Still looking for our May Flowers...
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beaglemom
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Ladies,
I thought some of you in the later 30s age might find this interesting. It was on my clinic's website. I did not read through all of it. And I just want to say, I am not calling any of you OLD! I think our minds & bodies just don't agree sometimes.
Older Women Should Move More Quickly to IVF
ASRM Bulletin
Volume 16, Number 25
May 6, 2014
Highlights from Fertility and Sterility
Older Women Should Move More Quickly to IVF
A new study demonstrates that, for couples of older reproductive age with unexplained infertility, immediate IVF is the most efficient treatment, resulting in fewer treatment cycles and a higher live birth rate.
In an NIH-funded, randomized clinical trial, 154 couples receiving infertility treatment at Boston IVF and Brigham and Women’s Hospital were randomly assigned to one of three groups to receive a specific type of treatment for their first two cycles. One group was assigned to have IVF. The other two groups were assigned to have intrauterine inseminations (IUIs) with the female partner receiving either an oral medication to induce ovulation (clomiphene citrate- CC) or injectable ovulation drugs (follicle stimulating hormone-FSH).
If patients in the two insemination groups did not achieve an on-going pregnancy after two cycles, they were switched to IVF for their subsequent cycles.
The participating couples were required to have been trying to conceive for at least six months and to not have previously tried any of the treatments being used in the study. The female partner had to be between 38 and 42 years old, with regular menstrual cycles, at least one ovary and fallopian tube, acceptable ovarian reserve, no disorders of the reproductive organs and no history of ectopic pregnancy. The male partner had to have enough motile sperm.
After two cycles of the assigned treatment, differences were observed in pregnancy rates and live births between the groups. Of patients who went straight to IVF, 49% became pregnant and 31% gave birth. Of those taking oral medications and having inseminations, 22% became pregnant and 16% gave birth. For the injectable medication/insemination group, 17% became pregnant and 14% gave birth.
All couples who had not been successful in their first two cycles of any treatment used IVF in their subsequent treatment cycles, but the couples in the immediate IVF group of the study went through 36% fewer total cycles than the couples who began their treatment in either of the ovulation drug/IUI groups.
By the end of the treatment, of all the couples in the study, 71% had conceived a clinical pregnancy and 46% delivered at least one live-born baby. 84% of all live births in the study came about as a result of IVF. For those couples having a live birth, those who started with IVF took an average of two cycles to conceive, while those who started with ovulation drugs and IUI averaged three to four cycles. Of the 154 couples enrolled, 140 started and 115 completed treatment.
While the major finding of this study is that immediately starting infertility treatment with IVF in older couples is the most effective treatment, it also showed that, if a couple chooses to try ovulation drugs with insemination first, oral fertility drugs (clomiphene citrate) are as effective as injectables (FSH).
Richard Reindollar, MD, Executive Director of the American Society for Reproductive medicine (ASRM) was the study’s principal investigator when he was at Dartmouth Hitchcock Medical Center (DHMC), prior to ASRM. He described how the study came about. “Previously, in the Fast Track and Standard Treatment (FAST-T) trial, we found that for young couples with unexplained infertility, proceeding to IVF after three cycles of clomiphene with IUI was more cost-effective than the standard approach at the time- which required them to go through several additional cycles of injectable ovulation drugs with insemination before allowing them to try IVF. We suspected that immediate IVF without any prior cycles with IUI would be more effective in an older age group but needed to demonstrate that through a rigorous trial.” Marlene Goldman, ScD, Professor at DHMC and first author of the paper stated, “While we recognize that not all patients might choose to start treatment with IVF, the results of this trial will give reproductively older patients with unexplained infertility the evidence they need to skip less effective treatments and start their families more quickly if they wish to do so.”
Goldman et al, A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T), Fertility and Sterility, in press.
Editor’s Note: This article is the basis of a continuing education module through ASRM eLearn® which will be available in the coming weeks. For more information on this and other CME/CE activities, go to https://www.asrm.org/eLearn/.
I thought some of you in the later 30s age might find this interesting. It was on my clinic's website. I did not read through all of it. And I just want to say, I am not calling any of you OLD! I think our minds & bodies just don't agree sometimes.
Older Women Should Move More Quickly to IVF
ASRM Bulletin
Volume 16, Number 25
May 6, 2014
Highlights from Fertility and Sterility
Older Women Should Move More Quickly to IVF
A new study demonstrates that, for couples of older reproductive age with unexplained infertility, immediate IVF is the most efficient treatment, resulting in fewer treatment cycles and a higher live birth rate.
In an NIH-funded, randomized clinical trial, 154 couples receiving infertility treatment at Boston IVF and Brigham and Women’s Hospital were randomly assigned to one of three groups to receive a specific type of treatment for their first two cycles. One group was assigned to have IVF. The other two groups were assigned to have intrauterine inseminations (IUIs) with the female partner receiving either an oral medication to induce ovulation (clomiphene citrate- CC) or injectable ovulation drugs (follicle stimulating hormone-FSH).
If patients in the two insemination groups did not achieve an on-going pregnancy after two cycles, they were switched to IVF for their subsequent cycles.
The participating couples were required to have been trying to conceive for at least six months and to not have previously tried any of the treatments being used in the study. The female partner had to be between 38 and 42 years old, with regular menstrual cycles, at least one ovary and fallopian tube, acceptable ovarian reserve, no disorders of the reproductive organs and no history of ectopic pregnancy. The male partner had to have enough motile sperm.
After two cycles of the assigned treatment, differences were observed in pregnancy rates and live births between the groups. Of patients who went straight to IVF, 49% became pregnant and 31% gave birth. Of those taking oral medications and having inseminations, 22% became pregnant and 16% gave birth. For the injectable medication/insemination group, 17% became pregnant and 14% gave birth.
All couples who had not been successful in their first two cycles of any treatment used IVF in their subsequent treatment cycles, but the couples in the immediate IVF group of the study went through 36% fewer total cycles than the couples who began their treatment in either of the ovulation drug/IUI groups.
By the end of the treatment, of all the couples in the study, 71% had conceived a clinical pregnancy and 46% delivered at least one live-born baby. 84% of all live births in the study came about as a result of IVF. For those couples having a live birth, those who started with IVF took an average of two cycles to conceive, while those who started with ovulation drugs and IUI averaged three to four cycles. Of the 154 couples enrolled, 140 started and 115 completed treatment.
While the major finding of this study is that immediately starting infertility treatment with IVF in older couples is the most effective treatment, it also showed that, if a couple chooses to try ovulation drugs with insemination first, oral fertility drugs (clomiphene citrate) are as effective as injectables (FSH).
Richard Reindollar, MD, Executive Director of the American Society for Reproductive medicine (ASRM) was the study’s principal investigator when he was at Dartmouth Hitchcock Medical Center (DHMC), prior to ASRM. He described how the study came about. “Previously, in the Fast Track and Standard Treatment (FAST-T) trial, we found that for young couples with unexplained infertility, proceeding to IVF after three cycles of clomiphene with IUI was more cost-effective than the standard approach at the time- which required them to go through several additional cycles of injectable ovulation drugs with insemination before allowing them to try IVF. We suspected that immediate IVF without any prior cycles with IUI would be more effective in an older age group but needed to demonstrate that through a rigorous trial.” Marlene Goldman, ScD, Professor at DHMC and first author of the paper stated, “While we recognize that not all patients might choose to start treatment with IVF, the results of this trial will give reproductively older patients with unexplained infertility the evidence they need to skip less effective treatments and start their families more quickly if they wish to do so.”
Goldman et al, A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T), Fertility and Sterility, in press.
Editor’s Note: This article is the basis of a continuing education module through ASRM eLearn® which will be available in the coming weeks. For more information on this and other CME/CE activities, go to https://www.asrm.org/eLearn/.
MissStacy
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I did think about you and that I was getting married on your anniversary, hopefully I have many years of happiness like you and your DH. Happy belated anniversary!!
beaglemom
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floridasian
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My cousin is 39, turning 40 in December. After trying for a while she got pregnant through IUI but lost it early. She had a D&C and got pregnant again on her own 6 months later. It was an ectopic and she lost a tube. The clinic strongly recommend IVF and she went with it. She got pregnant on the first IVF and she's due any day now.
ERosePW
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Congrats on the wedding MissStacy! I'm sure it feels good to be married now and just be able to lay back and relax instead of planning every day, hehe!
beaglemom, i'm so sorry for the BFN. Ugh!! Well, there's still tomorrow. How are you feeling? Any cramps or anything? I know you mentioned the spotting isn't there, but any crampiness or anything?
When I went in today for my scan, as I was sitting there waiting for them to come in, I really got to thinking. I don't want to do IUI this cycle, only to find out from my RE next Wed at my IVF consult, that they could've started IVF prep stuff this cycle (my appt with her is the day after I would do the trigger shot), so I decided to talk to my nurse before doing a scan. I'm so glad I did. She said my Dr usually puts people on BCP for 2 weeks, and that can be done at any time in the cycle. Then once you stop the BCP, I guess AF comes and the IVF cycle starts. But there are other routes, and that's up to the Dr to decide. I didn't want to do IUI and not be able to start the IVF prep, but I also didn't want to miss out an IUI if my RE ends up going some route that waits until my next cycle. So the wonderful nurse rescheduled today's scan for this Wed (that will be day4 for me, and that's the latest they'll do them), and she's going to talk to my Dr first thing on Wed morning when she gets back and is going to ask her what her plan would be for me. If she does want to do the BCP route (which she said is most common), then they'll start me on that on Wed! I'd still have my consult next Wed to go over everything in detail, but at least I wont be in the middle of an IUI cycle and have to wait it out. I'll already be a week into the BCP. Now, if for some reason she wants to go a different route (like just starting w/ my next cycle), then I can still go ahead w/IUI this cycle and come in for my scan on Wed. I can't believe how well that worked out, and I'm so excited that I decided to talk to her! It worked out that I can either start my IVF prep on Wed, or if it turns out she wants to wait until next cycle, then I can still do IUI since today I'm only day2. Seems like everything fell into place really well, I'm so happy I brought it up today!
beaglemom, i'm so sorry for the BFN. Ugh!! Well, there's still tomorrow. How are you feeling? Any cramps or anything? I know you mentioned the spotting isn't there, but any crampiness or anything?
When I went in today for my scan, as I was sitting there waiting for them to come in, I really got to thinking. I don't want to do IUI this cycle, only to find out from my RE next Wed at my IVF consult, that they could've started IVF prep stuff this cycle (my appt with her is the day after I would do the trigger shot), so I decided to talk to my nurse before doing a scan. I'm so glad I did. She said my Dr usually puts people on BCP for 2 weeks, and that can be done at any time in the cycle. Then once you stop the BCP, I guess AF comes and the IVF cycle starts. But there are other routes, and that's up to the Dr to decide. I didn't want to do IUI and not be able to start the IVF prep, but I also didn't want to miss out an IUI if my RE ends up going some route that waits until my next cycle. So the wonderful nurse rescheduled today's scan for this Wed (that will be day4 for me, and that's the latest they'll do them), and she's going to talk to my Dr first thing on Wed morning when she gets back and is going to ask her what her plan would be for me. If she does want to do the BCP route (which she said is most common), then they'll start me on that on Wed! I'd still have my consult next Wed to go over everything in detail, but at least I wont be in the middle of an IUI cycle and have to wait it out. I'll already be a week into the BCP. Now, if for some reason she wants to go a different route (like just starting w/ my next cycle), then I can still go ahead w/IUI this cycle and come in for my scan on Wed. I can't believe how well that worked out, and I'm so excited that I decided to talk to her! It worked out that I can either start my IVF prep on Wed, or if it turns out she wants to wait until next cycle, then I can still do IUI since today I'm only day2. Seems like everything fell into place really well, I'm so happy I brought it up today!
beaglemom
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Erin that is great. I am so glad timing is on your side. It seems I have had nothing but bad timing for 7 months. But this last cycle my timing ended up working out, but it was hectic.
I have had cramping off & on. Sometimes it feels like AF, & sometimes it is just dull. So frustrating not knowing how my body will handle the progesterone coming out of my system. I am also still very emotional...but it is probably from the negative this morning.
Good news is my husband is working all week instead of the normal 3 on 3 off...which means he gets off earlier...so we had the weekend & we will have every evening this week plus another weekend at the end. I really need it.
I have had cramping off & on. Sometimes it feels like AF, & sometimes it is just dull. So frustrating not knowing how my body will handle the progesterone coming out of my system. I am also still very emotional...but it is probably from the negative this morning.
Good news is my husband is working all week instead of the normal 3 on 3 off...which means he gets off earlier...so we had the weekend & we will have every evening this week plus another weekend at the end. I really need it.
floridasian
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That is so exciting, Erin!!
savvysaver
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Erin, from what you have said over the last few weeks it seems like this cycle is coming together nicely and to me it sounds like things are happening the way they are meant to be, along with a bfp at the end. I really believe things happen for a reason, first you call and get into the IVF class, now something told you to speak up and talk to the nurse today. Good things are happening here!
Beaglemom, sorry for the bfn, don't lose hope. Fx'd for a bfp tomorrow with a frer!
AFM, I had quite a bit of right side pain last night, it got super intense during our BDing where we had to stop (not really romantic) but I was able to move a bit and make it through, even though it was painful. Not sure if it was ovulation pain, it was gone in the morning but my temp didn't rise. Throughout the day I have been having some on and off dull cramping...guess I will see what happens with my temps tomorrow.
Beaglemom, sorry for the bfn, don't lose hope. Fx'd for a bfp tomorrow with a frer!
AFM, I had quite a bit of right side pain last night, it got super intense during our BDing where we had to stop (not really romantic) but I was able to move a bit and make it through, even though it was painful. Not sure if it was ovulation pain, it was gone in the morning but my temp didn't rise. Throughout the day I have been having some on and off dull cramping...guess I will see what happens with my temps tomorrow.
ERosePW
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Thanks Moni, you're right behind me.
I was hoping we'd be closer in cycles, but I didn't expect to start the prep stuff this soon. You sure you want to wait until Jul/Aug? 
Remind me, when did you have to reschedule your class for? I tried to find the post you mentioned it in, but got tired of scrolling through and not seeing it, lol!
beaglemom
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So I went to the dentist...I hate the dentist...if any of you are in the profession, I hope I do not offend...but I hate it. A few years back I had to get a deep clean followed by appts every 3-4 months. I had not been to the dentist in the while. Now I have gone for years every six months. I do not floss. So today they tell me I need another deep clean. I just want to cry. Is my whole body just falling apart? So now that is stressing me out. It cost a fortune the last time because insurance wouldn't cover. I think it was a preexisting condition thing. Now it will cover up to a certain amount. I just don't want to spend money on this. I know it sounds stupid. I just have more important things to worry about than my teeth. Now I have to fit in those appointments along with everything else. Not to mention my boss is out again tomorrow. It is so stressful. I can't get anything done. He just stresses me out lately. He ignores everything I need to do then wonders why there is so much to do. My actual manager sent an email to a bunch of the other assistants Friday & said we could go home. It was a nice day & we work hard so go home. It was like an hour early. I didn't even get to it until 30 minutes later...then my banker was all pissed because he was leaving & the office would be empty. I said she said I can go, I am leaving. I didn't change the management around here...I am doing what I am told. I cannot believe with everything I have going on he wants to give me shit. I am barely taking time off because saving time for appointments. I deserve a break.
Okay...I think I am done. Sorry guys...I just have a lot on my mind these days. And again I just want to cry all the time. I feel so stupid. I think if I am not pregnant this cycle, I am going to have to take some time off...I think I need it.
Okay...I think I am done. Sorry guys...I just have a lot on my mind these days. And again I just want to cry all the time. I feel so stupid. I think if I am not pregnant this cycle, I am going to have to take some time off...I think I need it.
Suzy18
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Suzy18
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So I had my OBGYN appt today. The last time he saw me he said See you next time when youre pregnant. And now it started with me saying Im here because Im not pregnant. Hes really great and asked all the right questions. He did an ultrasound and saw that my endometrium was ready for AF. Follicles in both ovaries, more on the left side, but no dominant follicle. He couldnt tell if I Od or not. So I started taking Provera today for the next 5 days to start AF. Then I will wait and have a natural cycle. If I dont O or AF doesnt appear, take Provera again for 5 days. And THEN, start with Clomid from CD2 until CD6. He wants me to start on CD2 to shorten my cycles. They tend to be a bit long, just look at my Ticker
Once AF starts next week, I have to get some blood tests for all types of stuff. And DH has to do his little test too 
. I asked if we could that and he absolutely agreed. So I will have 1 more natural cycle and 4 with Clomid. IF it doesnt work out he told me to go and see him again. He says he wants to refer me to the best professionals he knows. He even said that there are a lot of fertility facilities out there and it sounded like he wanted to protect me from quacks or something and send me directly to the right professionals. I really liked the way he handled things, hes very down to earth and practical but also kind and delicate with me. Once my blood work and DHs SA come back, well go and see him together to see if anything additional is needed.
But I have to tell you, I feel good about this. I mean, it feels good to take action and know that you can start controlling what happens with your body instead of just sitting around and wait for AF to appear in my case. Like most of you know, my cycles take forever and I never know when I O. Well thats not going to happen now. Im in charge of that! And Im glad to be getting the blood test and DHs SA. These are all more answers and problems we can solve or eliminate from the list of possible issues. So Im feeling pretty good right now. Although I must admit I have an underlying feeling of sadness because of the fact that I even have to do this. But Im not going to feel sorry for myself now. We are all in the same boat.
Oh and just in case, heres some more
. I asked if we could that and he absolutely agreed. So I will have 1 more natural cycle and 4 with Clomid. IF it doesnt work out he told me to go and see him again. He says he wants to refer me to the best professionals he knows. He even said that there are a lot of fertility facilities out there and it sounded like he wanted to protect me from quacks or something and send me directly to the right professionals. I really liked the way he handled things, hes very down to earth and practical but also kind and delicate with me. Once my blood work and DHs SA come back, well go and see him together to see if anything additional is needed. But I have to tell you, I feel good about this. I mean, it feels good to take action and know that you can start controlling what happens with your body instead of just sitting around and wait for AF to appear in my case. Like most of you know, my cycles take forever and I never know when I O. Well thats not going to happen now. Im in charge of that! And Im glad to be getting the blood test and DHs SA. These are all more answers and problems we can solve or eliminate from the list of possible issues. So Im feeling pretty good right now. Although I must admit I have an underlying feeling of sadness because of the fact that I even have to do this. But Im not going to feel sorry for myself now. We are all in the same boat.
Oh and just in case, heres some more
savvysaver
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Hugs, Beaglemom
Sounds like a rough day, and I agree...I dislike the dentist too. Last time I went they wanted to do the x-rays but it was the day after I got my bfp in December so I declined...guess I get to have done in June. I just wasn't sure if it was safe if I was prego and to be honest I am glad I didn't get them done because I would have been convinced it was what caused my m/c. I also have to get 3 fillings and have been putting them off since the winter. After the cost of the RE appointments, any GI procedures and the cost of my fillings I might be hoping to win the lotto!
I think either way it would be nice if you and your hubby could fit in a short vacation...would you be able to do something this weekend when you are both off work? Sometimes it is nice to go away, once my hubby and I stayed at a hotel about 20 minutes from our house. We got a hot tub in our suite and ordered take out and just relaxed. Even though we were close to home it really felt like a vacation!
savvysaver
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So as some of you know my hubby travels a lot for business in the summer. I think we missed some peak BDing times last summer. Over the winter he changed groups at work. So I asked him today if he knew how much he would be traveling this summer, I got all excited when he told me he wouldn't have to do any work trips. Then he says, he could be sent out of the country! I freaked out, at least if he goes somewhere in the US I could go with him...but if he travels out of the country I can't! He acts like it is no big deal, I just said I am not paying this RE thousands of dollars to have him jet off to another country during my fertile time! 
savvysaver
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So I had my OBGYN appt today. The last time he saw me he said See you next time when youre pregnant. And now it started with me saying Im here because Im not pregnant. Hes really great and asked all the right questions. He did an ultrasound and saw that my endometrium was ready for AF. Follicles in both ovaries, more on the left side, but no dominant follicle. He couldnt tell if I Od or not. So I started taking Provera today for the next 5 days to start AF. Then I will wait and have a natural cycle. If I dont O or AF doesnt appear, take Provera again for 5 days. And THEN, start with Clomid from CD2 until CD6. He wants me to start on CD2 to shorten my cycles. They tend to be a bit long, just look at my Ticker Once AF starts next week, I have to get some blood tests for all types of stuff. And DH has to do his little test too
But I have to tell you, I feel good about this. I mean, it feels good to take action and know that you can start controlling what happens with your body instead of just sitting around and wait for AF to appear in my case. Like most of you know, my cycles take forever and I never know when I O. Well thats not going to happen now. Im in charge of that! And Im glad to be getting the blood test and DHs SA. These are all more answers and problems we can solve or eliminate from the list of possible issues. So Im feeling pretty good right now. Although I must admit I have an underlying feeling of sadness because of the fact that I even have to do this. But Im not going to feel sorry for myself now. We are all in the same boat.
Oh and just in case, heres some more
Suzy, that sounds like a great appointment! I am glad you have a good doctor who is willing to do what he can to help get you pregnant!
Glad you are moving on with the provera and it is great you can regulate with clomid if needed the following cycle. I think you will be getting a bfp very soon!
beaglemom
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Savvy I hope your husbands timing isn't too awful. How long is he gone at a time?
If my insurance doesn't cover this dental thing, I am not doing it. I don't want to do it anyways.
It is hard for us to go anywhere overnight because of our dogs. Plus we are so burned out by the time weekend hits. Maybe I will try to do more around the house during the week so we don't feel obligated to clean on the weekend. Maybe have a good day trip or a nice night in of junk food & tv.
If my insurance doesn't cover this dental thing, I am not doing it. I don't want to do it anyways.
It is hard for us to go anywhere overnight because of our dogs. Plus we are so burned out by the time weekend hits. Maybe I will try to do more around the house during the week so we don't feel obligated to clean on the weekend. Maybe have a good day trip or a nice night in of junk food & tv.
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