Reining It In

Our appointment with Dr. C. went well this morning.  It was so much fun to show Goldie off to everyone.  The front desk people and the nurses cooed over G more than adequately – I imagine they must love the success that babies represent after seeing so many tears everyday.  I had a surge of anxiety this morning over bringing her into the office but, luckily, no one else was in the waiting room and we hardly saw any other patients in the halls.  I know I hated seeing babies at the RE and I would have felt bad marching her around a full waiting room.  Fern joked that we should make her a sign saying she took three years to conceive.  When we were walking out with Dr. C. after the appointment we saw our favorite nurse and Dr. C. said, this is Goldie, and promptly started listing her IVF stats - an 8 or 10 cell, grade four, perfect 3 day transfer.  I found that so endearing.  Yes, our Goldie had a long road here.

No one was more excited about Goldie than Dr. C.  We spent a good part of the appointment talking about Fern’s pregnancy and complications and we got some gentle ribbing about our sleep situation.  After listing the IVF stats to the nurse, Dr. C. was like, and they NAP with her in a CARRIER.  Can’t do that with two babies!  Coming from anyone else I would have been annoyed, but Dr. C. can do no wrong, I’m pretty sure.  Also, she admitted that they coslept with her daughter until she was 4 or 5 despite many efforts to get her out of their bed, so clearly she understands a difficult sleeper.

Our plan for me is a tiny bit slower and less aggressive than I had wanted, but, after thinking about it today, it seems really appropriate.  We are going to start with a non-insem test cycle – resting follicle, thyroid, prolactin, progesterone, AMH and then get an HSG before the first insem cycle.  Because of the cost of doing all this at Dr. C’s office, I am going to schedule a dummy appointment with the Kaiser REs and tell them we’re inseminating there to see if they will order the AMH, day 3s, HSG etc. at Kaiser (we’d still do resting follicle at Dr. C’s).  I don’t like the delay this creates (I’m worried Kaiser will be booking far in the future), but it saves us thousands (ugh) so it’s worth it.  We’re worried Kaiser won’t order everything without demonstrated infertility so Dr. C. thinks we should play up our finite sperm (and maybe report that we have fewer vials than we even do) – as in, we have to make this work on 4 tries so we want to know any problems beforehand.

I had all of the above tests done in Sept. 2010 and they looked strong for my age.  If I haven’t deteriorated significantly and still look good overall, Dr. C. wants to start with 3 unmedicated IUIs.  If we had been starting inseminations in 2010, that’s what she would have recommended.  I had been thinking 1 unmedicated, but the doctor told us that in an otherwise fertile person clomid only increases the twin rate and does nothing to increase the pregnancy rate.  Fair enough.  After 3 unmedicated we’d go to clomid, most likely.  I asked about going right to injectibles but, again, she said that would only increase my multiples rate.  Apparently there is a newish study that’s showed injectible pregnancy rates lower than previous studies had found and lower than most REs quote – rates were more similar to clomid.  But the multiples rates with injectibles in the study were still high.  The lower pregnancy rate is possibly due to doctors no longer inseminating with an injectible cycle when 5, 6, and more eggs are present.  When there were fewer eggs, injectibles didn’t outshine clomid as much.  Anyway, I might not be explaining it well, but I appreciated her reining in my enthusiasm a bit and prescribing what she sees as medically best.  If I can get pregnant without fertility drugs that would really be my preference anyway.  She said if my progesterone is low during the test cycle or there are other alarms with the tests then I should start with clomid.

Since we’re ttc vets Dr. C. just threw around acronyms and protocols left and right.  I very much appreciated this but, man, how quickly I’ve forgotten some of it!  When she said HSG I was wracking my brain – was that the trigger shot or the tube x-ray?  Since I’m me (stubborn/proud), I didn’t want to ask and seem like I couldn’t remember and then have her explain everything else for the rest of the appointment so I waited for some context clues.  I guess it’s a bit of a relief that all that stuff didn’t make a permanent home in my brain.

Anyway, all of the doctor’s study citing and straight talk is comforting to me and I trust her opinion.  If I can get in at Kaiser soon then we might be able to start inseminating by July.  I was initially disappointed that we’d have to wait this long, but now I feel a little relieved that I’ll have some breathing room.  And July isn’t that far off anyway.  Dr. C. said more than once that the 8 vials of sperm that we have is plenty.  I sure hope she’s right.

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