coming up. 

What would be our success rate for IVF? How long is the wait list? What is a basic overview of the protocol? 

The clinic rates for IVF success within our demographic is 55-60%, with a 30% chance of conceiving twins. Most patients will get pregnant within 1-3 cycles of IVF. There is currently a 2-3 month wait list. We went over what a basic IVF schedule looks like.

I asked what happens if 3 IVFs fail? Do we qualify for additional testing then? Obviously not willing to go that far without testing, but it was worth asking. She said any issues that could be identified or tested during the IVF process would happen within the first 1-2 cycles.

Are there any additional medications, supplements, or practises we can follow to improve our fertility? 

No, we are healthy and doing the right things except we could try some antioxidants. She gave us a bottle of Fertil Pro LQ  and recommended we take 1 pill/day each. Yes this was FREE and she joked it will probably be the only free thing we get from her. *eyeroll* Nice. 

She also suggested I could consider loosing some weight, but then, she back-peddled and said something like it’s not THAT much of an issue.  *gasp* Ugh, I know. I gained about 8 lbs of emotional eating poundage thanks to 3 months on clomid. Yes, I have a BMI that is higher than it should be. I’ve always been round or should I say curvaceous? Who doesn’t love a woman with some nice ta-tas? These wide hips are meant for child-bearing!  Guess me and my treadmill are getting reacquainted. I might as well kiss that fresh batch of brownies good-bye. I just baked them last night 😦

The Verdict: to be determined… 

My husband and I decided we have until the end of March to make a decision. We know we will proceed with 1, maybe 2 more IUIs. We need to decide when we want to start cycling again, and what to do if we have to proceed beyond IUI.

In the meantime, I’m going to put together a list of pros/cons for each possible option and take a deeper dive into explained infertility.

I’m not sure I’m 100% comfortable with our RE’s approach, but then again, maybe I just need to trust the process?

What are your thoughts on my RE’s perspective?

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24 thoughts on “Explaining the unexplained… or not?

  1. I think the worst thing ever when going to WTF appointments is that we ultimately just want an answer. We go there so prepared with questions that will define the next several months of our lives- and affects almost every aspect of it- and all they can give us is their statistics and best guesses.
    It always feels like a let down… then you focus on the good numbers and try to get your head back in the game. Positivity goes a long way… But with all the money we are pouring into these clinics, could they not just purchase a crystal call already?? 🙂

    Good luck!! xx

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    • Thanks Adele! Your advice is more than appreciated. Thank you and good luck to you on your journey as well. 🙂 And I’ve tried the crystal ball approach on my own. They are’t always right either. 😦 haha

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  2. Nooooo! Don’t waste the brownies! Lol, I’ve been working out but this past week I’ve been obsessed with pasta and cheese, and sweets–so I haven’t needed to “tighten my belt”. But the workouts feel great and both times I conceived (fruitlessly) it happened when I was on a solid workout schedule so I feel like there’s something to it.

    Good questions! I believe in reproductive immunology, but the tests are expensive. Some RE’s will just put you on daily baby aspirin and a high dose of folate (B6+B12) supplement, so you might google it/ask about doing that for your next IUI, if you’re interested. I’ve done NK cell testing and ATA testing (anti-thyroid antibodies) and ANA’s (anti-nuclear antibodies), but I have autoimmune disease(s).

    Have you considered continuing IUI’s and postponing the lap & autoimmune testing as things to consider after IUI’s, before IVF?
    In the end, I think it’s good to trust your gut. Sorry for the long response! Hope there’s something helpful in there.
    XOXO

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    • Definitely. What I got out of it was: eat brownies but work out so your ass stays the same. Try IUI but demand testing before IVF. RE’s don’t like to spend more $ than they have to. hahaha 😀 Thanks! I didn’t mention that I’m also considering doing a consult with another clinic that does the auto-immune/lap testing IF we have to move to IVF. We will stay where we are for IUI though.

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  3. In an ideal world, where the tests are free and pose no risk, the more tests you can do the better, I suppose. But in the real world, tests are expensive and some can do more damage than good. My RE likes to think about whether or not the results of a certain invasive or expensive test will make a difference in the type of treatment she would recommend. If no, then she doesn’t see a point in doing the test. For instance, the jury is still out on exactly how much endo plays a role in infertility. It seems to affect each woman different. So, if you do the lap and find that you do have endo, will that change what your RE recommends for treatment? Why or why not? Only YOUR RE can answer that question for YOU. My RE said the same thing as yours about immune testing.

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  4. Thanks for posting. This is very informative. I believe at the end of the day YOU need to feel comfortable with your RE and feel that she is an advocate for YOU and your unborn bab(ies). Last month I did my 2nd round of IUI+Injectables and at the end of the day, statistics don’t mean anything to me because my body and God will do what it decides is best. I think what is more important is keeping a positive. And about those brownies… brownies always make me feel positive. 🙂

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  5. See, I never did IUI without the injectables. I did 2 IUI cycles and both were a bust. We took this month off because of vacation and couldn’t be monitored by our RE. Please keep in mind that I’m turning 40 next month, and that may also have something to do with why my IUIs were a bust. I’m sure you are much younger and you probably produce healthy happy and young eggies. 🙂

    I don’t know how many more IUI’s my RE will recommend for us. They have been pretty stressful and this break and trying naturally has really helped my spirits and outlook on life (as a whole).

    I have read that if you are under 35yrs, you should do no more than 1-6 cycles of IUI. Over 35 (to be more aggressive due to age) 1-3 cycles of IUI, then moving on to IVF. My husband and I aren’t in a rush to move on – as at this point in time, we aren’t “sold” with moving onto IVF.

    Good luck and I look forward to hearing more about your cycle!! xo

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      • No worries! I am totally enjoying our break too! Glad to hear your month off has reduced the stress-level, for now at least. That was the vibe I got from our RE. Since we are still young, she doesn’t want to push us to IVF too fast (which is good right?). She said at our clinic for every 20 IVF cycles in a month, there are about 5 IUI + injectable cycles. I’m not sure about regular IUI in comparison though. Guess we need to consider that IUI + injectables is still an option before IVF. Thanks so much for all of the info!

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  6. This sounds like it was at least a good intro meeting. Our RE also has said that she gives each plan about 3 tries before she discusses moving on to a new plan. She also quoted the same stats yours did…about 1/3 of couples will conceive with each IUI. Although I am all about moving forward as fast as possible, the doctor in me definitely tries to rein in the crazy. If the least invasive, least medicated cycle will most likely work, definitely do those cycles first. Especially if age and other severe complicating factors like ovarian reserve aren’t running amok. So the Hubs and I are going to give this mini-stim protocol at least 3 tries and then may ask for injectables next. Not move to IVF unless some new shocking information comes into play. One is because all of these medications have side-effects, some extreme, the cost can be ridiculous, and there is a fair chance these IUIs will work. At least in our case, with our circumstances. It sounds like your RE feels much the same way. Hope ya’ll are feeling ok with everything and that this meeting helped!!!

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  7. I’m not sure if its more about getting answers or about getting pregnant and having a healthy pregnancy! : ) But I got my answer for the most part of why I was having problems getting pregnant then bam, I got pregnant & now Im lost for answers again since 4 miscarriages this part 18 months. I have know a few people who have had a laparoscopy done and were pregnant a month or two later. But who knows if there really had anything to do with it. 🙂 & things for giving me a good laugh because who doesn’t love a woman with some nice ta-tas ? I will use that the next time my doctor says I ned to shed a few lbs. I couldn’t stop laughing. Good luck on your decision and i hope you have success 🙂

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  8. I was really interested to hear what your RE had to say, especially being that you are in Canada too. I have an appt with our RE in April, even if we don’t choose to continue treatment for some time, I just want to know what he has to say.

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  9. It sounds like you had a good meeting with your RE and got a lot of questions answered! Good for you!! Sounds like you’re on the right track, I’m sure the unexplained part of your infertility is really annoying. Not really having an answer would be very frustrating to me too. You & I sound a lot alike…..our plan is ever changing too. As of right now we’re going to do IUI’s indefinitely, lol.

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  10. Thanks for posting this. I am currently preparing for our next RE appointment in April and it sounds like we have very similar questions. I found this very helpful.

    One thing I am struggling with is that it sounds like folks outside of Canada get way more monitoring than we do in Canada. I asked about getting an ultrasound to see how my body is reacting to clomid (i.e. cysts, uterine lining) and they said they don’t do that! I don’t know how to approach this at my next appointment. I constantly worry that the drugs are making things worse, not better!

    I look forwarding to ready your future posts!

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    • Are they doing an unmonitored cycle then? I’ve heard that Calgary does unmonitored cycles too. Are you using OPKs at home and then going in for IUI once you get that smiley face? We are fortunate to do monitored cycles, but I typically only have 1 ultrasound before they guesstimate my follicle growth until trigger. I’ve questioned them many times as to why we aren’t monitored more, but I guess I can’t complain if I am getting at least one ultrasound.

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