Home Again, and a Visit with Dr. Local

Detroit was wonderful, as always.  Manly’s immediate family (grandparents, aunts and uncles, cousins) is over 50 people, and the majority of them showed up for his cousin’s wedding.  The photographer took a family portrait of us all on a winding staircase, and I’m itching to get a copy already.    The food was fantastic: Original Pancake House, National Coney Island, Emily’s, the Franklin Cider Mill — the only place we missed was Bommarito’s because they were closed for vacation.  Oh, and we just didn’t make it out to Shatila’s.  Between the food, the family, and my sheer enjoyment of urban life, part of me would really, really like to move up there.  If they could just do something about all that snow in wintertime …

Anyway, I had my return visit with Dr. Local today.  Manly didn’t go, which is fine, because Dr. L just said what I figured he would say: my choices are laparoscopy, IUI, or straight to IVF.  And that Manly needs to stop smoking.  Nothing any self-respecting infertile blogger doesn’t already know. 

We talked a little about the HSG results; he still stands by his opinion that the “blocked” tube is not actually blocked.  He says it takes 70-80 millibars of pressures to force the dye through the tube, and since my left tube flowed so freely, the right side just didn’t build enough pressure to push through.  Since the left flowed freely, with no other factors, tubal scarring or blockage is simply unlikely.  He believes that a laparoscopy would be completely diagnostic in my case, with perhaps a 30% chance of finding any problems.  I have no symptoms of endo, but he will perform the lap if I want one.

He thinks that IUI will give me a higher cumulative statistical chance of pregnancy if I go through 3 or 4 cycles.  Say around 20-25% in a given cycle, and up to 40% cumulatively.  Given my response to oral meds (1-3 follicles per cycle), he said he would most likely try another oral, t.amoxifen, or do a combination of orals and injects.  I have to call the pharmacy to find out if my insurance covers injectibles, but I think they do (they’ve covered my o.vidrel, which is in the same class of prescriptions as gonadatropins).  If my insurance company will cover the injects, then my out-of-pocket cost would be around $350 per cycle.

He did point out that due to my age and my ovarian response to the oral meds, he would also support me going straight to IVF if that’s my choice.  Statistically, we would be looking at about a 50% chance of pregnancy, and if I got frozen embryos, then we could see a 65% chance cumulatively over the course of a single egg retrieval with FETs.  (I think I made him smile when I mentioned that I would prefer single-embryo transfers because, honestly, I am too small to carry twins safely.  Dr. L is very anti-multiples, and will cancel any cycle with more than a 4% chance of triplets.  I got the feeling that he was preparing to defend his position, and was glad that he didn’t have to.)   Again, if the insurance company will cover the injects, then we’re looking at around $7500.  But I would have to wait until the next IVF cycle at the clinic, which I think will be starting in January.

The only surprise that I got was when I asked him about the cramping after ovulation that I seem to get most months.  He told me that it could be my ovarian healing process, my body’s reaction to the estrogen & progesterone levels at that point in my cycle, or a “micro-loss”.  Basically, that I could be experiencing an implantation that aborts before it gets to the point where a pregnancy would register on a urine test.  He says there’s no diagnostic test that would show that, and the treatment regimen would be the same no matter what.

So.  Tomorrow I call the pharmacy to check my insurance coverage.  And tonight, I talk with Manly.  Unless he has some serious objections, I think our next year will be: IUI next cycle (Oct), IUI cycle (Nov), break for the holidays, IUI cycle (Jan), then possible IUI cycle in Feb or break until we could line up with an IVF cycle in summer or fall.  It’s painful to be planning all this out, but at the same time it’s a relief to know that within another year we could have an answer one way or the other, and that I’ll be able to move out of this holding pattern I’m in now.

Ciao, babes. 

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8 thoughts on “Home Again, and a Visit with Dr. Local

  1. sounds like you have a great and thorough RE. If your insurance does or does not cover injectibles. I found the cheapest pharmacy around. I will email you the name of it. You can see their proces online or you can call and ask them

  2. Terribly sorry to hear this cycle didn’t end well. It never gets easier seeing that empty space on the HPTs, but having a good doctor with initiative always make it a little more bearable.

  3. I’m so glad that you feel that you are moving out of holding pattern mode. Being there can be so frustrating and can really drive one crazy. I am going to hope like mad that you don’t have to go any further than this upcoming cycle. 🙂

    *This is a very, very late response, but we have three babies on ice for transfer.

  4. Oh cool! The Franklin Cider Mill AND National Coney Island AND Original Pancake House… I am so jealous. Funny to hear those landmarks called out and know exactly what they’re like. 😉 Glad it was such a fun trip.

    Also glad to see that you’re getting good counsel and that your RE and you are on the same page as far as treatment options. Welcome back…

  5. I grew up in Detroit, and love all of those restaurants you mention, except I don’t know Emily’s… but I’ve always thought it odd that Detroit is home to so many Coney Islands. What is it about the place?

    I’m glad you’ve got a plan worked out for your treatment. Hopefully you won’t have to follow it through to the end, but I find it good to know what the next steps are.

  6. Sounds like a good trip and a good consult. Just a couple of pieces of assvice.

    If the IUIs aren’t working, think about whether you might go to IVF sooner. IUIs have a very low success rate -generally more like 15% so I’m very surprised at the numbers he’s quoting you, particularly given the status of one tube is uncertain. And not sure re his hypothesis on the endo/lap – I had no symptoms, both tubes were open, yet my insides were totally gummed up with endo. Now if you feel you’ve got time, no reason not to do a few cycles of IUI first, but if they don’t work you might want to reconsider the lap before IVF – it’s not a big op and would give you some more information about what’s going on.

    Second, I’m glad you’re thinkign of taking a break between cycles. No clinic in europe would let you cycle back to back like that, they always want your ovaries to recover from the hyperstim before the next cycle. If you’re not feeling up to it, wait an extra month in between (in the UK you’d have to wait 3!).

    anyway, feel free to ignore, I’m not the doctor! I will keep everything crossed that your first IUI works and you can stick out your tongue at me and go nyah nyah nyah nyah nyah.

  7. I say go with your gut. I’ve done both the lap and the IUI, and if you have any questions (since we both see Dr. L), feel free to ask away.

    It always feels good to have plans laid out. I hope you and Manly find a path that feels right for the both of you.

    Hope to see you tonight!!

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