Update again
Dr. SF did call me back yesterday--I was out all afternoon and evening and so couldn't update. Then this morning Blogger wouldn't let me post--grr.
As I predicted, he wants to go to a straight Follistim cycle. Since I'm continuing to get only one follicle on Clomid, even on a higher dose, and there's a good chance that on another Clomid cycle, I'll get the follicle on the wrong side again, he feels it's best to stimulate both ovaries more in the hopes of getting one good follicle on the right side. I'm totally on board with that, but I did tell him that my concern with injectibles is the risk of multiples (remember, even twins are a bad idea with my unicornuate uterus), and I made it clear that reduction is not an option for us. He said that the dose of Follistim he'd start me on (100 IU) is very low, so the likelihood of overstimming is also low. He also said that two follicles does not necessarily equal twins--in fact, "With two follicles you're still more likely not to get pregnant at all than you are to have twins." But he said it was totally up to me if I wanted to try another Clomid cycle. I said I was willing to try the Follistim and see what happens, and he said we can of course always cancel if there are too many follicles for my comfort level.
(Re: the low dose, thinking of Robbie's 37.5 IU of Gonal-F and Ornery starting on 75 IU Follistim (though eventually going up to 125), I wonder is that still not low enough? Anyone have thoughts?)
There is still a tiny chance that the egg from my left side could cross over and get picked up by the right tube. "Try to have intercourse this weekend," Dr. SF urged. Um, thanks. Will get right on that.
Dr. SF said my nurse would call me to schedule me for an injection class--she called, I kid you not, about 60 seconds after I got off the phone with Dr. SF. (Love my new clinic!) Class May 11--of course, it's from 10-11:30 am, a hideously inconvenient time given that I, you know, have a job, but whatever, I'll have to make it work.
Thalia asked if continuing with IUI is really the right thing to do, rather than just going straight to IVF to circumvent the whole tube issue. I keep wondering that myself, especially because with single-embryo transfer, we could bring the chance of multiples down to almost zero. But every doctor I've spoken to feels that we really haven't given sperm and egg a decent chance to get together on their own--remember, I still have not had one completed IUI cycle--and that given my age and that the real problem is still my irregular cycles, it's worth it to give IUI a chance. I do think about this a lot--all the doctors say that unicornuate uterus isn't what's keeping me from getting pregnant, but come on, if I keep on ovulating on the side where there's no tube, of course it has something to do with it.
But here's the other issue: I have basically unlimited insurance coverage for IUI and related costs--all I pay is a $20 copay for office visits, and a small copay for meds. I only have $10,000 in coverage for IVF--that barely covers one cycle, and since I'd definitely do single-embryo transfer, it's likely I'd have to do more than one cycle, or at least an FET or two--and meds for IVF are not covered. So as long as there's a chance that IUI could work, from a financial perspective it makes sense to keep going with it as long as possible.
I'm willing to trust my doctor and give it a go for a couple more cycles. It helps that my husband is pretty relaxed and optimistic about everything--when this cycle got canceled, his take was to focus on the good news that I did produce one perfect-looking follicle. He said it shows we're on the right path, and something will work eventually. I'm not sure I believe it myself, but I'll go with it for now.
As I predicted, he wants to go to a straight Follistim cycle. Since I'm continuing to get only one follicle on Clomid, even on a higher dose, and there's a good chance that on another Clomid cycle, I'll get the follicle on the wrong side again, he feels it's best to stimulate both ovaries more in the hopes of getting one good follicle on the right side. I'm totally on board with that, but I did tell him that my concern with injectibles is the risk of multiples (remember, even twins are a bad idea with my unicornuate uterus), and I made it clear that reduction is not an option for us. He said that the dose of Follistim he'd start me on (100 IU) is very low, so the likelihood of overstimming is also low. He also said that two follicles does not necessarily equal twins--in fact, "With two follicles you're still more likely not to get pregnant at all than you are to have twins." But he said it was totally up to me if I wanted to try another Clomid cycle. I said I was willing to try the Follistim and see what happens, and he said we can of course always cancel if there are too many follicles for my comfort level.
(Re: the low dose, thinking of Robbie's 37.5 IU of Gonal-F and Ornery starting on 75 IU Follistim (though eventually going up to 125), I wonder is that still not low enough? Anyone have thoughts?)
There is still a tiny chance that the egg from my left side could cross over and get picked up by the right tube. "Try to have intercourse this weekend," Dr. SF urged. Um, thanks. Will get right on that.
Dr. SF said my nurse would call me to schedule me for an injection class--she called, I kid you not, about 60 seconds after I got off the phone with Dr. SF. (Love my new clinic!) Class May 11--of course, it's from 10-11:30 am, a hideously inconvenient time given that I, you know, have a job, but whatever, I'll have to make it work.
Thalia asked if continuing with IUI is really the right thing to do, rather than just going straight to IVF to circumvent the whole tube issue. I keep wondering that myself, especially because with single-embryo transfer, we could bring the chance of multiples down to almost zero. But every doctor I've spoken to feels that we really haven't given sperm and egg a decent chance to get together on their own--remember, I still have not had one completed IUI cycle--and that given my age and that the real problem is still my irregular cycles, it's worth it to give IUI a chance. I do think about this a lot--all the doctors say that unicornuate uterus isn't what's keeping me from getting pregnant, but come on, if I keep on ovulating on the side where there's no tube, of course it has something to do with it.
But here's the other issue: I have basically unlimited insurance coverage for IUI and related costs--all I pay is a $20 copay for office visits, and a small copay for meds. I only have $10,000 in coverage for IVF--that barely covers one cycle, and since I'd definitely do single-embryo transfer, it's likely I'd have to do more than one cycle, or at least an FET or two--and meds for IVF are not covered. So as long as there's a chance that IUI could work, from a financial perspective it makes sense to keep going with it as long as possible.
I'm willing to trust my doctor and give it a go for a couple more cycles. It helps that my husband is pretty relaxed and optimistic about everything--when this cycle got canceled, his take was to focus on the good news that I did produce one perfect-looking follicle. He said it shows we're on the right path, and something will work eventually. I'm not sure I believe it myself, but I'll go with it for now.
posted by electriclady at 2:55 PM
5 Comments:
Dear Electriclady, I think I love your clinic too. It's good to be called when they say they're going to call...
The money consideration is of course very important. IVF is expensive as heck. It's just that with your particular combination of problems, I'm surprised the doctors aren't actually pushing for it as a solution in which they'd have all factors (except, uh, the most important ones) under their control.
I'm hoping like heck for you that everything turns out perfectly on this Follistim cycle. C'mon, right ovary, wake up!
Yeah, it surprises me too. I thought for sure that when I started going for consults with other doctors (when I was switching clinics) that everyone would say my best option was to go straight to IVF. But every doctor I consulted recommended waiting. It didn't sound quite right to me, but when three different doctors say the same thing, I figure there's at least a little merit to it. Honestly, though, if I had more/better IVF coverage, I'd be pushing to go to IVF myself.
Also, I suspect that if I were 5 years older, they'd be singing a different tune. I wonder if REs (especially here in Big City) are so used to dealing with 40-something women that a 32 year old seems like she has all the time in the world.
That makes sense, thanks for answering my question. Just don't faff around with IUI too long, is my advice.
But again, let's hope you don't need any more of my assvice.
Glad your new clinic is acting like they're actually in the business of helping people!
Your clinic sounds amazing! But 1 1/2 hours for an injection class sounds pretty long. I actually never got a class...just an instructional DVD and a quick review from the nurse. Hopefully, the class will be a lot shorter than what they've scheduled and won't be so inconvenient for you.
As for the dose, I think the reason why Robbie and I were put on lower doses was because of our polycystic ovaries, which is not an issue for you. But if the dosage level concerns you, you should talk to Dr. SF again. It sounds like he's one of those rare but wonderful REs who will actually listen and respect what you have to say. Good luck!
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