Comparing Treatment Options: Conflicting advice regarding IUI versus IVF

Choice Chat

This question was posted to the Choice Mom discussion board, and elicited several responses. We particularly liked the advice of 45-year-old Linda, mother of a 10-year-old conceived by IUI and a 4-year-old conceived by IVF, who gave us permission to reprint.

Q: I'm getting conflicting advice regarding IUI versus IVF. On one hand, I've been encouraged to be more aggressive and move to IVF right away because of my age. On the other hand, I'm told that IVF doesn't work that well with older women and to stick with IUIs. How does one reach a decision about IUI vs. IVF. Meds or no meds? And how do you decide which clinic to use and which doctor to listen to?

Advice will seem conflicting because each person brings his or her bias and experiences to the table. There are tremendous variables, and each individual is her own case, and each doctor will have his or her own opinion about each case. What will work for one won't work for the next. My best advice is meet with a RE, discuss your options in your particular case and see what you both agree is the best next step for your case. And if what the doctor comes up with doesn't make sense to you, visit another doctor.

I personally didn't care to hear or discuss odds, as they meant nothing to me and my reality. In other words, in my mind, it didn't much matter what the odds said had worked for others, as in the end it only mattered what happened to me. I examined my situation, my money, my energy, my benefits, my work commitments, goals, etc. I combined that with various input from doctors and wisdom from peer groups like this. And I picked the best decision I could at that point in time.

What folks are saying about IVF and older women is that the odds are already greater, as the eggs are aged and might not respond well to the overall IVF process. I've known older women who responded great on an IVF cycle, and I've known others who struggled to get ONE healthy egg. But it only takes one.

What if you, say, wound up doing three IUIs and they were unsuccessful? Then you've wasted precious time with no clue as to egg quality. That might be one reason some would suggest you go straight to IVF, as it has the appearance of being more aggressive. Most of the older women that I know had to resort to IVF to conceive. And many of those had to use donor eggs after multiple failures with their own eggs.

For my case, I was 39 when I attempted for my second child. I assumed that since I got pregnant with one IUI try for the first kid, that surely I must be healthy and able to easily conceive #2. Wasn't true. And I wasted lots of time attempting IUIs when there was no way it would have ever worked, given that I had developed endometriosis after my first child was born. So I "had" to use IVF.

In my case, the best hindsight advice would have been for me to use IVF from the start. But I didn't have the luxury of knowing that.

Find a doctor you are able to work with, talk, and pick a direction. Don't try one direction for too long without readdressing the path.

As for finding an IVF clinic, my best reference was other women. I wasn't even going to consider IVF, as I had always heard it's $$$ cost. Fortunately, before I threw in the towel, someone let me know a local RE who did IVF quite cheaply. And that is where my youngest child came from. One IVF cycle that produced a SINGLE embryo.

As I said, my girl is the proof that it only takes one! But IVF costs can vary greatly across the country. And when I say greatly, I mean from roughly $5,000 to $20,000. Good luck!