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.