We just returned from our appointment with Dr. Y for our first serious discussion about IVF, as in actually considering doing it. First, I’ll say, it went better than I had expected. Why is this? I’ve met other people that had recommended Dr. Y and said they liked him because they were able to communicate well with him, so I guess I went into my first appointment (back in November 2013) with high expectations. I have to say I was disappointed- he didn’t seem to be familiar with my test results, my story, I felt like he kept saying the same thing over and over again and didn’t really answer my questions. Also, I missed the best timing window with my schedule to do our first injectable IUI because no one mentioned I’d have to take a “class” about it first. So why, after visiting and moving on from 2 other REs previously, have I stayed with him? Well, because we now have Kaiser (the only insurance plan offered by my husband’s work that had any infertility treatment options AT ALL), and there is only one other RE to choose from and they work in the same office so it seemed awkward to ask to change, plus I really liked his nurse, and she was the person I was often in contact with the most. I haven’t actually talked to him since January since we did our second injectable IUI completely with the nurse practitioner- who I also liked. So, this was why I was a little concerned that things wouldn’t go well. But, thankfully, it was much better today than last November!
He was on the verge of suggesting we do another injectable IUI cycle despite my crash in AMH last month when we filled him in on our/my scheduling conflicts. Basically, I’ve agreed to teach a class at a University 2 hours away that includes a 5 week stay on an offshore island starting in October and going through the holidays. This means that if we don’t do IVF now, it will be at least late December/January until I can consider it again. For the past 3 years I’ve taught a class at this same 2-hour-away University from January to March, so if I taught this class again, that would mean no realistic window for IVF until March/April. With my numbers, waiting that long just seems to everyone involved like a pretty bad idea. Dr. Y was not totally discouraging about waiting at first, but then he agreed that it wasn’t the best plan for our hopes of a good outcome from IVF.
So, on with the details: He suggested a kind of hybrid between his 2 go to protocols based on my numbers and my response to our injectable IUIs. It would look something like this:
- Start estrace on day 19 of this cycle (today is day 1), and an androgen (around the same time?) for about 2 to 2.5 weeks
- Do the saline sonogram, cyst check, follicle count, and trial “mock” transfer all in one after my next period.
- Assuming all went well, I would start menopur and follistim for about 10 days
- Do the retrieval and possibly fresh transfer, or consider freezing until later depending on how all of the above turned out with the timing etc.
It’s a hybrid because the androgens and estrace (phase 1) are usually done with a low dose protocol for people with an expected smaller number of eggs to get fewer but better quality. Instead of following that stimulation protocol I’d be combining it with the normal high dose protocol of menopur and follistim (phase 2) to try to get a better follicle number (from phase 1) and then get as many of them as possible to develop into retrievable eggs (from phase 2).
So what does this mean for us?
1. The timing is going to be REALLY close to get this all in before I start teaching (we estimated the retrieval and transfer would fall right around the first week of class (perfect- insert sarcasm here)
2. It’s certainly not the “cheapest” protocol (I place in quotes because nothing associated with IVF is cheap in my book- if only our insurance actually covered it or we lived in a state where it was covered!!). Follistim is (from what I understand) one of the more if not most expensive IVF drugs. Plus we are adding in the “priming” drugs taken in advance. So, it’s clear we’re not going to be on the lowest end of the range they give for cost, but we will get more detailed information as part of our next step- speak with the cost professionals at the facility where the IVF will actually take place. Although not the cheapest, I do think it may be the right thing for us if we want to really give this our best shot and hopefully never have to go through it again!
3. He estimated our chance of success somewhere in the 40-60% range, though he emphasized it “could be higher!” This is not as bad as I was expecting based on the DOR success rates I’ve seen, which are pretty dismal- I’ll compare in a future post.
4. We guess this means actively trying not to get pregnant this month (as if that’s a likely problem!) so I can start the meds on day 19- we realized after we left that we should have specifically asked this!
5. It’s really decision time. We need to let them know within the next week or so if we are going to definitely go forward with this. Time to do some more soul searching and come to terms with our decision and all of its complications (like pumping myself full of hormones when I should be focused on getting ready to teach! And knowing that IF it works, I won’t be able to dive while I am on the island- which I would be expected to do otherwise, and IF it works, trying to make it to monitoring appointments by coming back to the mainland, meanwhile giving myself progesterone shots through the two week wait and while I’m on the island- I thought the suppositories were bad, I’d take those over shots any day!).
My brain feels a little fried right now, I guess I’m glad we have a little more time to think about it all, but it kind of feels like the calm before the storm. Like there’s something else I should be doing to get ready for this, not just drifting along until day 19!