Initial Fertility Specialist Appointment

Wow.  Joel and I just got back from the doctor.  There is a lot of information to process.  It's funny, I felt like we were on this magical mystery tour.  First we started in the waiting room (which appeared to be furnished by TJ Maxx) and then was moved to a couch in a hallway where they took my height, weight, and blood pressure.   From there we met with the doctor to discuss our situation.  After, she took us to the financial advisor to discuss insurance options, who then took us to the lab area for my blood work!  I also stopped by the bathroom, so I feel I really experienced the entire office.  Although we weren't in any of the..."sample collection rooms" as I have decided to call them, but that would have probably made me giggle.  (There was a guy there who was dropping off a "sample" and it was really funny/cute to watch him.  So of course that made me think of Joel and I had to grill him about his experience).


I think overall we had all of our questions answered and are in a really good place about deciding what to do next.  I feel like she gave us a lot of information and now we have an idea of the options ahead of us.  I think she did agree with us though that just doing another round of Clomid at the increased dosage was not the most ideal choice.  She said by the time you get to round 4 or 5, if you haven't already conceived, you should probably move on to other options.


She did say that she was 100% confident, we would get pregnant again.  Whether that is naturally or with help is the only unknown.  I wish I could share her optimism.  I believe her when she says that we will get pregnant again, the question is whether we make it full term.  I guess I've just seen too many women who go through rounds and rounds of treatments and still are not carrying a baby to term (if they get pregnant at all).  Let's just say I'm not completely convinced.


We have already done most of the testing we need to do, but today they did one more blood test that is checking my AMH (anti-mullerian hormone) levels.  This is basically a measure of my "egg reserve" or a measure of my remaining egg supply.  She assumes for me it will be fine because of my age, but she said there are some people for whom it is a problem.  I'm all for any kind of informational testing by the way.  I think the more information you have, the better equipped you are to resolve any problems.


The next step is going to be conducting a HSG (hysterosalpingogram).  This is a check to see if my fallopian tubes are open.  They inject a dye that will show up on an xray into my uterus and if it spills out of the end of the tubes, they know they are open.  Again, she's pretty sure they will be open (since I was pregnant once, one of my tubes is open), but still wants to confirm.  This I will wait to do until after my next period starts (unless it magically doesn't start because of this last round of Clomid).


At this point she brought up genetic testing.  She made the point that most people who get pregnant never get this information because they are not put in a situation where someone would tell them about it.  She gave us information regarding a test for Cystic Fibrosis (CF) and Spinal Muscular Atrophy (SMA), both fatal.  Carrying these genetic diseases is semi common in Caucasian people, about 1 in 30.  If both parents are a carrier there is a 1 in 4 chance of passing it on.  If we are tested, we are both carriers, and we go with IVF, then we have the option to biopsy the eggs and only implant healthy ones.


I'm not sure how I feel about all of this (yes, I know I just said I was all for informational testing).  On the one hand, yes, it would be nice to know.  On the other hand, what would we do with the information?  Do we take the risk and whatever happens, happens?  Could I live with myself knowing that I knew this was a chance but didn't do anything about it (if our child was born with the disease).   Are we willing to take such extreme medical action as biopsying the egg if we are carriers?  Actually, I'm sure we are willing, I think the better question is will we be ok with it?  I know I'm jumping the gun here a little, but I feel like I need to think about all of the options and outcomes to make a decision.  Joel and I are still talking about it, but I feel like we are leaning towards getting tested.


Finally we came to the heart of the matter.  If all the tests come back normal, what to do next.  She basically said we can move to the next step, which is IUI (intra-uterine insemination) or go straight past that to IVF (invitro fertilization).  There are a few considerations here including time, money, and multiples.  


The medication we would take that goes along with the IUI has a higher chance of giving multiples (ie-twins).  She basically said if we were completely against multiples, then we should skip this option.  We're not, so we eliminate that as a consideration.


Time becomes a factor when we think about how much time we want to spend working on getting pregnant.  We've already been at this for almost two years and she said there is nothing wrong with wanting to move straight to IVF (which she said has ~65% success rate).


Finally, money comes into play.  One round of IVF costs ~$15,000 and I believe the financial advisor said the IUI is ~$8500 (I have to confirm that with her).  Through my insurance I have no infertility treatment or medication coverage.  My insurance will cover tests and doctor visits, but no fertility procedures.  On Joel's insurance we have a one time use of $10,000 of infertility coverage (which includes medication).  So the question becomes do we want to use up some of the pool of money towards IUI or move straight to IVF.  IVF has a higher success rate but is also more medically invasive (I believe, I'm researching it now).


As of right now we have made no decisions.  Joel is leaning towards moving straight to IVF.  For him it's a numbers game.  He sees the 65% chance versus 15-20% of IUI.  For me, I can't explain why I'm hesitant to jump to IVF.  It seems so drastic.  I feel like we should try all of our options first but I don't have any good reason to believe that.  I don't know if it's the way I try to have everything so orderly and IUI is the next step, so that's what we have to do next.  I think I need to stop thinking about it in terms of steps and just see it as a variety of choices with no prerequisites.  I also need to do more research...