I'd been told the place was a well-oiled machine, and we definitely got that feeling the minute we walked in. Everything was very efficient, but my husband and I agreed later that we felt very at home and comfortable there. I was even joking around with the receptionist. We did have to wait about 25 minutes to see the doctor, but I've been so downtrodden by Dr. S. that anything less than an hour seems like heaven to me.
We met the doctor and went over my records. (Let's call him Dr. Silver Fox, since he is silver-haired, mustachioed, and sleek.) I went over the details of my three canceled cycles, and Dr. Silver Fox said, "So basically, you haven't really done anything yet." I blinked, then had to agree. Yet again, that depressing thought--seven months of treatment with nothing to show for it.
He wasn't that surprised that I didn't have a very good response to Clomid--"It's just not that good a drug," he said. The lining-thinning side effect that Clomid can sometimes have is a particular concern in my case, he said, because "with unicornuate uterus, you want a really nice thick lining." So initially, he said that while we could do more cycles on Clomid if we really wanted, he'd recommend going to injectibles, which he feels work much better. (Since the main issue so far seems to be getting me to ovulate, and my husband's sperm analysis looks good, he didn't think we needed to go to IVF yet--same analysis as Dr. She.)
We then headed for an exam room--my husband was reluctant to come along, but Dr. Silver Fox strongly encouraged it. They have a 3-D ultrasound machine there, and Dr. SF wanted to check out my uterus for himself. (He also threw in a Pap smear and cultures while he was down there.) It was weird but cool seeing my uterus--it really does look like a long tube, or a banana. Also, based on the appearance of my left ovary, I had definitely ovulated (about one week prior, by my reckoning), making it infinitesimally possible that I could be pregnant.
After looking at everything, we went back to Dr. SF's office and talked some more. He suggested doing a Clomid-Follistim combination. In this hybrid cycle, you start with Clomid (days 3-8, like usual), then add low-dose Follistim. As he explained it, this allows us to have the best of both worlds--a low number of follicles, like Clomid (highly desirable for me, since high-order multiples in particular are a very bad idea with my uterus), but with the extra stim factor of Follistim. And the Follistim also counteracts the lining-thinning effects of Clomid. Basically, Clomid does the work of selecting the follicles, and Follistim juices them up.
I always like a creative approach, so I was sold. (I think my poor husband was still traumatized by the dildocam--he wasn't saying much at this point.) We decided that, provided I'm not pregnant already (ha!), I'll go in for day 3 bloods, then start 150 mg of Clomid (days 3-8). We can start the Follistim anywhere from day 9 to day 12, so I'll go in for a wanding on day 12, and if not much is happening, I'll start 75iu Follistim daily, with monitoring every other day.
I left feeling pretty good about the doctor and the offices. And I talked to the insurance coordinator on the phone the next day and she was soooo nice--very key, because insurance discussions frequently reduce me to tears and mean billing/insurance people do not help. My husband also said that this was his favorite place so far: "It just felt more accommodating."
The one thing that bugged me a bit was that, when we were talking about risk of multiples, selective reduction, etc., I said, "We really don't want to have to do selective reduction," and Dr. SF sort of rushed over it, saying, "Oh, sure, no one wants to do selective reduction." I brought it up later (12:30 am) to my husband, who pointed out, reasonably, "Well, you didn't explain why we don't want to do selective reduction." I was worried that it meant Dr. SF wasn't really listening to me. But I've decided to go with the flow for now. My husband and I both liked him otherwise, and really liked the clinic, and I like that I felt like Dr. SF thought about what would really be the right protocol for me given all the different factors. At the end of the day, if I see three fat follicles on my right ovary on that ultrasound screen, I have the power to say, "No, I don't want to go ahead this cycle." And I will keep emphasizing this to Dr. SF and whichever other of his colleagues I see at my monitoring sessions.
I did ask about single embryo transfer, and he said that it drops the success rate to "only" 40 percent, versus 60 percent at their clinic with two embryos transferred.** I'll take that.
So now, we wait. I should get my period no later than Wednesday, based on OPK and temps. And then we're off.
*Even though I knew it was likely I wouldn't be doing IVF just yet, of course I combed the latest (2003) CDC statistics to compare. Of the three clinics I was comparing (including my first clinic, Heinous Clinic of Evil), Clinic C had by far the highest success rates in my age group, with the most singleton pregnancies and lowest average number of embryos transferred (important for me, since I will likely do single-embryo transfer to avoid taxing my freaky uterus with multiples). Their FET rates are also the best (again, important because even if I get more than one embryo out of IVF, I will only transfer one and keep the rest on ice).
**I double checked: In 2003, 63.6 percent of all transfers for under-35s at Clinic C resulted in take-home babies, with an average of 2.3 embryos transferred. That's even better than the super duper famous Clinic Amazing, also here in Big City (yes, you've definitely heard of it).