Question 45. How would I know when to pursue more advanced fertility treatments?

In the Kenny Rogers song the gambler there is a very famous line "you gotta know when to hold them, know when to fold them, know when to walk away, know when to run...." Sometimes I think about that line when counseling patients, but fortunately for them I never break out into song during a consultation. Deciding when to move onto more advanced treatments is a common concern among most fertility patients. Even those that start with IVF have to consider moving to donor egg/embryo if success is eluding us. I wish that I had that crystal ball to provide a glimpse into the future. That way I could advise patients "Don't worry, I know the 3rd IUI will work or the second clomid cycle or the first IVF or the FET or whatever.....But I don't have that ability...and if I did I would have used it to play the Powerball lottery and then it would be "see-ya later."

In general, most successful treatments will occur in the first 3-4 cycles of whatever treatment has been chosen. It can be hard to hold my tongue when a patient describes 18 months of continuous clomiphene or 9 clomid / IUI cycles or 7 FSH /IUI cycles etc etc.

No one wants to be a professional fertility patient....there just isn't any money in it. But seriously, most couples/individuals can only take so much disappointment before they throw in the towel and consider alternative paths to parenting. So if you don't have a Magic Eight Ball handy....how do you know when to "fold 'em" and move on.....well that is the Question of the Day from the 2nd Edition of 100 Questions and Answers about Infertility.

P.S. Princeton lost to Kentucky by 2 points.....oh well.


45. How would I know when to pursue more advanced fertility treatments?

The decision to seek out more advanced fertility treatments is a complex question, and multiple factors must be considered when making it. For most couples undergoing treatment with IUI (either alone or with fertility drugs), the best chances for success usually occur within the first four treatment cycles. After that, the likelihood for pregnancy decreases. In many of our patients, we recommend only one or two IUI treatments. If these efforts are unsuccessful, we suggest that the couple proceed with other more aggressive treatments including both Natural Cycle IVF and traditional IVF using injectible fertility medications.

For some patients, IUI should rarely be utilized. For example, those couples with severe tubal disease, severe endometriosis, pelvic adhesions, or severe male factor infertility may do best by directly proceeding with IVF as their first treatment option. If an age factor is present or if the couple has prolonged infertility (infertility lasting more than 5 years), we often recommend IVF first, as well. Remember that IVF is the only treatment for which even a failed treatment cycle provides some insight into a couple’s fertility potential. IVF does allow us to make some assessment of egg quality, fertilization and embryo development. A failed IUI cycle yields no such information as we only know that the cycle failed but learn nothing about fertilization, embryo growth or embryo quality.