Friday, December 18, 2009

A lot to consider

I met with Dr. D today, to talk about what went wrong, next steps, and options. What went wrong? One thing: my eggs. "You just can't get around egg quality," he said. I asked what my highest FSH was ever with them, and he said 14. Terrible, right? Except that 3.5 years ago, I had an FSH of 13, and got pregnant with IUI and tamoxifen. My first IUI, by the way. He responded that an FSH needs to be considered along with a woman's age; so, an FSH of 13 in a 34-year old is a much better consideration than an FSH of 14 in a 38-year old.


I asked if there was anything else to try, anything that might lead to a better response, and he said no. They started me at a fairly high dose of meds already for this IVF, and unfortunately there's just no other combination or protocol that he thinks would lead to me producing more eggs. No tricks up their sleeves. I was sort of hoping for another shot, but honestly - truly - knowing that IVF is off the table is a good thing for me. At least I know.

Then he said what I was secretly hoping to hear. He said, "we could try more IUIs. I have no objections to that, and in fact, what if we tried an IUI with tamoxifen?" (Tamoxifen, for those of you who aren't familiar, is like Clomid, but a much smaller dose.) Then he said, "now, wait, I know you're going to say that this is like taking a step backwards..." Um, no. It's exactly the option I was going to ask him about next. I told him I'd been thinking of that, and asked him if maybe there was a benefit of fewer eggs in response, like maybe there'd be higher quality with less quantity. He replied that he has never seen any data to support that, but that his embryologist swears that the outcome she sees is better for women with high FSH on Clomid rather than injectibles.

I also asked him about my tubes. What if they're blocked? What if my endometriosis came back, but more this time? I had an HSG and a laparoscopy previously (when I got pregnant with my kiddo), but this time around I've only had an SHG. We talked at length about this, because I had a terrible experience with the HSG (I swear it hurt worse than my epidural-free labor and delivery). He said that the clinic's Physician Assistant does all the HSG's, and "she's rather good; of course I'm sure you'll feel some pain, but I would guess that it's not going to be like what you felt before." I wouldn't be surprised if it were a walk in the park compared to the one I had before; that guy was an oaf, twisting and turning me on the table, cursing my cervix, and generally acting like an ass. Dr. D even reminded me that some believe that fertility is enhanced in the few months following an HSG.

We also talked a lot about the option of donor eggs. I told him we were absolutely open to the idea, but it was the cost that was prohibitive at this point. He advised that I talk to his insurance person, because she could outline the costs more specifically - taking into consideration my awesome insurance coverage (albeit without donor coverage) - so that we can make an informed decision.

In the end, he kept repeating that there's nothing to suggest that I can't get pregnant. He told me that they've had women with an FSH over 20 who got pregnant successfully. But, he also said a few times that IVF is not going to be the way to go for me. He said something like, "It's too much to go through, too much stress on your body, your time, and your wallet for you to go through that." Apparently for women like me, IUI has about the same chance as IVF (which, yes, is very small, but still a chance), so he wouldn't recommend IVF at all any longer. I asked him at what point he'd cut me off from treatments, and he replied that we could try the HSG and then one - maybe two - IUI's, and that would be all he would recommend. He even stressed that we could be that rare couple that gets pregnant on their own. I liked his attitude - stressing to me that it's not impossible, but yet reminding me to be realistic about our chances.

Clearly, we have a lot to think about. I'm no less confused about our next steps than I was before, but I have to repeat that it's a relief that we know what roads we won't be able to go down. I plan to get through the holidays, and decide what happens after the new year.


  1. I would tend to agree. I am a perfect example in that it was easy for me to get pg on IUI's. BUT, not ONE IVF worked for me... even with DE. Something to think about.

  2. I love that your doc is not trying to shove high-cost IVF down your throat! He sounds like a really reasonable guy who is looking out for what's best for you.

    Personally, I would probably get another lap if I were you (providing it is covered by insurance). They can also flush the tubes while they are in there, and it's much more effective and reliable than an HSG. I had a friend who had an HSG, they told her that her tubes were clear, so she did a couple of IUIs. Then they did a lap and found they were BLOCKED! They were able to fix the problem and she conceived on her next IUI. So when I was going through it, I insisted on a lap before my IUIs. Just a thought. :)

  3. Well, this was an educational post.. thanks for the expanation. I, too, am glad that your RE is being upfront with you instead of having you throw a ton of money down the IVF rabbit hole. I hope this new info sits well with you and that your new plan comes into focus soon.

  4. Thinking of you as you try to determine your "next steps." :)

  5. I'm glad to hear that you were able to have a good conversation with your doctor about your options. When it's someone you trust, it can be very clarifying, even if it doesn't make the decision for you. I hope that you can get clarity on your next steps in January.