Unexplained IF- what's the best treatment?

[mrs.gorilla]

Hi there...I've lurked here for a while and everyone around here knows so much I thought I'd finally post:

I'm at the end of my rope.
We were checked out after a yr of TTC- everything was normal.
So we kept trying...and trying...and trying...
I have cycles like freaking clockwork- I couldn't ask for better cycles. I ovulate like a champ, my CM is abundant and fertile, DH's sperm are top notch. We are healthy non-smoking, non-drinking only 28 and 29. We do everything right! We're just cursed or something...seriously.

DH is working in another country for a few months and I'm going with. In the country we're going, money can buy whatever first-class treatment you ask for, no waiting or anything. I feel like this is an opportunity to get away from the doctors who say just wait, you don't qualify for this or that treatment. I want something done to HELP us.
We've done all the tests before and I'm bringing all our records with us.
We've already tried lots of TCM, acupuncture, natural supplements etc- you name it we've done it or are doing it now!

My question is, what's the treatment for a couple with totally normal functioning systems? I guess I'd mostly like to know about the meds that might help us- western medicine. I want something that would get things going from normal to high gear, like a boost, jump start, hyper drive... or something.. I'm holding off on IVF IUI for now. But anything, ANYTHING else I'm willing to try.

Maybe these questions sound ridiculous but we're at that point. We were at that point 6 mos ago and I want to use this opportunity! I want to get pregnant, at this point I don't care how.

TIA for the input and not judging me in my insane state of desparation !

[MeepyCat]

I hear your frustration. Oh gosh, I really do.

I hear that you want to *do* something. I think anyone in your shoes would want the same.

But without a sense of why you aren't conceiving, there's no way to say what treatment is best, or even that any particular treatment would help at all. Under those circumstances, you could have every top notch fertility treatment known to science and get nothing but side effects. Sometimes the sound practice of medicine requires that a doctor not take action - they can't just take shots in the dark if they don't have even a general sense of what the problem is or how to solve it.

If you are going to spend your money, I'd spend it on testing first - can you do ultrasounds to confirm that ovulation is occurring when you think it is? Run another check on his sperm?

After that, I guess the question is, why hold off on IUI? If there is nothing apparently wrong with either of you, than it seems like it might be the way to go.

[DaisyMae08]

DH and I are in a very similar situation. His numbers are great, my bloodwork was great, HSG was great, thyroid was great, the only thing is my cycles aren't necessarily clockwork (they vary between 28 and 42 days which is sort of borderline). After a year my regular ob/gyn sent us to a RE who decided to start with 100mg clomid, trigger shot, and IUI. So we're in our first cycle of IUI right now. I'll find out next Friday if it worked or not. It sounds like we were lucky to have doctors that are proactive. I'm 29 and DH is 33, so it's not as though age is really a factor in our case, but they still wanted to get going right away for which I'm grateful. Good luck!!

[LiamsMommy31905]

I am exactly in your shoes (except I'm a bit older...33.) I have a DS that we conceived in only 4 cycles when I was 29. We've been TTC #2 now for 17 months. DH's sperm (motility, morphology, and numbers) are perfect, I ovulate like clockwork, my HSG/countless ultrasounds showed nothing, and bloodwork for both of us came back normal as well. We've tried 5 cycles of Clomid, 3 IUIs...with a miscarriage and OHSS thrown in as an added bonus.

My RE can't tell us why it's not happening this time around. It's unbelievably frustrating.

My insurance covers one round of IVF, so before I become too jaded about the whole process, we're just jumping into IVF with both feet this month. It gives the best success rate of all treatments (I was quoted about 60% success rate.)

Hope you get your BFP soon.

[mrs.gorilla]

Originally Posted by MeepyCat

If you are going to spend your money, I'd spend it on testing first - can you do ultrasounds to confirm that ovulation is occurring when you think it is? Run another check on his sperm?

After that, I guess the question is, why hold off on IUI? If there is nothing apparently wrong with either of you, than it seems like it might be the way to go.

We have done ultrasounds and every test under the sun. We have no problems- I've been told my ovaries are "model specimens"- no joke. Literally everything about both of our reproductive systems is perfect. This is what makes it soo frustrating. I WISH I had a problem- at least it would be something to address.

We're holding off on IUI because we're hoping for something cheaper. We've spent so much in the past couple of years, we'd have to save for a while if were to put down thousands for IUI or IVF. The money we've got left that we set aside for this I'm hoping to spend on treatment and meds when we go away since my doctors won't yet give it a try here.

So clomid can work for women who are ovulating regularly? It causes you to release more eggs at once? I want to ask for something specific. I don't want ANOTHER doctor pouring over my records and test results. I'll be in the situation where I can ask for what I want and get it. So that's why I'm looking for info...

Thanks for the responses and understanding so far, I appreciate it!

[*Jade*]

Thats very tough

We've been trying for almost a year, and while I'm still trying to get DH tested (Men, and their fragile egos!!) my cycles are fine. I've been having accupuncture, and one thing my practitioner noted is that my temps aren't very high. She thinks this wouldn't be picked up in Western medicine, and raising them might help. So I suppose my point is could you try some different therapies, and see if there might be some answers in non-traditional idealogies.

[DaisyMae08]

Originally Posted by mrs.gorilla

So clomid can work for women who are ovulating regularly? It causes you to release more eggs at once? I want to ask for something specific. I don't want ANOTHER doctor pouring over my records and test results. I'll be in the situation where I can ask for what I want and get it. So that's why I'm looking for info...

My dr said that according to all of our results, that if DH and I kept trying for we'd probably get pregnant on our own eventually as far as he can tell...it just might take a while since my cycles are sort of borderline. So the clomid causes you to have more than one egg. For my first cycle with Clomid, I went for a day 12 ultrasound and there were 6 mature follicles which all presumably have eggs in them. So I have a chance with 6 eggs this month, rather than just one.

The IUI then gives you a greater chance with all of the eggs because more sperm gets where it needs to go and they choose only the best quality sperm.

[DaisyMae08]

Originally Posted by *Jade*

Thats very tough

We've been trying for almost a year, and while I'm still trying to get DH tested (Men, and their fragile egos!!) my cycles are fine. I've been having accupuncture, and one thing my practitioner noted is that my temps aren't very high. She thinks this wouldn't be picked up in Western medicine, and raising them might help. So I suppose my point is could you try some different therapies, and see if there might be some answers in non-traditional idealogies.

Yeah, my DH was cranky about seeking treatment until he got his SA results back and saw that his numbers are fantastic. Now he's totally on board. They are fragile, aren't they?!

[Aly22681]

I just wanted to chime in here....I too was in your shoes a few months back. I was 26 and DH was 27 and had EVERY fertility test under the sun done to us. I have PERFECT cycles, always o'd, HSG was perfect, and DH had great sperm over 100mil count, and over 90% motility and morphology (on 4 different SA's he had over the course of 18 months) The first step for us was CLOMID, (which caused me to produce 2-3 eggs on the lowest dose 50mg, 5-6 on 100mg) We did 6 Clomid cycles, none of which worked for us, then we did one cycle of Femara which made me CRAZY!, then we did 3 cycles of Follistim and IUI's (I produced 8 eggs on one of those months, I had to sign a waiver about multiples inorder to procede with the IUI). None of those things worked for us though. I am not trying to discourage you, but rather just tell you our story. We decided to move forward with IVF since we could do it for around $5,000 through the military (yes, we were very lucky).
Upon doing IVF we found out why we were not getting pregnant. 1) My eggs have very very thick zona (shells) on them. So it is EXTREMELY hard for DH sperm to break through and fertilize them. 2) When you do IVF they do a VERY STRICT SA using the Kruger (sp) method. It showed that while DH's sperm is great at first glance, if you really look at each and every one of them, only 3% of them were totally normal. So his morph was only 3%. So we did IVF/ICSI to correct the sperm issue and AH to help with my thick zona's and it worked for us.

If I was in your shoes again here is what I would ASK for over the next few months.

1) Ask for a Kruger SA for your DH. Even if you pay out of pocket for it, it should only be about $150. That way you at least know for SURE what you are working with. The normal SA you have already had is a great place to start but if you are still not getting pregnant it might be a good idea to look a little closer at it.

2) Ask to start clomid. Yes, it does work for women who ovulate on there own because it gives you more/better quality eggs each month. More eggs=more chances of one fertilizing.

3) Ask for a Trigger shot to force you to ovulate. While you may ovulate on your own already, a trigger shot really helps out with timing, so you know exactly when you need to be getting busy. I was a stresser the months I didnt have a trigger, I was so scared I would O early or late and not not bd on the right nights.

4) Sit down with your Dr and tell him you are sick of sitting around and that you want to be proactive about getting pregnant. Ask him to sit down with you and set up a 12 month plan of steps to get you pregnant (EX... 4 months on Clomid, then maybe move to 3 months of injectibles with timed intercourse, then maybe try an IUI on month 8, etc....you know just something that you both feel comfortable with.) You might find it will make it easier to deal with a BFN when you already have a plan of how your going to try again next month. Not knowing from month to month used to eat me up inside.

Good Luck, I really hope things work out for you and SOON!!

[mrs.gorilla]

Aly thanks SOO much for your input and advice! This is exactly what I was looking for. I'm going to get the SA that you referred to, I read a just read about it and I'm going to see if there is some way I can have my eggs examined without going in for IVF, which we can't afford yet. After that I guess the first thing I'm going to ask to try is clomid.
Thanks so much and congratulations- wishing you and your family all the best!

[mischievium]

I think Aly has given you some great advice, to it, I would add the following:

1. When you ask about having a strict morphology done, also ask about having his sperm tested for antisperm antibodies (assuming they haven't tested for it already). Your DH most likely does not have ASA, but it's worth asking about in cases like yours where they have no other explanation but may not really have tested for *everything*. My DH has a risk factor for ASA and I still had to push the issue of testing for it in order to get them to do it and, lo and behold he had ASA. I have also heard several cases of couples that had unexplained IF for years until they finally heard about ASA and asked to be tested. Anyway, the test is relatively cheap and it's at least worth knowing about and asking about.

2. It is totally up to you how aggressive you would like to be, but I would consider IUI sooner rather than later-- especially because it sounds like you've done ~2 years of timed intercourse. IUI is not super expensive, is minimally invasive (especially compared to IVF) and can help you decide faster if you need to move on to IVF. A plan that I would consider would be:

A. 3 rounds of clomid with HCG trigger and timed intercourse (assuming you respond well to the clomid, if not, consider injectibles at this point)

B. 3 rounds of clomid with HCG trigger and IUI

C. From there, discuss the merits of trying injectible medications (but, if you are ovulating well on your own and/or responding to clomid well, ovulation may not be the reason you're not conceiving) or whether you should save your money for IVF.

Also, there was a recent study that casts some doubt on the efficacy of clomid and/or IUI for couples with unexplained IF-- which, I have only read the article and not the study, itself, but the way I would think about it is that it might be a reason not to spend a really long time (and money) trying IUI and clomid.

Good luck with whatever path you follow!

[janine6745]

Keep your head up!

I'm sorry you've found yourself here. Dealing with fertility issues really stinks, and most of the women here ... myself included ... have been through the wringer. Having just gotten a wallop of bad news that you didn't expect, I understand that you are reeling. Take some time to digest the information, and then you can begin to plan. A low sperm count used to mean no children. But now, with ICSI, parenthood is still possible. It's expensive, though. So first, figure out if your insurance covers any fertility treatment. If so, you are WAY ahead of the game.

Again, I'm sorry you're going through this, but I hope after you digest the bad news, you'll begin to see some reason to hope. I have been trying hard to get pregnant and I tried so many affordable options, and nothing really helped but this book I bought from the Fertility Clinic website. It's a natural way to overcome infertility. I read this book and it helped me so much.

Anyways, below is the link to it, if you are interested.
Hope it all works out for you!
http://val207.kjt78.hop.clickbank.net