Moving on to IVF

Well, after discussion with Dr. S. on the phone the other day, I think I am going to move on to IVF after all.  My husband and I are having a formal consultation with her tomorrow to go over our plan for the cycle.  In the meantime, she has prescribed birth control pills for this month in order to allow my ovaries to rest.  It seems ironic to be taking birth control pills at a time when I want to become pregnant!

I am a little nervous about jumping right to the "big guns"(with the associated BIG price tag), but at the same time, I am happy to be moving to something that has a higher likelihood of success.

IUI was a bust

Well, I am officially not pregnant this month.  I had some spotting on the 25th (yeah...Merry Christmas to me!) and my period started for real today.

I am really undecided about where to go from here.  There has been some recent literature in the reproductive medicine journals suggesting that IVF may actually be the most cost effective first line therapy (from a population-based perspective) for unexplained infertility, because it has a significantly higher success rate per cycle than IUI.  It makes sense when you think of it....with an overall success rate of 25-30% of IUI per cycle, and a cost of 800-1000 dollars per cycle (if you include meds and ultrasounds), many people who have to do several cycles before getting pregnant can come pretty close to the cost of an IVF cycle.

I feel like a gambler trying to size up the odds and place my bet accordingly.   The question is...do I pony up the (rather significant) funds for the "money shot", or do I keep trying the thing with lower odds of hitting the jackpot, but with significantly lower "risk of ruin" per try? BTW, I hope the gambling analogy doesn't come across as flippant.  My fertility is not a game to me, but the parallels with using statistical odds to make a decision about the next step are striking.  There is, for many people, more to it than statistical odds, like willingness to undergo a much more invasive process, personal/spiritual reservations about the IVF, etc.  But for me, I think I am of the frame of mind that I just want to do whatever will get us to our goal as quickly as possible without ruining us financially.

I wish my RE had a shared risk program.  It would make me feel better about IVF.

2 week waiting.....

When my husband and I were trying "au naturale", the concept of the two week wait never really occurred to me.  I was never tempted to use home pregnancy tests too far in advance, and only on very rare occasion tested more than once per cycle.  If I was a day or two late (which wasn't uncommon, because I have irregular cycles), I would go ahead and test after I was already a little late.

It's hard to explain what it is that is so different when you are actually doing IUI, IVF, etc.  Maybe it's because it's a procedure that either worked or it didn't.  Maybe it's because the procedure was done on a specific day, so we have a better idea of when we will know if it worked or not.  Maybe it's because we are so much more invested emotionally once it gets to the point of using expensive and invasive treatments.

Whatever the reason, I have never been more hyper-aware of my body and my cycles before.  I have been feeling little crampy twinges the last two days, and keep imagining that it could be implantation.  I took a pregnancy test today, even though I know darn well it's WAY WAY WAY too early.  I mean seriously, implantation (if it is going to happen this month) won't happen until 6-12 days post ovulation.  Even if it happened at the early end, what are the chances that there would be enough HCG to give a positive test yet?  Pretty slim!

It was negative, not surprisingly.  I guess the good news about that is that the Ovidrel trigger is out of my system, so I know that if I get a positive, it will be a real one.

Who wants to take bets that despite what I just said, I will still test each day up until Christmas?

Now the wait begins....

I had my IUI done today.  I was concerned about being able to leave work at the appropriate time, but since I was already going to be gone part of the morning to teach a class to the grad students (on a different campus), I had an excuse to be away from the hospital anyway.  Plus, the chair of my department has been really understanding about this whole process, so it hasn't been too hard to leave at odd times here and there for appointments.

The IUI procedure was pretty easy, really.  My husband dropped off his sample early this AM, and then my appointment was an hour and a half later.  The whole process for me took only about 15 minutes.  However, I do have to admit that there are a lot of cramps afterward.   Seems like a good evening to take it easy, and maybe even go to bed early.

And the 2 week wait begins!

Preparing for IUI on Tuesday

As part of the diagnostic workup and also in preparation for the IUI, I took Clomid for five days starting last Saturday.  Folks, if you have not needed to take Clomid, consider yourselves lucky.  I have never been so labile emotionally in my life.  I was sitting in my office on Wednesday, and just started crying out of nowhere.  Sometimes, guys are prescribed clomid for fertility, too.  I wonder if they get "hormonal" on the drug like we ladies seem to?

My ultrasound on Saturday showed that my follicles were more or less ready for ovulation, but my uterine lining was a a little thin, according to Dr. S.  So, she wants to push the IUI procedure back to Tuesday.

Tonight, I have to inject myself with Ovidrel to stimulate ovulation.  Actually, I am going to make my husband do it, because I can't handle the idea of sticking a needle in myself.  Isn't that pathetic?  I am a physician, for crying out loud, and although I have no problem sticking someone else with a needle, I get queasy thinking about doing it to myself.

Well, at least it's just one injection...for now.  I know there may be a lot more if we wind up doing IVF!

First Post

I will begin my blog with a little background about who I am and where I am in the process of my journey.  I am T, a 34 year old physician.  My husband is S, also 34 and a physician. We have been married for 7 years, and have been trying unsuccessfully to get pregnant for nearly two years.

At first, we approached our goal the way many couples do:  timing our activities based on ovulation predictor kits and taking a few relaxing "procreation" vacations.

It became apparent after 18 months of trying that this approach was not getting us anywhere.  I talked to my OB, who felt it was time to begin working us both up for infertility.  She suggested a semen analysis for my husband, and a Clomid challenge (which I will describe in more detail in a later post) for me.

We started with my husband, who (bless his heart) was quite self-conscious about collecting a specimen.  His semen analysis was completely normal.  I did the Clomid challenge, and all the laboratory values came back normal as well.  Because all of our tests were normal, my OB suggested that we try for a couple more months, and if nothing happened, she would refer us to a reproductive specialist.

Three more months passed, and I was referred to Dr. S, a reproductive specialist.  She wanted to repeat the Clomid challenge test, and this time, run a few additional tests including an Anti-mullerian hormone (AMH).  She also suggested a hysterosalpingogram (HSG), which is an imaging study of one's uterus and fallopian tubes that involves injecting contrast dye into one's uterus and snapping x-rays as the  contrast passes through the tubes.

The HSG was completed early last week, and I am happy to report that I am totally structurally normal.  However, the results of my other laboratory work were more concerning.   Although the FSH and estradiol were doing what they were supposed to do during the course of the cycle, my AMH was only 1.0 ng/mL, which is low.  

AMH is a relatively new marker, but is being used as a marker of ovarian reserve.  So, the fact that this is low suggests that my ovarian reserve is becoming depleted.  In addition, Dr. S told me that my cycle length is also concerning, as it is irregular, and on average only 25 days.  Apparently, a shorter cycle length is associated with decreased ovarian reserve and decreased fertility.

Because of this, Dr. S wants to "fast track" us to in vitro fertilization (where eggs are harvested, fertilized, and embryos are implanted into the uterus), rather than doing multiple rounds of intrauterine insemination, (a much less invasive procedure where washed sperm are placed in one's uterus).  The likelihood of IUI being successful is quite small in someone with decreased ovarian reserve.

However, this month we actually are going ahead and doing IUI.  This is simply because we didn't know the results of our diagnostic workup until last week, and we didn't want to waste the month, plus I was already taking the Clomid for the challenge test.  The actual procedure is scheduled for Tuesday.  

So this is where we are starting.....we are just about to do IUI, and in all likelihood will be doing IVF next month.  I will try to give updates as we tackle each step of the procedures.