And one step back
Anyway, the upshot is that after much discussion, we decided to do one cycle of very low dose injectibles before moving on to IVF. Mostly because my husband and I are still a little leery of doing IVF--and my Catholic-school hubby is suddenly having some discomfort with the idea of freezing embryos, discomfort that he can't really pinpoint or explain, so I think we need to deal with that before going forward.
Also, Dr. SF feels that since IUI/injectibles clearly worked well for us last time, it's worth giving it one more shot, this time doing a lower dose (starting at 75 IU instead of 100 IU like last time). And we are very clear that if there is any more than one good-looking follicle, we cancel. I said several times, "I would rather not be pregnant at all than be pregnant with twins," so he definitely got the message. I asked if he would ever convert an IUI cycle to IVF, and he said that while he knows other doctors do that, he prefers not to--he thinks you just get better results with IVF if you start off with that protocol from the beginning.
As far as IVF goes, he said that doing IVF instead of IUI would definitely be "easier" for him (meaning more control), and normally IVF has a higher success rate than IUI. But since we are doing single-embryo transfer, the success rate is about the same (since the higher success rates for IVF are based on transferring two or three embryos).
The other plus of doing an IUI cycle first is that since my insurance will pay for meds for IUI but not IVF, I can stockpile now (they gave me a Gonal-F script with 6 refills for just that purpose) and either use the meds for IVF later, or donate them if I don't need them. Then the only meds I'll need to pay for are Lupron and maybe the trigger shot.
We didn't get into all the details of IVF protocol once we made the decision to do IUI, but we covered the basics--birth control pills, then Lupron, then stims. Dr. SF said he'd expect me to get around 25-30 eggs (!) but warned me (as K pointed out on my last post) that out of that number, we'd expect only 4 or 5 to make it to blast, and maybe 1 or 2 to freeze. ("There are some super fertile women who get 10 or 12 embryos, but that's really unusual," he said.) We would definitely do a day 5 transfer, because of the single embryo factor. He pointed out that really the only difference between IUI and IVF are the suppression phase and the retrieval--the stims are essentially the same, and transfer is just like an IUI, from the patient's perspective at least.
I asked how soon after the IUI we would be able to do IVF, and he said that if we canceled before trigger, I could start BCP immediately and we could start as soon as my ovaries calm down. If we go to trigger, then it would take a little longer. But basically we're looking at October at the latest.
So I'm on Provera this week (because I still haven't gotten my period since I was on Clomid in June), and assuming my period arrives next week, we begin. Deep breath.