Thursday, July 23, 2009

Options, lots of them.

I don’t even know where to begin, because my head is spinning. An advance warning to anyone reading this, I’m preparing to just write this as stream of consciousness, so I apologize if I just flit from topic to topic.

Our appointment went well and I feel like we’re finally getting somewhere with people who will listen to us and try to help us solve this problem.

Turns out I’m a terrible Clomid candidate because Clomid thinned my lining so drastically that even if an egg were to fertilize it wouldn’t be able to implant. I’m so glad we didn’t go back to the gynecologist’s office this month because they were going to do another Clomid/hCG round and it would have been futile. I’m angry that no one looked at this issue and suggested an alternative. But I’m trying not to focus on the what ifs and just move forward.

We are unexplained infertile.

We have a few more tests to go through, some bloodwork, an ultrasound to check my ovarian reserve, an SHG and a repeat SA – more for specific diagnostics than for any issue. Joe’s first SA was outstanding, so we're not really sweating the next one. All of our upcoming tests are pretty low stress.

We’re definitely taking this month off. And my cycle which should start August 13 will be a monitored normal cycle. I’ve elected to use no drugs for that month. We had the option, but I want the RE to look at my body and evaluate what it does on its own, versus looking at what it does on Femera or some other ovarian stimulator. If we are going to find out what the hell is going on in there, then doing a medicated monitored cycle wouldn’t be all that helpful.

On any given cycle we have a 15-20 percent chance of conceiving (although the PA said that our chances are more likely 10-15% since we've been TTC for over a year with no success). The goal of our treatment is to up those odds, so here are our options with the chances of success that we were given, along with the pros and cons of each option. I'm going from memory here, so pardon my lack of details.

1. Monitored cycle(s) of Femara with hCG trigger and IUI/TI – chance of success 15-20%. Pros – stronger ovulation, better timing, they’re cheap, covered by insurance and more effective than natural conception. Cons – doesn’t guarantee a success, may take several months before the desired outcome is achieved.

2. Gonadotrophins/Injectibles with hCG trigger and IUI/TI – chance of success about 20-30% Pros – more aggressive than Femara, better chance of success Cons – extreme instances of HOM, ovarian hyperstimulation, possibility of cancelled cycles, possibility of cysts.

3. IVF (with gonadotrophins, ICSI) – chance of success is 50% Pros – best bang for the buck, fully covered by insurance, less chance of HOM because they will likely only implant 1 or 2 eggs back in my uterus based on our prognosis. Cons – ovarian hyperstimulation, possibility of cysts, using up our entire IF (lifetime) coverage on our first child.

We were told most people with unexplained IF do 3 rounds of Femara or Clomid/hCG/IUI, 3 rounds of injectibles/hCG/IUI and then move onto IVF. Because we are fully covered through any course of treatment we were given the option of doing any combination we want or to just skip right to IVF.

If we choose to be less aggressive they are going to do laparoscopy on me to check for endometriosis. If we go straight to IVF they will not bother with the laparoscopy because if they find something they’ll just go to IVF anyway, and since IVF circumvents laparoscopy then it’s not necessary.

Um, that’s all I can remember for now. We have a lot to think about. We won’t be starting ART until the second week in September so we have a while before a decision needs to be made. I think it depends on how aggressive we want to be. But we're so lucky that IVF is covered by insurance. For once we'll be making the decisions and not having financials or extraneous circumstances deciding for us. I’m just glad that we have a very long car ride tomorrow to hash some of this out. It’s a lot to think about. Our timing for a vacation couldn’t be better.

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