Doctor can't find anything wrong but suggests a medicated IUI cycle

[nl13]

I finally finished all of the testing with my fertility doctor and he couldn't find anything wrong with me or my husband.

He said our chances of getting pregnant naturally are 30%, whatever that means. And for someone with no issues, in an optimal scenario it would 45%.

We have been trying for over 2 years. He tested my FSH and estrogen at day 3 of one of my previous cycles. Tested progesterone on day 7 of my latest cycle that did not work. Did an HSG on day 5 of my current cycle (currently I'm at around 4dpo).

He could not find anything wrong. Also checked my lining on the cycle right before the HSG cycle and it was nice and thick, triple line and all that. He also tested for a bunch of antibodies that would show if I ever had chlamydia. Also negative. My husband had a semen analysis, that was actually done before they tested me at all and doctor said he was fine. Although there is an observation stating that some of the sperm are weak or something like that. I have no idea, it's in Dutch as we live in the Netherlands and my Dutch is not great. Another doctor that I go to, who takes a more natural approach said that the semen analysis results are not great, that they are on the low end of normal.

Fertility doctor suggests a medicated IUI in 3 months if I'm not pregnant naturally by then. I asked about doing IUI without meds because I am not comfortable with taking a lot of hormones, specially injectable ones, specially considering I am ovulating just fine and my hormone levels, according to him, are fine. I don't why I should be taking the meds. He said that IUI without meds only has good results when the sperm quality is poor, so he says the meds are needed. I agreed with it doing it that way because I'm quickly approaching 35 but I'm not happy about this choice. I'm hoping I'll get pregnant naturally by then, but lets be honest, I haven't succeeded in over 24 months of perfect timing so something must not be right.

I asked about any more tests that I could do, like see if maybe I have hostile CM, clotting issues, killer cells or anything else that can be tested. He said those are very rare and it's not worth testing for.

Clearly there must be SOMETHING wrong or I would be pregnant by now. I feel like if I have a clotting issue, for instance, the IUI will be a waste of time and I'll take strong meds for nothing and be stressed and anxious when maybe that's not what I need. I know that sometimes you just can't know why, but I feel like we have not even came close to exhausting options.

I have tried lots of natural supplements in the past 6-8 months but had zero luck so far. I could notice some improvements in my charts but nothing major. I'm thinking of trying baby aspirin this cycle, but I'm not sure if it's too late for that as I'm 4 dpo already.

If anyone has any advice or suggestions or natural things I could try, I would really appreciate it.

I do have Hashimoto's but I'm taking medication for that and my TSH is at a great level and has been for the past 6 months or so. It was never that high to begin with, usually between 4-5 at most. Other than that and anxiety I have no health issues, not overweight and have been taking prenatals this whole time.

I have no idea what else I can do besides hoping for the best and doing the IUI if that doesn't work.

 

[WishnandHopn]

Hey there sorry to hear you are going through all of this! It is so frustrating not knowing exactly what the problem is.

I think they prefer to do medicated IUI instead of natural because you have a chance of ovulating more eggs and better quality eggs and this increases your chances that one will get fertilised. You could always try it natural and then move on to medicated if it doesn't work?

It sounds like you're doing all the right things, but is your DH taking any vitamins or supplements to help with sperm quality? I've researched and heard from others on these forums that it really can make a difference. My DH's SA results are down at the bottom of the 'normal' range (like 90% of men have better quality sperm), but both doctors who looked at his results didn't seem to be concerned. I think male subfertility is not well understood by the medical community.

You can compare his results (if you can figure out the dutch!) to the WHO reference range (Table A1.2) to see where he stands:
https://apps.who.int/iris/bitstream/10665/44261/1/9789241547789_eng.pdf?ua=1

My DH started taking fertilpro, L-arginine and pycnogenol for sperm quality a couple of months ago and we're going to repeat the SA in another month or two to see if it's helped his numbers.

Good luck with everything...I hope you get your BFP soon!

 

[KatO79]

I agree with Wishn, the hormones help you to make more eggs so hopefully increases your chances of having at least 1 good egg that can be fertilised. I've been through 6 medicated IUIs myself so know a bit about it although all 6 failed in my case (we ended up needing IVF to conceive).

My DH and I were also "diagnosed" unexplained which means they couldn't find any issues with either of us - but it doesn't mean that there isn't an issue somewhere. Clearly when you've been trying for 2 years and still no pregnancy, there's an issue. Unfortunately they can't test for everything and some end up never knowing why they had problems (my DH and I are among them).

I'd personally go with the medicated IUI and see how that goes. But if you're really into it being natural, you could try a natural IUI 1-2 times and then move on to medicated if they don't work.

As to supplements, I started taking Royal Jelly when doing my IVFs (as it was IVF #2 that worked) which is suppose to help with egg quality (figured it couldn't hurt even though none of my results suggested an egg quality issue). Maybe you could try taking that if you haven't already? Unfortunately though, doing natural supplements won't work for everyone, some do need assisted conception to conceive. And I can tell you that once you do get that BFP and are pregnant, it won't matter in the end how you got there!

 

[nl13]

Thank you both for replying, it's good to have different opinions to help me decide what to do. Thank you for the well wishes, I'm hoping I'll be one of the lucky ones who becomes really fertile after the HSG and will see a BFP this month or the next.

WishnandHopn, I did ask to try natural and doctor said no. Here IVF and IUI is covered by health insurance from what I could understand it will cover up to 3 attempts. So maybe that's why he won't do it without meds when he thinks the odds may be higher with meds and doesn't want to waste health insurance money. Although I imagine unmedicated IUI would be much cheaper but still costs something. I'm not sure how I could convince a doctor to go that route because as far as I know there are no private clinics.

And thank you for the link, I will compare DH's results to those. He is currently taking CoQ10, selenium and a multi vitamin. Unfortunately, he is not extremely consistent with taking them. I did not know about l-arginine for men, but had been taking that for me, to improve my lining just in case that was the issue.

As for redoing the SA, my doctor will not do that because he already thinks DH is doing very well and does not think anything needs to be improved. I'll research those other supplements and see what they do and if they would improve anything DH is lacking.

KatO79, It's nice to hear from someone who has been through this. I am sorry you had so many unsuccessful IUI but I'm glad that you were finally successful with IVF. What concerns me with doing medication, besides the risks and side effects, is that I'm afraid that if everything is working well with ovulation and it's just an issue of hostile CM, for instance, I might end up with twins or triplets even. Don't get me wrong, I'd not picky, I'd be extremely happy with twins, but at the same time I am a very small person and I'm not sure I could safely carry twins, let alone more babies. So that scares me a little because if the eggs are there and the sperm really is as good as the doctor says, what's stopping them from fertilizing all of the eggs I may produce? Maybe the odds are small, but in my mind they seem big. Just like the risk of ovarian hyperstimulation syndrome if my ovaries are already working optimally (which apparently they are since the doctor said they are normal).

As for the supplements I do take royal jelly from the beginning of my cycle until I ovulate and have been doing that for a year or so.

I have also been taking Vitex (agnus castus, started 4 months ago), l-arginine and primrose oil until I ovulate, B6 after ovulation and CoQ10, Vitamin E, Vitamin C non stop.

I have also tried Rhodiola before, but thought maybe I was mixing too many supplements so I did a few cycles without it. Also tried taking vitamin B6 the whole cycle and decided to just take it during the second half because I was concerned it was interfering with ovulation but who knows. Hard to say what really works and what to take.

I have also used pre-seed at least one of the fertile days for the past 6 months. And progesterone cream for 4 cycles.

I don't really mind that much that I might need medical help to conceive, I'm not against it at all. I would not even care if the baby wasn't biologically mine, to be honest. It's just that these procedures and taking medication with potentially serious side effects makes me very anxious. Having to do injections for many days makes me extremely anxious because I have a pretty bad fear of needles, sadly. I'll be completely terrified before every single shot. Those are even worse than blood tests, which are pretty terrifying to me and nt matter what I do I can't get over it. I have only recently gotten to a point where I'll only be anxious a few minutes before instead of days before and sometimes I can get through them with minimal anxiety but not always.

If that's what it takes then I will have to find a way to do it but I was hoping to avoid unnecessary interventions that are either very uncomfortable or have serious risks so I was looking for reassurance that this is really needed and is really recommended in a situation such as mine.

 

[KatO79]

KatO79, It's nice to hear from someone who has been through this. I am sorry you had so many unsuccessful IUI but I'm glad that you were finally successful with IVF. What concerns me with doing medication, besides the risks and side effects, is that I'm afraid that if everything is working well with ovulation and it's just an issue of hostile CM, for instance, I might end up with twins or triplets even. Don't get me wrong, I'd not picky, I'd be extremely happy with twins, but at the same time I am a very small person and I'm not sure I could safely carry twins, let alone more babies. So that scares me a little because if the eggs are there and the sperm really is as good as the doctor says, what's stopping them from fertilizing all of the eggs I may produce? Maybe the odds are small, but in my mind they seem big. Just like the risk of ovarian hyperstimulation syndrome if my ovaries are already working optimally (which apparently they are since the doctor said they are normal).

As for the supplements I do take royal jelly from the beginning of my cycle until I ovulate and have been doing that for a year or so.

I have also been taking Vitex (agnus castus, started 4 months ago), l-arginine and primrose oil until I ovulate, B6 after ovulation and CoQ10, Vitamin E, Vitamin C non stop.

I have also tried Rhodiola before, but thought maybe I was mixing too many supplements so I did a few cycles without it. Also tried taking vitamin B6 the whole cycle and decided to just take it during the second half because I was concerned it was interfering with ovulation but who knows. Hard to say what really works and what to take.

I have also used pre-seed at least one of the fertile days for the past 6 months. And progesterone cream for 4 cycles.

I don't really mind that much that I might need medical help to conceive, I'm not against it at all. I would not even care if the baby wasn't biologically mine, to be honest. It's just that these procedures and taking medication with potentially serious side effects makes me very anxious. Having to do injections for many days makes me extremely anxious because I have a pretty bad fear of needles, sadly. I'll be completely terrified before every single shot. Those are even worse than blood tests, which are pretty terrifying to me and nt matter what I do I can't get over it. I have only recently gotten to a point where I'll only be anxious a few minutes before instead of days before and sometimes I can get through them with minimal anxiety but not always.

If that's what it takes then I will have to find a way to do it but I was hoping to avoid unnecessary interventions that are either very uncomfortable or have serious risks so I was looking for reassurance that this is really needed and is really recommended in a situation such as mine.

I do think the risk of the sperm fertilising all eggs really is small. I had 1-3 eggs each time (most of the time 2 eggs) and ended up with none fertilising all 6 IUIs. But if you're worried, try talking to the RE about these concerns and agree on how many eggs you want to aim for to decrease the risk.

As to OHSS, I would think that they would only be going for 3-4 eggs max which means you wouldn't be on a very high dose of FSH. I was on around 75-77 IU Puregon for my IUIs as my clinic was going for max 3 eggs. I think OHSS first develops if you're developing many, many more eggs than that so it's more of a risk when doing IVF than IUI since with IVF they're trying to get a much higher number of follies/eggs, my clinic was going for around 8-12 eggs although I never developed more than 3 eggs each time.

As to side effects, I don't think there are so many with FSH injections and it's extremely rare for someone to experience any of the really serious ones. I'm sure there are also potential side effects to taking those supplements but yet you still do it, right? Why should taking injections be any different? Because supplements are natural? There are lots of natural things that can give you serious side effects, just look at how many plants are toxic.

As for the actual injections, you quickly get use to it. The hardest is the first one and it quickly becomes easy after that. I would think you'd be taking your FSH in pen form so the needle is extremely thin and not very long, you barely feel it going in. Not at all compareable to blood tests since those needles are thicker and longer.

 

[CaliDreaming]

n113,
I went through the same thing you went through when we were TTC our second child. I would recommend that you focus more on hubby because often when all looks good with the woman, the problem is often a sperm issue. However, most REs focus almost exclusively on the woman and really don't have much expertise in male fertility. If the issue is really hubby's sperm, then the hormones are really a waste of time and IUI will only slightly improve your chances. IVF would be an excellent option, but sperm issues are usually an easy fix so it would be worth it try fixing that before proceeding.

We had been trying for nearly two years with perfectly timed intercourse each cycle. I went through all the tests, and my labwork, antral follicle count and lining were excellent. My hubby had had a sperm analysis, which my RE had said was "fine". However, after a year of clomid and injectibles and a laparascopy that ruled out any other problems with me, we still hadn't gotten pregnant. The RE chalked it up to my age (38 at the time).

A different doctor looked at my hubby's results and determined that his sperm was not in fact "fine" and referred him to a urologist. He said that my hubby would be very unlikely to get me pregnant unless his sperm improved. We didn't go to the urologist, but ended up putting him on supplements and we were lucky to get a bfp the following month.

There have been tons of other women who have a similar story. Doctors really don't spend enough time evaluating male fertility, and it leads to a lot of wasted time, money and heartache. Sometimes all that is needed are supplements if counts, morphology and motility are on the low end, but occasionally they'll find other issues that may require surgery, antibiotics or IVF to address. Most of the time it is a diet and lifestyle issue that is easily fixed. If IVF is needed, there is a great chance of success.

 

[jjbubbles28]

Hi. For what it is worth I did 13 months of perfect timing, with tons of supplements, pressed, and cervical caps. Nothing worked and all tests were negative. Then I started clomid/IUI cycles. They found I have cervical stenosis and would NEED an IUI to bypass my cervix. 5 IUI's later still nothing. Then I did a medicated cycle with IUI at the end and now have a 5 month old. It sucks and I hated the hormones, but for me its the only that worked. We conceived at 19 months.Best of luck.