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Why IVF v IUI (the second time around)

So many of you have asked me why I chose to jump into IVF rather than attempt and IUI when we started trying again in 2017. Clearly we had great success with our IUI in 2010 and got our beautiful twins, so why not try it again? Well let's dive into that a little deeper.




My IUI in 2010 was pretty wild. I say that because I had NO idea what I was doing. I basically shut my eyes and pretended like everything was fine. I tried clomid, an oral medication that can be used to stimulate ovulation (since I wasn't ovulating on my own), but that didn't work at all. So then we moved onto Menopur, a medicine that contains follicle stimulating hormones which then stimulate the ovaries to produce eggs. This worked, it worked very well. I actually, without any hormones, have a lot of follicles naturally. So you can imagine with some stimulation I had a lot of follicles and thus a lot of mature eggs (this means my eggs were at a good size to be able to fertilize with sperm, about 18-22mm). To be honest I don't remember how many mature eggs I had. I was embarrassed to even be in the fertility center back then so I feel like I "closed my eyes" to a lot of it.


When the time came and my follicles seemed to be ready, we did our "trigger shot," this was a shot in my stomach (similarly to where I was injecting the menopur) to trigger ovulation with the follicles I had. We went into the clinic 36 hours later and the nurse inseminated me, using Nick's sperm in a very long syringe, and I laid there for 20 minutes after. Then we were cleared to go home. We had to come back for our blood work to see if it had worked 14 days later, or yes, exactly 2 weeks later.


I honestly never worried about it much. I assumed it would work, that was my young naive self talking of course. I remember we even biked to the blood test and back, not a care in the world. Of course I was anxious that day but I let myself believe it had worked. And well, it did. My first beta test was through the roof. My numbers were already in the thousands! The nurse "warned" me that this could mean multiples but I replied "ha, no that would be crazy."


Two weeks later I started bleeding a lot. I was so panicked but we were told to come in the following day. "Congratulations you guys are having triplets!" My jaw fell to the floor and so did Nick's. We were crying because we were so thrilled it wasn't a miscarriage but now we were in shock. As a lot of you know, we were advised to get a reduction. My body, according to the doctors, was not going to be able to safely carry twins and my life and the babies' lives would be at risk. So we had to drive to Los Angeles, get a reduction, and never speak about it again (is what we agreed on). It was the most traumatic thing I had ever experienced. We knew it was the right choice and when my twins were born healthy and vaginally at 37.5 weeks, well we were clear that we had made the right choice, but to this day we rarely talk about it and still feel tremendous guilt.


So fast forward to 2017. The girls' were 6 and we were ready for another one. We tried for a few months but no sign of a period again which meant fertility treatments once again. This time I knew a little more about what that meant. I was a little (not a lot) more aware of IVF v IUI and Nick and I knew what we wanted to do. "We don't want to worry about getting another reduction and we really dont think we can do another set of twins." So the doctor agreed that we should move straight into IVF.


That was our big meeting, our big moment of why and when we decided on IVF. We knew with IVF we could choose to transfer just one embryo (and most of the time that's all we had anyway). We knew there was a risk that the embryo could split but at that point we would embrace it if it happened. The doctor ran my first ultrasound pre- IVF treatments and sure enough, like before, I had a lot of follicles already. So we were reassured we were making the right choice for us.


However, after the first year of two egg retrievals only yielding one viable embryo each and two failed transfers we were tired. We were so shocked as to how hard this was in comparison to our IUI years ago. How is this possible? We were already almost $60k in deep and felt lost. So we decided to throw our hands up and try an IUI.


IUI's in our clinic, were significantly cheaper. We had spent about $5,000 for the IUI (including medications etc), versus $30,000 per round of IVF. We knew the chances of an IUI working were much slimmer (20% v 60% in our case according to our Reproductive Endocronologist), but we just couldn't fork over another $30k again at that point. We were obviously worried of multiples but at that point we just wanted to get pregnant. So we moved forward.


This time I knew I had 3 mature follicles. I insisted on them moving forward with the IUI because we knew what the risks were. This clinic did move forward (when I moved to my current clinic they do not allow anyone to move forward with more than 2 mature follicles). Anyway, we did it. We triggered, I was inseminated and I laid there for 15 minutes this time. We went to have Mother's Day lunch afterward (yep it was Mother's Day 2018).


Two weeks later I was bleeding a lot. But I knew it wasn't multiples. I knew it was my period. I was devastated. For some reason this one was really hard for me. I think it's because I thought it would work since it worked so well years ago. I felt like my body was really truly failing me. Not only did I not have multiples in my uterus I didn't even have one! I was so confused how something could work so well and then years later fail so miserably.


So there I was. Filled with trauma. I didnt want to try another IUI. Yes financially it would have made sense and who knows, it could have worked, but I couldn't fathom the idea of this not working again when I had been so proud of how well it had worked before. My issue with an IUI now was far greater than the fear of a reduction, it was now the fear of my body rejecting something that created the most important things in my life, my twins.


PTSD is real. Whatever your reasons for choosing your path to fertility remember that it is your journey. You get to decide and no matter what the doctors suggest, always listen to your gut. Ask questions, get informed, weigh out your options, but always follow your heart.

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