Friday, June 05, 2009

Back in the saddle

Going back to our fertility clinic after a 3-year absence was kind of like going back to your high school after you've graduated. Everything is familiar, but just a little different (they moved the reception desk! they got rid of the stuffed animals in the phlebotomy room!), and it looks a little smaller and shabbier than you remember. You recognize some of the staff members, but you know they don't recognize you--to them, you're just another face among hundreds that have passed through those doors. You wonder if you look different, more mature or changed somehow, compared to the last time you were here, and compared to those who are here for the first time.

In our case, we were of course glaringly different, because we had Bat Girl with us. I felt bad, especially when I saw the multiple discreet signs on the front desk (new since the last time I was there) saying "Due to the special nature of our services, we ask that you make child care arrangements before coming here." But we did the best we could. We stayed out near the elevators instead of in the main waiting room--not ideal, since people coming in saw us as soon as they stepped off the elevator, but at least we weren't rubbing it in the face of everyone else. Unfortunately, it was a horrible rainy cold day, otherwise I'd have had my husband stay outside and run BG around a bit while I filled out paperwork.

Dr. SF brought us around to his office through the back corridor instead of the main waiting room, which I think was also a gesture toward those waiting. I was reminded again why I like him so much--he had reviewed my files beforehand, and had all our cycle stats up on his computer screen, which he referred to repeatedly through our consultation. He wasn't all about the chitchat and personal talk (though he complimented BG's cuteness and behavior) but he remembered things like where we live (unlike most addresses in Big City, ours doesn't immediately signal our neighborhood to those not in the know).

He asked for all the details of how my pregnancy went, what my OB found regarding my uterus when she did the c-section, and how my cycles were now. He wasn't that surprised that I'd only had two periods since December--he said that while some people do get "reset" after a pregnancy, it's just as likely to continue with the same problems. He confessed, "We really got lucky with you getting only one--it could just as easily have been multiples," since I'd had two or three mature follicles on the right side (my good side). Because of this, and because I had such a fast response to Follistim, and because of the problems I had in pregnancy, he's wary of doing another injectables cycle right off the bat, since, he said, "If you got pregnant with multiples, you would definitely have to reduce."

We told him that we were really not comfortable reducing and would prefer to minimize the possibility of multiples. So since I did respond to Clomid at a higher dose, he feels that it's a good idea to start with Clomid, to get a slower response and see how my ovaries do now. I typically got only one egg at a time on Clomid (on the left side as it happens, but it could just as easily have been on the right side) but that's actually a good thing--normally, he said, on average in PCOSers it takes four eggs to get one baby, but that's on average, and in my case it's better to go slow. Once a follicle starts to develop, we might juice it with Follistim, depending on how the cycle is going.

We all agreed that if a few cycles of Clomid don't work, then the best move would be to go straight to IVF. I told him we'd probably want to do single-embryo transfer, and he said that while I'm not an ideal candidate for SET, since I'm 35 (ideal apparently means under 30), as long as we understand that SET carries a lower chance of pregnancy on any one cycle, since they can't know for sure if they're choosing the best embryo, and we're willing to have it possibly take more cycles in exchange for eliminating the risk of multiples, then he's on board with that. Usually he likes to transfer two in patients my age. At any rate, he said, we're a long way from having to decide that right now.

I asked if it would do any good for me to go back on metformin, and Dr. SF said that while they used to think everyone with PCOS was helped by metformin, no matter what size they are, at the latest ASRM conference, the talk was that metformin is not turning out to be terribly useful in thin women. So since I don't have signs of insulin resistance, and didn't develop gestational diabetes, he thinks it's not worth putting me through the side effects. I brought up the whole breastfeeding/metformin connection, and he didn't know anything about it, so I think that's something that I'll have to bring up with my OB. (Dr. SF recommended a high-risk OB who I think I'll try, since we told him we want to deliver at a different hospital this time, should we get that far.)

I rode the dildocam once again, to confirm that my ovaries are not doing anything productive on their own--yep, classic string-of-pearls polycystic appearance. And Dr. SF switched to 3D to get a good look at my uterus and confirm the shape. He also looked to see if there was any sign of scarring or anything that would warrant a saline sonogram to get a better look, but all looked fine. So they took some blood to check where I am in my non-cycle, which will determine if I should take Provera to bring on my period or just wait for it come on its own. Once I get my period, I'll go in for day 3 bloodwork to check thyroid and prolactin levels.

And then...we begin! Clomid, 150 mg, with a dash of Follistim if warranted. A few cycles of that, and then on to IVF.

My head was spinning a little--I made the appointment thinking we'd just talk about the possibilities and then decide to start cycling sometime later. My husband was like, "Well of course we're starting, why else did we make the appointment?" I think we're both not quite 100% there yet, but Clomid is so low-key in the grand scheme of things, that it feels like a good way to dip our toes back in the water. And given the insurance situation, it makes sense to just get going now, so that if we do have to do IVF, we'll start by the early fall.

And I feel like we're going into this with such a different, probably healthier, attitude, than last time. If any given cycle doesn't work, I won't be devastated. If we can't get pregnant again at all, I will be okay with that. I would like to have another child, but I can be happy with just one.

So I guess I'm an infertility blogger again, for a while at least. Yay?



Blogger Erin said...

I know what you mean by "Yay?" It's exciting but when you've been there, you know it's really only exciting for a little while. Then it's tedious. Then it's annoying. Then it's stressful (actually, that's always true). Then it's nail-bitingly-anxiety-ridden. Then it's...well, you know.

I'm hopeful for you! It sounds like you've got a good plan (actually, very similar to ours though we're not starting yet). I hope that the Clomid is all you need!

10:00 PM  
Blogger May said...

Sounds like an excellent plan!

Re: string of pearls, my word verification is "string". Seriously. My iPod knows as much about your ovaries as your RE.

12:25 AM  
Blogger statia said...

Good luck!

8:50 AM  
Blogger caramama said...

Good luck to you! Sounds like you have a great doctor! I hope things go smoother than expected!

I found it such a weird mixture of emotions to go back to the fertility center when we started trying for our second child, so I know what you mean.

11:33 AM  
Blogger Molly said...

Here goes, lady. Fingers crossed.


12:30 PM  
Blogger MsPrufrock said...

Ah, the good ol' "string-of-pearls". That brings back such fond memories...

I think we're kind of, sort of approaching the same place as you have found yourself. Sigh. I look forward to reading about your cycles once again (how creepy am I?)

8:26 AM  

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