Saturday, April 01, 2006

Miscellaneous

We had our consultation with an RE at Clinic B on Thursday. I'm still processing, and will post at greater length when I've had my Clinic C consultation and my followup with Dr. S--I need some comparisons to put it all into perspective. But to summarize: I liked her (yes, her!) well enough--she was very businesslike but friendly, and I found her pretty easy to talk to. The clinic seemed reasonably well run--we got there at 2:15 for a 2:30 appointment (they asked us to come early to fill out paperwork) and were seen at 2:40. Nurses seemed nice, and took a lot of time explaining to me what we'd need to do should we decide to cycle there. One stress--the clinic is located in an office building right across the street from mine, the same building as the radiology lab where I had my HSG and MRI. I happen to know a lot of people who work in that building (people in my industry). Every time I've gone in there, I've been worried I'd run into someone I know in the lobby. Worse yet, I discovered that the elevator opens directly into the waiting room of the clinic, where you can see the words "women's reproductive care" very large on the opposite wall. Can you imagine riding the elevator with a work acquaintance and stepping out into that? Not sure I could take doing that 2-3 times a week.

My big concern was treatment recommendations. I believe my question to her was something along the lines of, given that I only have one tube and that we want to avoid multiples at all costs, are we kidding ourselves if we continue trying IUI? Should we just go straight to IVF? But she said no, she'd actually recommend I try a few more cycles of Clomid IUIs. I haven't had any Clomid side effects, and despite the fact that this cycle produced a follicle on the wrong side, she said because I am still young (32), and because my lack of regular cycles is what's really at the root of my infertility, it's worth it to keep trying. She'd keep me on the metformin--even though it hasn't had any noticeable effect, I'm tolerating it pretty well now (after a gruesome first month or two, the last few months on it have been a piece of cake, relatively speaking), and there's very little downside to staying on it, and big potential upside (lower risk of first trimester miscarriage, better embryo quality if I go to IVF). After Clomid, she said that she'd recommend low-dose injectibles--so Dr. S. isn't crazy after all, I guess. "Low and slow," she said--while most women on gonadotropins do 9-10 days of stims, she says she'd put me on a very low dose (say, 75 iu of Gonal-F to start with) for a couple of weeks and monitor very carefully.

Basically, her philosophy is that if there is no urgent reason to go to IVF (age, no tubes at all, etc.), "if you can possibly get pregnant without it," as she put it, it's good to exhaust all other options first. She kept reiterating that I'm young, my FSH level indicates my egg quality is probably fine, and although the risks of IVF are small, they are real, so why not give the less aggressive options a shot? Again, I'm not really sure how I feel about that. On one level, it's reassuring to hear that I have plenty of time, biologically speaking. But I've already been trying for two years, I'm frustrated, I just want to kick things into gear already.

Will post more thoughts about this after the 10th, when I have my Clinic C consultation.

Thursday night I had dinner with a very good friend of mine who I hadn't talked to in several months--since before the whole Thanksgiving debacle. She is a DES daughter and has had associated health issues, and though she's not actively TTC herself, we've talked a lot about infertility and she's the one person I know in real life who understands what I'm going through. It was sooo good to see her. We had brightly colored cocktails and too much food and talked and talked and talked. I started laughing when she said, "And can I just say that EVERYONE I KNOW IS PREGNANT?!?"

What else...oh yes: The RE at Clinic B (let's call hr Dr. She, in honor of the singularity of her gender in a world of asshole male REs), after hearing that I had a 15 mm follicle on Monday, asked if I was using OPKs. I said no, we'd decided to scrap the cycle--I'd just been charting BBT so I'd have an idea when to expect my period. Dr. She said, "Well, it's a very slim chance, but it is theoretically possible. Everything is kind of crowded together in there, and your right tube could pick up the egg. It couldn't hurt to try." So I have been watering OPK sticks and checking CM for the past couple of days. I'd thought I'd missed it yesterday, when my BBT went up a little, but lo and behold, this morning my BBT went down again and the OPK showed a strong positive. I dutifully seduced my husband, much to his surprise and delight--I didn't tell him about the OPK, so he probably just thinks I was overcome with lust, a rare occurence these days.

I don't want to get my hopes up--the chances are so, so, so slim--but it's really hard.


**ETA: One thing that really bothered me about Dr. She: When she looked over my bloodwork from 1993 (the results that got me diagnosed with CAH), she said, "Well, looking at your 17-OHP levels, you weren't in range for CAH. I wouldn't have diagnosed you with it." She showed the results to another doctor there, who concurred. But here's the thing: That lab expressed results in ng/ml, so my number was 190. However, the scale more commonly used today is ng/dl, which translates to 19,000. Now, 190 ng/dl would be a normal number. 190 ng/ml, however, is way, way out of normal range. Every doctor whom I have ever shown this bloodwork to has figured that out right away, including Dr. S. Heck, I was able to figure that out in about one minute, and I have no medical training beyond a few college chemistry courses and a degree in Googleology. So what does it say about Dr. She (and her colleague, who is supposed to be one of the top REs in the city) that neither of them noticed that? And what does it say about me that I didn't point it out to her?

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