Aaaand here we go again

Thoughts on returning to the RE's office after a 14 month absence:

• This place reeks of desperation and despair.
• Why do I see more Hasidim at the fertility clinic than anywhere else in the city?
• (Well, where else would I run into them? It's not like they're hanging out at the clubs on Friday night.)
• (Not like I've hung out at any kind of club myself in the last 10 years or so.)
• Boy, all these comfy upholstered chairs would be a perfect breeding ground for bedbugs.
• Must be Bring Your Husband to the Clinic Day. Lots of sheepish-looking dudes getting called back solo.
• I can't believe I'm back here.

Dr. SF was really pushing for IVF this time. He said that while we can keep doing what we've been doing (low-dose gonadotropins plus IUI), it's pretty inefficient especially given our desire to avoid multiples. He said that with IUI I'm just as likely to get pregnant with twins as with a singleton, and reminded me (as if I needed reminding) that I could easily have ended up with twins when I got pregnant with BG. But he also said that really, we still haven't done all that much with project baby 2.0--those 3 (or 4?) back-to-back cycles in 2009 notwithstanding, the sum total of eggs I've produced so far is actually not that high. So he didn't have any objections when I said that we really wanted to try a couple of IUI cycles first and see how it goes. (My husband and I had discussed this beforehand and settled on trying 2 cycles IUI before we reconsider IVF.)

So we settled that we'll start a new cycle this month, pending today's bloodwork, and try to duplicate as closely as possible the 2006 cycle where I actually got pregnant. That is, rather than starting at 75 units and ratcheting up, we'll start with a few days of 100 units and dial down, since that cycle I did 3 days of 100 units, 2 days of 75 units, and a day of coasting before triggering on day 9. The Gonal-F pens in my fridge are still good, just barely, so I can use those.

Looking ahead, I asked if there was an option to do a low-dose IVF with the intention of ending up with as few leftover embryos as possible (since freezing is one of the aspects of IVF my husband is squeamish about). Dr. SF said yes, they do a letrozole plus follistim protocol for women who have had breast cancer or for whom high estrogen levels are otherwise inadvisable, with the aim of getting 4 or 5 eggs--with a day 5 transfer, that would mean probably few survivors. Since my insurance will cover 3 full cycles of IVF (meaning we don't have to try to pump out as many embryos as possible in one round that's our only shot), he thinks it would be fine to try that first, if it comes to that. And the other interventions my husband isn't comfortable with--assisted hatching, ICSI--would most likely not be needed in our case anyway.

Dr. SF ordered up bloodwork--progesterone, hCG (ha!), estrogen, TSH, the usual--and I'll get a call tomorrow letting me know whether I need Provera or can just wait for my period to come on its own. (I'm on CD 30-something and spotting, but that doesn't mean anything in PCOS world.) And--I can't even remember the last time this happened--I GOT TO LEAVE WITHOUT TAKING MY PANTS OFF. I know, right???

So there you have it. It seems this is an infertility blog once again. Yay?

Everything old is new again

Funny how I still have my clinic's phone number memorized, even though it's been over a year since my last failed cycle.

Yep, we're officially diving back in. What it amounts to is this: I just turned 37. Bat Girl is about to turn 4. My husband will be 40 this spring. We want another baby. My eggs ain't getting any younger. And incidentally, those Gonal-F pens I stockpiled in 2009 are going to start expiring next month. (Though at this point I might not even use them, since my new insurance will cover meds and I do feel a little weird about using meds that are about to expire and that have been sitting next to some aging kimchi for the last 13 months.)

I do have insurance coverage for IF treatment now...but my current plan has a lifetime limit of 3 IUIs and 3 IVFs. Since IVF is still off the table, that means we basically have 3 more chances. That's...a lot of pressure. At the same time, though, I'm not sure I have more than 3 cycles in me, given that I'm still shuddering a little at the thought of another injection.

So perhaps this is our last chance. I have a weird superstition that I might get pregnant in March, because the last time I got pregnant I had been at a new job for 9 months, which meant I told my boss I was pregnant right before my 1-year anniversary. And in March, I will have been at my current job for 9 months. I know it's stupid, but we have to hold on to our stupid little fancies so we can get through the day, right?

Appointment with Dr. SF in two weeks to talk details. Yikes.