Saturday, July 11, 2009

Some good news, and something else to consider

I had my consult with Dr. D yesterday, and learned a few things, including a nice surprise. First of all, he said that he thought I responded well to the meds, especially considering my FSH. In any IUI candidate with injectibles, they hope for four to five good mature follies, and I had five. That was probably more than they expected to happen with someone who 1) never produced more than one follie on oral meds, and 2) has an FSH of 14. So he said that was the bright side: I responded well. In fact, he said he'd consider me a candidate for IVF. That surprised me - I asked him what their FSH cutoff was, and he didn't give me a firm answer, but just said that they had no reason to believe I wouldn't fare well in an IVF cycle. However, he did recommend we go with "a couple more" IUIs first, mostly because I had already had a successful pregnancy with IUI in the past.

We talked a bit about the financial aspect of this decision. I am lucky enough to have decent coverage, but I am working with a lifetime max on infertility. Unfortunately, I have no idea where I am with that lifetime max, and the insurance company hasn't returned my call yet. But Dr. D. said that if I have the funds remaining, let's go with a couple more IUIs and if we're still trying we can move on to IVF. He said I could think about moving right now to IVF (to get more bang for my buck, so to speak), if my insurance funds are running low.

I honestly had never thought I'd be a candidate for IVF, so this is a lot to consider. It was sort of safe to know that we'd do a few IUIs and then move on from fertility treatments ... this is a whole new thing to consider. And not just financially. More on that later, I suppose.

We discussed a couple other things. He took the time to answer my questions that I had from this cycle, namely around the follie sizes. I always thought follicles had to be 18mm in order to ovulate, but we triggered when mine ranged from 13mm to 17mm, and he said at that point that I had already started to ovulate on my own. He confirmed yesterday that follicles on Gonal-F are mature when they're smaller in size, and can even ovulate on their own when they're 15mm and more. He also confirmed that a slightly shorter LP is normal on these meds than on Clomid and natural cycles. And lastly, I asked him about going back on Avandia. We went back and forth, during which he told me that being 20 pounds over my ideal weight doesn't make me "obese" (ok, I never said I was), and that even for really overweight folks, being on Metformin or Avandia doesn't necessarily offer any increased advantage in getting pregnant (according to recent studies). But we ended with him giving me a script for Met, because it was part of what worked last time for us, and he said "it probably can't hurt." I am on Met now, and not 100% wholeheartedly, for a few reasons. I'm not even sure I need it, but just felt this desire to ... well to try everything and anything, I guess. I used to be polycystic, and I had insulin resistance, which is why I was on Avandia last time. Now, I'm clearly not polycystic any longer (in fact, I have a low antral follicle count), so will this really help? I have no idea. For now I'm taking it, and I'll figure out to continue or not based on how my body takes to it.

Another marathon post. I'm going to do my best to come up with something short and sweet next time. :)

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