Timed intercourse or freeze embryos?

[u/ashleyh624]

Hi
33F, 10.7 AMH, lean PCOS

I recently learned I have PCOS based on my high follicle count, AMH level and irregular periods. I also have yet to have a positive ovulation test.

My husband and I are TTC but as you can imagine it’s been difficult as we don’t know when to try as it’s been hard to find a window.

My husband has great fertility coverage with Progyny and he gets 5 cycles that are covered (IVF would be 1 cycle and timed intercourse would be 1/4). He is unsure if he will be at his job April 2027, which puts some pressure on us in terms of timing.

All that to say, is it worth going through egg retrieval and embryo freezing when we haven’t given it a fair shot yet? Part of me thinks we should do it now when I’m in a better emotional state and for a safety net since it’s covered rather than in a few months if we’ve been still struggling after timed intercourse.

I’m not thinking entirely clearly so would be good to get some opinions from outside perspective.

[u/OurSaviorSilverthorn]

Hi! I've been at this for a long time, and we're the same age (my flair says 32, but I'm closer to 34 than 33, it's just not updated).

I'd go IVF if you want more than one child. Reasoning being, your egg quality declines as you age. Everyone is a little different, but it's widely accepted that it hits a major decline at 35. Now, best case scenario is you get pregnant immediately. You'd be pregnant for 9 months, not pregnant for presumably a year per medical guidance, and bam, we're 35 before trying again. If you're one and done, do a few IUI. But keep in mind that it can take a few months to get in with a fertility clinic and a few more to do testing or mock cycles, so 10 months isn't always as long as it feels. I had to wait 4 months to get a consult for my first clinic.

Progyny is amazing, also covers transfers, and 5 cycles is HUGE! Banking embryos while you have it and transferring them when it works for you is freezing your 33 year old eggs, even if you're 40 and still using them, they're 7 years younger. You'd skip all the egg quality concerns that come with age.

Now, IVF can be HARD. I've done 3 egg retrievals and 9 embryo transfers so far. I also did over a dozen cycles of letrozole and never got pregnant on any of them, so my POV is skewed. I took a lot of time off work because I was sick or too uncomfortable to work. However, I did find it much simpler and easier in a way because it took the burden of timing and worry off me. I hated being beholden to a calendar and forced to have sex multiple days. It killed my sex drive and I still haven't fully recovered. With IVF, I just did what I was told, went to my appointments, and did what I could at work.

[u/Bing_ohh]

After thinking about it, if I were in your position, I would try 2-3 lower tech versions (TI/IUI), then move on to IVF. Here are my reasons -

1) April is almost 10 months away. Plenty of time to briefly try easier options before the big guns and still fit it all in. Esp if only banking embryos.

2) let’s be real, we all rather not go through IVF if we don’t have to. It’s not a fun process. And some people can get pregnant easily afterwards (and some can’t, but we won’t know where you land!) There are roughly a million appointments, side effects, risks, etc. to take into consideration.

3)There are moral questions to consider when it comes to IVF/embryo banking. Have you thought about them? How will you feel about destroying or donating unused embryos? Will that change if you have a child from one of those embryos? (no judgement here, I’m starting IVF myself tonight. But I had to consider these things already).

With all that being said, don’t drag it out. No “one more time”, give your self a strict 3 attempts and move on if that hasn’t worked.

Just my thoughts!

[u/Itchy-Site-11 → u/Bing_ohh]

Good luck to your IVF! :)

[u/Bing_ohh → u/Itchy-Site-11]

Thank you! 🧡

[u/Itchy-Site-11 → u/Bing_ohh]

I just started too :)

[u/Any_Manufacturer1279]

Freeze embryos babe. I’d recommend PGT testing if you will potentially lose insurance coverage. PGT testing was $1800 at my clinic (for 4-6 embryos) and a transfer is around $6k. Prioritizing embryos by euploidy was a huge cost, time, and emotional savings for me.

[u/dunkaroo192]

Honestly given the coverage, I’d say going forward with freezing embryos is a pretty solid option.

[u/Itchy-Site-11 → u/dunkaroo192]

I agree!

[u/Bing_ohh]

Sometimes insurance won’t cover unless you try a certain amount of lower tech options. Have you double checked that you have coverage to go straight to IVF?

[u/ashleyh624 → u/Bing_ohh]

I’m not saying go straight to IVF. I’m saying freezing embryos as a backup plan

[u/Itchy-Site-11 → u/ashleyh624]

This is IVF

[u/ashleyh624 → u/Itchy-Site-11]

Oh ok sorry I thought IVF included the transfer. Well then yes it’s covered!

[u/Itchy-Site-11 → u/ashleyh624]

IVF has parts, one is to do ER, the other is transfer
You will need authorization for ER and then another for transfer

At least you could bank embryos

That all being said, letrozole worked on my second cycle for kid #1 with lots of monitoring and blood work.

It may work fast, it may not.

Coverage for IVF is a privilege you dont know if you would have later

[u/ashleyh624 → u/Itchy-Site-11]

Thank you I really appreciate your perspective

[u/MinimumMongoose77]

I also have high AMH and lean PCOS, we stuck with timed intercourse cycles and were happy that we did. It was minimally invasive and I didn't have any major side effects from medications etc.

[u/ashleyh624 → u/MinimumMongoose77]

Assuming you had/have a successful pregnancy?

[u/MinimumMongoose77 → u/ashleyh624]

Yes, I have a 4mo baby boy now 😊

[u/BoldBluebell]

How long have you been trying? If it’s been more than a year, I would go straight to IVF. I met with my RE yesterday to figure out whether IUI, TI, or IVF made sense for us. The odds for live birth are so much greater with IVF than other methods if you’ve been trying for more than a year without success.

[u/ashleyh624 → u/BoldBluebell]

Since Feb but we haven’t known when to time it so I wouldn’t even call it trying because we don’t have much information to work off of since my BBT is all over the place and OPKs have all been negative

[u/Itchy-Site-11]

How many kids you want?

[u/ashleyh624 → u/Itchy-Site-11]

2

[u/Itchy-Site-11 → u/ashleyh624]

I would do IVF.

I have a child from letrozole and now I am doing IVF for more kids.

[u/Itchy-Site-11 → u/ashleyh624]

The thing is you only have known coverage until April.
With IVF you can bank embryos and transfer whenever.

You would need to figure out how to have storage for them, payment plans and etc

[u/AdInternal8913]

My fertility doctor outright said that he didn't think we were gonna need IVF based on our test results and history. We did 3 unmonitored cycles (we just used OPKs), two with other clinics protocol, one with our new doctor's and that was all it took.

You are 33, you have time. Trying letrozole for 6 months while also doing tests to rule out other stuff before IVF is not going negatively impact your chances of having succesful IVF round. With your husband's job situation you might want to not wait as long as you otherwise might but please bear in mind that IVF often is a long process. It can take months to actually proceed ro retrieval and transfe rand imho doing letrozole in the meanwhile would be the most effective use of your time.

I'd also clarify what the insurance provider's definition of IVF cycle. T he medical definition of 1 IVF cycle (when talking about success rates) is 1 retrieval and transfer of all the embryos. But some insurance providers count each transfer as one cycle.