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Need opinions-- IUI or IUI+ trigger?


Forum: Trying to Conceive with Medical Assistance

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  #1  
January 25th, 2012, 02:51 PM
bryan and nina's Avatar Love being a mommy!
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I would love to get some opinions since I am feeling a little overwhelmed at the moment... Here is our situation:

TTC over a year and a half with an early m/c (8 weeks) in August 2010. We got pregnant our very first cycle ntnp but it ended in the m/c and since then we can't manage to get pregnant again.
My progesterone is low and I was on clomid for 3 cycles, which lengthened my LP (from about 10 days to 14) and brought the progesterone up to 95!!
We've done about 5 SAs; the first one revealed a high WBC. The urologist gave DH a 7 day antibiotic and after several more SAs the WBC is down to 1-5, which is ok according to urologist.
I had an hsg done last week Monday which revealed open tubes and a normally shaped uterus.

Since DH's count is low, in the mid 20s and his motility isnt good either, we have decided on moving ahead with an IUI.
The RE told us the IUI is about $670 but I found out yesterday when we went in for more BW that this is for a non-triggered cycle.
The ovulation induction cycle is $1400 and I guess that's when they give you clomid and the hsg shot.

We are waiting on our labs to come back within the next 10 days and if they look good we are cleared for the IUI!

So I would love to get some opinions.. The way I look at it is that with the triggered O, I am pretty much guaranteed a good progesterone level and the chances of a bfp are also increased. I'd rather shell out that money the first go around and hopefully have it end in pregnancy than to do one IUI (no trigger) and it not work. Now I realize even with the triggered O there is a good chance of it not resulting in pregnancy but I feel like my chances are better, especially since my progesterone will be where it should be and my LP will be a few days longer.

Sorry for the long post but thanks in advance for the input!
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  #2  
January 25th, 2012, 03:00 PM
mistletoe's Avatar Mega Super Mommy
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These are the statistics that we were given, based on studies the university medical center where we go conducted for the NIH. They found, statistically, that IUI with Clomid + Trigger lead to no more "take-home baby" success than just IUI with Clomid. But I do not have a breakdown of the numbers based on a specific diagnosis, i.e., low progesterone, or whether that would affect those success rates. I don't know if that helps or just confuses matters, but I thought I would offer it. Good luck with your decision.
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  #3  
January 25th, 2012, 03:03 PM
bryan and nina's Avatar Love being a mommy!
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I'm just happy for your input and for shared stories and experiences. Thank you.
Like I said; I am fairly overwhelmed with this and am still trying to understand it 100% so I may be looking at this the wrong way but I figured with the trigger shot they have an exact time that O will happen. My info papers that the RE gave me said with the trigger, O happens 34-38 hours after, very predictably. So I am thinking that alone would increase chances but I am just not certain that warrants paying over double vs just doing the IUI... I don't know if I am making any sense.
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  #4  
January 25th, 2012, 03:06 PM
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see i was going to do ivf, im in a same sex relationship, and was going to use her eggs but since that is 20 thou i was thinking about doing the iui and saving up for the ivf and i was also looking at the same thing to use a trigger or to not. im thinking im going to try without trigger shot the first time because i dont want to pay the extra and then not actually have needed it you know what i mean and im pretty good at donig my chart and ovulating so i think i am going to try it like that and if no success then ill try with the trigger.

All i can say is do what you think is best for you if you think you wil have trouble without the trigger use the trigger but if not try one time at least without the trigger.
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  #5  
January 25th, 2012, 03:08 PM
*JenJen*'s Avatar impatiently waiting
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Why is there such a difference in price between a medicated and unmedicated cycle, especally just a clomid + trigger? I'd ask about that, because clomid is fairly cheap(under $30), a trigger is less than $100. I'd assume they are still doing some kind of monitoring with an unmedicated cycle as well, so those would really only be the price differences.

Personally, I'd do the trigger. I prefer doing the trigger and knowing within a very precise window as to when I will ovulate.
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  #6  
January 25th, 2012, 03:13 PM
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Quote:
Originally Posted by *JenJen* View Post
Why is there such a difference in price between a medicated and unmedicated cycle, especally just a clomid + trigger? I'd ask about that, because clomid is fairly cheap(under $30), a trigger is less than $100. I'd assume they are still doing some kind of monitoring with an unmedicated cycle as well, so those would really only be the price differences.

Personally, I'd do the trigger. I prefer doing the trigger and knowing within a very precise window as to when I will ovulate.
I was wondering the same thing too Jen. Unless the no Trigger option also includes NO monitoring, I don't understand why the price difference is so much.
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  #7  
January 25th, 2012, 03:14 PM
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In the end, I think the best we can do with all of these decisions is to look at the information or statistics, measured against our budgets, and then, eventually, we just get a feel for what is right for each of us. Again, sorry, probably not terribly helpful. (And you're absolutely right about being overwhelmed. It feels like that each step of the way for me.)
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  #8  
January 25th, 2012, 03:40 PM
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I would say do the IUI+ CLomid+ Trigger I would ask why the pricing is so much different as well! Most likely you are paying for the IUI itself and no monitoring with ultrasounds but I do not know. GOOD LUCK!!!
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  #9  
January 25th, 2012, 04:06 PM
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My first three IUIs were natural...no monitoring, no Clomid, no trigger. I called my doc (OB/GYN at that time) when I got a positive OPK, and we did the IUI 24 hours later.

My next 3 IUIs were the whole she-bang...Clomid, u/s monitoring, b/w, trigger shot.

None of them worked, but I was happy with what we tried. We did the natural ones first because we just weren't ready for the next step...we were still trying to wrap our heads around the fact that we weren't already pregnant on our own. When the more natural approach failed, we saw an RE and jumped in with both feet.

I don't know if any of that helps at all, but I hope that you and DH can decide on a plan that you both can be excited about!
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  #10  
January 25th, 2012, 04:13 PM
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Quote:
Originally Posted by *JenJen* View Post
Why is there such a difference in price between a medicated and unmedicated cycle, especally just a clomid + trigger? I'd ask about that, because clomid is fairly cheap(under $30), a trigger is less than $100. I'd assume they are still doing some kind of monitoring with an unmedicated cycle as well, so those would really only be the price differences.

Personally, I'd do the trigger. I prefer doing the trigger and knowing within a very precise window as to when I will ovulate.
i was wondering the exact same thing....and wondering if i exist in a little bit of a bubble with my RE b/c i'm not paying anything right now other than co-pays for all of the monitoring they're doing during my cycle. The trigger shot & clomid were both cheap - maybe $30-40 combined? So the difference is i'm not doing IUI...and I don't understand why combining in a trigger shot + 1 or 2 u/s would be such a huge jump in price....unless your insurance is covering nothing at all from a monitoring perspective?

Anyway, if the cost is essentially the same, i'd do the trigger shot - it's nice to have a little more monitoring & control of ovulation (speaking as someone who missed O last cycle and couldn't then use the trigger shot)...but if it's really hundreds of dollars more I'd probably skip the trigger shot.
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  #11  
January 25th, 2012, 04:22 PM
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Quote:
Originally Posted by L-SBB View Post
i was wondering the exact same thing....and wondering if i exist in a little bit of a bubble with my RE b/c i'm not paying anything right now other than co-pays for all of the monitoring they're doing during my cycle. The trigger shot & clomid were both cheap - maybe $30-40 combined? So the difference is i'm not doing IUI...and I don't understand why combining in a trigger shot + 1 or 2 u/s would be such a huge jump in price....unless your insurance is covering nothing at all from a monitoring perspective?

Anyway, if the cost is essentially the same, i'd do the trigger shot - it's nice to have a little more monitoring & control of ovulation (speaking as someone who missed O last cycle and couldn't then use the trigger shot)...but if it's really hundreds of dollars more I'd probably skip the trigger shot.
my insurance covers nothing. At my RE's office, monitoring visits are $170, IUI is $180(+ $90 for the sperm wash), trigger you have to get at the pharmacy downstairs, but it's $85, and clomid you have to get at the pharmacy as well, and I know it was $27 for my last dose. Standard cycle is 1 monitoring + 1-2 IUI appointments, but of course it varies based on an individual case(the least amount of monitoring I have had is 1, the most 5).
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  #12  
January 25th, 2012, 04:36 PM
bryan and nina's Avatar Love being a mommy!
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First off, thanks SO very much for all these responses!! It helps more than I could ever express just having such a support system. Thank you!

I want back over the two sheets (one is IUI info sheet the other is ovulation induction therapy sheet) and it looks like (as far as I can interpret) that with the IUI ($670), all you are getting is just the IUI. It doesn't say anything about monitoring... So maybe that's where the price difference lays? With the induction it states on the sheet that you get 2 u/s visits along with bw and medications. Maybe I need to call up there tomorrow. I guess with the IUI you monitor your opks on your own and call them as soon as you get a positive?

I'd hate to jinx I g myself but as you can see from my charts, I O very dependably on CD 17... Now leave it to my luck that the stress from an upcoming IUI delays my O the cycle we are supposed to get it done... lol. I guess that's why it would be nice to have the reassurance of the triggers.

As far as I know our insurance doesn't cover any part of the IUI. They have covered all the lab work so far so I guess maybe that will be covered if we go with the trigger.
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  #13  
January 25th, 2012, 04:45 PM
*JenJen*'s Avatar impatiently waiting
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that is a LOT of money for an IUI only! I'd definitely be checking the prices at other RE's near you. Like I said, a medicated cycle with monitoring doesn't even cost that much at my clinic.
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  #14  
January 25th, 2012, 05:42 PM
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That is a really high just iui fee. Most iui's are under $300 without monitoring from what I have seen. Definitely shop around a little unless you really love your RE and are ok with paying that price.

Honestly, I did just clomid and iui one cycle and obviously bfn, but this cycle I did a fully monitored cycle with clomid, trigger, and iui and I am feeling much better about it. It's nice to have the monitoring on clomid because I found out my lining was only at a 3.9mm (far too thin for implantation to occur) during my CD 10 u/s and they had to put me on estradiol to build it up. Without the monitoring I would've had NO chance of getting pregnant this cycle. It's also nice to know how many follies you have when going into the iui too. It's worth the monitoring in my opinion, if only for peace of mind.
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  #15  
January 25th, 2012, 07:08 PM
fromustobaby's Avatar Platinum Supermommy
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Want to ditto the other girls...those prices are crazy...you should definitely try to look around to see if you can get it done for a more reasonable price...
I have no infertility coverage (except for the bloodwork and U/Ss - which sounds like the same type of coverage you have), and my IUI with injectables cost less than that...

when I did Clomid, I got it for $20 (no insurance coverage)...
HCG trigger shot (10000iu with the needle and shot thingie) was $59 through Walgreens Speciality pharmacy...
IUI was $285 which included sperm wash...

FWIW, my injectables (900iu of Follistim) was around $850 with the Walgreen Speciality Pharmacy discount...
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  #16  
January 25th, 2012, 10:56 PM
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Originally Posted by *JenJen* View Post
that is a LOT of money for an IUI only! I'd definitely be checking the prices at other RE's near you. Like I said, a medicated cycle with monitoring doesn't even cost that much at my clinic.
Same here, Jen. That is a lot of money. IUI with u/s monitoring is $250 at our doctor. Then the trigger shot was $40 at the pharmacy that we used. Clomid was cheap. Like $10 cause of our insurance, maybe?

Anyway, I have no stats, just experience of what worked for me. I did clomid+trigger+IUI my first try. It was a bust.

Second try we did Clomid 100mg+mid cycle ultrasound and I chose to use OPK's and call them when they turned positive. I purposely waited an extra day because I surge for 2 days and not just one. I felt like waiting out increase the chances that the sperm and egg would meet...since washed sperm don't live as long. Well it worked.

You have to do what you feel comfortable with, but trust that you know your body very well. And ask about those prices. It just seems so steep.
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  #17  
January 26th, 2012, 04:45 AM
bryan and nina's Avatar Love being a mommy!
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I don't know what to do. It seems like EVERYONE on here unanimously agrees that the prices are too high--but on the other hand, I don't think we have much to chose from! As far as I know, the only other RE is about 2 hours away from here, a friend of mine uses them actually and I already asked her-- she said they charge the same. I think it's just the area we live in, unfortunately. DH and I still need to have the convo about which route we will take anyways. I will try to do a search to see if there are more REs in this area, but like I said, mine and the one 2 hours away are the only ones I came up with when I started the search.
That really sucks; I wish ours was less expensive! That would help matters tremendously.
I think I want to go with the trigger and just do the whole thing at once; hopefully that will do the trick. It looks like my progesterone is low again this cycle, judging from the low post O temps I have gotten so far so clomid will definitely help.

Hey Jillian, can you give me some pointers on the 2 day surging? I always get 2 days of positive OPKs too and then O on the second day. Is that something that I should factor in?

Thank you so much for all the responses! They are greatly appreciated.
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  #18  
January 26th, 2012, 07:29 AM
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Originally Posted by bryan and nina View Post
I don't know what to do. It seems like EVERYONE on here unanimously agrees that the prices are too high--but on the other hand, I don't think we have much to chose from! As far as I know, the only other RE is about 2 hours away from here, a friend of mine uses them actually and I already asked her-- she said they charge the same. I think it's just the area we live in, unfortunately. DH and I still need to have the convo about which route we will take anyways. I will try to do a search to see if there are more REs in this area, but like I said, mine and the one 2 hours away are the only ones I came up with when I started the search.
That really sucks; I wish ours was less expensive! That would help matters tremendously.
I think I want to go with the trigger and just do the whole thing at once; hopefully that will do the trick. It looks like my progesterone is low again this cycle, judging from the low post O temps I have gotten so far so clomid will definitely help.

Hey Jillian, can you give me some pointers on the 2 day surging? I always get 2 days of positive OPKs too and then O on the second day. Is that something that I should factor in?

Thank you so much for all the responses! They are greatly appreciated.
Sure. My doctor only did one day of IUI. When I triggered it was 24 hours before my IUI and I feel like it was just too soon. I cramped more the next day (you know how Clomid makes you cramp around ovulation). Anyway, I know it's the standard for a lot of doctors, but for me, I felt like it was a waste.

So, my other IUI I was so defeated and just DONE with TTC for awhile. I decided that I wouldn't trigger because I had no problem ovulating and with Clomid I always knew my progesterone was high enough if something was to fertilize. So.... I was told to test with OPK's and when I got my positive to call the doc. After almost a year of knowing I had 2 days of positives and watching the clues of my body, I knew I'd have better luck to wait until the surge was closer to leaving my body. I just KNEW it would give me a closer window for the sperm and egg to meet, instead of shooting the washed sperm in there and them dying off before my ovary pushed my egg out. So, that's what I did. I waited. I tested positive on one afternoon and then I called the next day and told them I tested positive THAT day. We scheduled for the next morning. So I tested positive. Then the next day I tested positive, then the next morning I was fading to negative and that was the morning of the IUI. I had read that IUI's were MOST successful 8-12 hours EITHER side of ovulation. I feel like that is how it worked. Truly.

I know this is long. Ask me anything you need for me to clarify. Maybe a trigger with a 30-40 hour wait before IUI would have worked better for me. IT just wasn't planned that way.
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  #19  
January 26th, 2012, 08:01 AM
mistletoe's Avatar Mega Super Mommy
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If it makes you feel any better those prices are exactly the same as we have around here. And we don't have lots of alternatives either.
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  #20  
January 26th, 2012, 08:24 AM
*JenJen*'s Avatar impatiently waiting
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Quote:
Originally Posted by bryan and nina View Post
I don't know what to do. It seems like EVERYONE on here unanimously agrees that the prices are too high--but on the other hand, I don't think we have much to chose from! As far as I know, the only other RE is about 2 hours away from here, a friend of mine uses them actually and I already asked her-- she said they charge the same. I think it's just the area we live in, unfortunately. DH and I still need to have the convo about which route we will take anyways. I will try to do a search to see if there are more REs in this area, but like I said, mine and the one 2 hours away are the only ones I came up with when I started the search.
That really sucks; I wish ours was less expensive! That would help matters tremendously.
I think I want to go with the trigger and just do the whole thing at once; hopefully that will do the trick. It looks like my progesterone is low again this cycle, judging from the low post O temps I have gotten so far so clomid will definitely help.

Hey Jillian, can you give me some pointers on the 2 day surging? I always get 2 days of positive OPKs too and then O on the second day. Is that something that I should factor in?

Thank you so much for all the responses! They are greatly appreciated.
If those prices are what is normal in your area, then don't stress it too much. Prices around the country vary greatly. I'd ask your RE what exactly each cycle covers, to get a better idea. Don't forget to ask if they offer a discount for self-pay customers too.
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