Thanks for all your comments, ladies. It really means a lot! Yesterday afternoon I stormed around the house screaming at the world that I just didn't care anymore and was giving up. I drowned my sorrows in a beer and french fries last night and I'm feeling a lot better today. My DH would say it's because it's sunny again and it was raining yesterday. I prefer to think that the weather reflects my mood rather than the other way around... ;) Yep, I have that kind of power. LOL.
This is going to be incredibly long because I'm really just trying to gather my thoughts together, so feel free to ignore it! For those who don't want to read a dissertation, here's a summary: no meds this cycle, RE thinks I still have a tube issue, we'll probably skip injects and move to IVF, we probably will be moving to a different clinic (in another state) for IVF.
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Anyway, I talked to the nurse yesterday and must have sounded like a gibbering idiot. All I could really say is that I was very uncertain and just didn't know what to do. She had the doctor call me and that was great. I told her about the timing issue for this cycle and she seemed disappointed. She did say that while taking the meds and doing timed BD'ing might give us a slightly better (like 2% better) chance than just doing timed BD'ing, it really didn't seem worth it. So, we're going to go med free this month. I was feeling disappointed, but I'm doing OK with it now. My brain (and my DH) could use a break from med crazy Rebecca.
We also talked a lot about percentages and where we go from here. We're going to use this cycle to make some decisions. Basically, she seems to think that I might still have a tubal issue. She said that she thinks that the HSG showed a dilated left tube and she really thinks that we should do a lap so she can look at it to see if there is a hydrosalpinx and possibly remove the tube. Now, when I look at my image and look at pictures of hydrosalpinx on the web, it looks nothing like that (no sausage tube, and dye spilled freely). But, I guess she thinks that it may be starting to form and causing fluid to flow back into the uterus preventing pregnancy. She also said, though, that of course there could be absolutely nothing wrong with it. She said that she'd like to do the lap before we went to IVF because it might prevent IVF from working, too.
The frustrating thing about this is that before we had the hysteroscopy in December she told us that it was OK not to do the lap/hystero combo because if we went to IVF we'd be bypassing the tubes so it would be redundant. The lap would cost us about $15k out of pocket (in addition to the $5k we spent on the hysteroscopy) and would then still most likely lead to IVF. (My insurance is, according to the nurses at the REs, the worst they've ever seen and once you've been diagnosed with IF, they essentially won't cover anything that might even vaguely be associated with IF even if you're in horrible pain -- which I often am.)
I told her I was disappointed with the fact that Femara was really giving me only one or two follies a cycle which didn't seem to be increasing our chances much. And, I reminded her about my borderline CD3 FSH level (12) and she said something about "that's why I want to be aggressive" which I find amusing because two weeks ago she said I should keep doing the Femara-IUI combo until we'd done it 7 times! Anyway, she said she thought adding injects would (assuming the tube isn't a problem) increase our chances from about 10-15% per cycle to 20-25%. But, of course, there are the risks of multiples or canceled cycles and the thought that it might not increase the numbers anyway. And, adding the expense and uncertainty, who knows if it is worth it. She said she thought that IVF would give us a 50-60% chance of taking home a baby within three cycles given my age. And, she talked about the study I've seen that essentially said that a cost comparison of injects to IVF made it seem like IVF was a better value.
So, it looks like we're heading to IVF (which alternately causes me to feel calm and happy and absolutely freaked out). The decision now, though, is where and what to do beforehand. I hate to say this, but I think we're going to be moving to a different clinic. I really love the people at my clinic. The nurses are wonderful, the staff is great, the REs are great. But, they're really small and don't have particularly good records with IVF. Mostly because they just don't do that many each year. Maybe 13 cycles
total per year. Their records with younger women are OK, but, their records for women my age are terrible. Looking back over all the years on record with SART they've basically had one successful pregnancy out of about 25 cycles over the past 6 years with women 35-37. That is
not encouraging! Now, my RE is the new IVF director and was successful at her previous clinic. So, that might help, but again, they just don't have the records and, when you're putting your entire savings into what might be a one shot deal, you want to know that they've at least done this before. So, unless they can say "we'll give you the cycles for free and make you part of some study or another" I don't see us staying there. (Especially because my DH is a statistician and those numbers
freaked him out.)
There's another clinic in the same area (mind you these are still both in a town 90 miles from here) but they don't have any records available with SART
at all so I have no idea what to think of them. My DH has been exploring a clinic about 160 miles away in a neighboring state in the town where my SIL works. He talked to them yesterday and they even mentioned the possibility of doing local monitoring (assuming someone around here can do it) and then working with them. They have excellent stats for IVF and lots and lots of cycles each year for women of all ages. They also have a really good "warranty" program to help with expenses (assuming we qualify). Their website has lots of information and makes it seem like IVF is normal for them rather than a "rare" thing for them to do. They're sending us some info and we'll make some decisions soon about setting up an appointment with them. The downside is that I'm sure we'll have a hard time setting up cycles because they'll be busy! If nothing else, I'd really like to get a second opinion about the tube issue.
So, I'm feeling more confident about our plans. I have
no idea how I'll work with a clinic that is almost 3 hours away and not take a leave of absence. But, it seems like they might be willing to work with us a little on that. I really wish I wasn't teaching this summer, but I can't get out of it. There is more flexibility, though, than in a normal semester so we'll see how it goes. There are still no guarantees and it may still not happen, but at least I'll feel like we're trying something that has a chance.
Anyway, that's where we stand right now. If you read this far I admire your ability to keep track of my scattered thoughts!
