Thursday, May 12, 2011

The Plan

Sorry its taken me a few days to update since my appointment. Honestly its taken us a little while to process things and decide what we're going to do. Let me explain.

It starts with the number 2.2. My AMH is 2.2. Right smack in the middle of normal. I have great egg reserve, and though I may have PCOS, if I do its so mild that it shouldn't affect my ability to conceive. So lets re-cap for a minute: I have enough eggs, I have two patent tubes, we have enough sperm, I have a normal uterus, and I do ovulate. So, whats the problem? The only identifiable problems are: I ovulate later than normal which could mean its not a strong ovulation and therefore cannot turn into a pregnancy, and/or my uterine lining is old when a fertilized egg enters the uterus it cannot attach. I have had one miscarriage, called an ectopic pregnancy only because the baby never made it to my uterus. This was extremely uncommon and has been written off by two different doctors as "a fluke." To me (and my RE agrees), that means that I need something to make me ovulation sooner. The #1 solution to that is Clomid, which for me, worked 1 out of 3 times. Conclusion: Clomid doesn't work for me.

After going over all of this, my RE still recommended IVF. To me, in the spectrum of fertility treatment, its a huge jump to go from oral medication to IVF. For my husband and I one IVF cycle will cost close to 9000.00. Holy Shit. That's a lot of money. The RE's rationale was that because I didn't react to Clomid, I would probably need injectable medications which can be about 300-500 bucks a cycle, I think. Plus the cost of IUI (intrauterine insemination) is about 500.00 making one cycle about 1000.00 or so with injectable medication. IUI is not nearly as effective as IVF, and the advantage of IVF is that they manipulate fertilization in a lab, so if there is an egg or sperm or sperm meets egg problem, they'll find it. If IUI fails, they cannot tell why it failed.

As much as I kind of thought I wanted to go to IVF, knowing that with my minimal issues it will probably work, once it was offered to me, I panicked. The RE told me he would do whatever treatment I wanted, but that his recommendation based on overall cost, and statistics was IVF. He did say that I had time to continue to try on my own, and could revisit IVF in a couple years because I have good egg reserve, so I'm not- in a sense- going to "run out" of eggs for a long time.

The bottom line, after a few days of soul searching and talking with my husband about where this journey has taken us is: we're not ready for IVF. I am also not very happy with my RE because his office has made several mistakes in their communication with me about costs of tests, they made me drive to my last appointment because they said they needed to see me in person, but my RE once I got there said that was wrong. I just don't know that I would trust this office to monitor me during an IVF cycle, if I ever decide to go that route.

I called my OB/GYN (the original doctor I was using who was treating me with Clomid) and asked for his help. I told him we wanted to try a couple of cycles using Femara, which is also a pill like Clomid, but works in a different way. It is used in women who don't respond to Clomid, and works to provide ovulation in a "normal" timeframe which would be on CD 14-17 (my ovulation is on CD 23-25). He agreed to work with me on a couple Femara cycles. He also said that if I was wanting to try IUI (recap: IUI= intrauterine insemination, so sperm are washed and the best ones are put directly into the uterus) he could perform that in his office as well.

So, we are going to take the summer to try Femara, and possibly do an IUI. Then, if after the summer I still haven't conceived, we will go to a different RE for a second opinion.

Whew, its been quite a week. Lots of crazy things have happened to me this week, and to people in my life. But we are almost through, tomorrow is another day, in the words of Dorie, "Just keep swimming."

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