Of Coughs and Plans

Today was our first appointment with a RE.  I wasn't nervous beforehand because I had myself convinced of what he was going to say.  I was 100% convinced that he was going to say I have DOR which means our only chance of conceiving a healthy baby would be IVF, but we could try a few months of IUI first if we really wanted.  See, this is where Dr.Google and other people's histories will fail you!

When Andy and I first walked into the office I knew that I was in the right place.  The office is decorated tastefully with leopard print fabrics in tans and browns.  I don't think I've mentioned it here, but I love animal prints!  I have a very strange obsession with zebra and leopard prints.  I wish I could wear them without looking like an idiot, but I usually just settle for admiring them from afar.  We even have a rocking chair that is upholstered in leopard print fabric that I chose when I was eight years old!

But I digress.  We had to wait about 30 minutes past our 3pm appointment time, which had me getting anxious.  I've been sick for a little over a week with a super annoying cough.  When I'm sick I tend to suck it up and deal with it, I hate to visit the doctor.  Poor Andy has slept on the couch for the last 5 out of 7 nights, I think!  So while we were waiting I was hacking away.  The poor receptionist commented that she wished she had some water to give me and that a summer cold must really suck.  Yeah it does!  We were finally led back to our RE's office to wait.  On his desk he had a framed real four leaf clover.  I was really excited to see it!  Several months ago, I think in March, Andy and I found our first ever four leaf clover in a potted plants in our yard.  At the time I was so sure it was a sign that we were going to conceive a healthy baby right away!  Well, flash forward at least five months and obviously that wasn't the case.  But maybe, just maybe, it was a sign that this RE will help us get knocked up..  A girl can dream, right?

I really like the RE.  He spent a long time explaining everything to us, as well as listening to our questions and answering them.  He doesn't believe that I have DOR!  His healthy range for FSH is less than 13 (mine was 10.8) and estradiol is less than 80 (mine is 56).  He explained that every lab does the test slightly differently, so although it was "elevated" at one, it likely would have been normal at another.  He wants to do an antral follicle count on cycle day 3 to verify, but isn't worried about AMH even if it's low (haven't gotten those results yet).  Woohoo!  For now, based on my history he thinks I likely have an ovulation defect paired with a luteal phase defect, both of which are highly treatable.  Yay!

He laid out several options for us.  On CD3 I will definitely be having the antral follicle scan, just to confirm that I have the high count he's expecting.  Either way, I think our course of action will be the same.  On CD5 I will likely go on BCPs for approximately two weeks.  Some time shortly after I start the pills I will have a diagnostic laproscope to check for endometriosis or any other complications.  Given my mom's history of stage IV endometriosis it seems like a good idea to check it out, and insurance will pay for it now.  If we don't conceive within a few months this would be the next course of action and insurance would not longer pay for it, so it seems really smart to get it out of the way now.  Although I can't say that I'm looking forward to surgery or BCPs!

If the laproscope is normal I will go off of the BCPs shortly after and four days later take a five day dose of Femara.  Our RE feels that Femara has a better response and fewer side effects than Clomid, and I'm quite okay with that.  Here's where our options differ:

1. After the five days of Femara I will do a trigger shot around day 13, depending on the monitoring ultrasounds.  We then will of course have timed intercourse, then I'll take progesterone until AF (or continue until 12 weeks if pregnant).  The RE projects that our odds of conceiving per cycle are about 10-12% higher than we would have just trying on our own.  He said the risk of multiples is very low.  Cost is $500 plus meds straight out of pocket per cycle.  I believe insurance will cover a portion, but that needs to be confirmed tomorrow.
2. Or, I will take five days of Femara as well as injectable FSH.  I wish have a trigger shot, timed intercourse and progesterone.  He projects our odds to be 20% higher than trying on our own, but a 20% risk of conceiving multiples.  Cost out of pockets is $1,000 plus meds, but again I think insurance might pay a portion.

Towards the end of our appointment I started coughing uncontrollably and our RE asked if I had seen anyone about it yet.  Andy immediately chimed in (after being relatively quiet throughout the appointment) that I would definitely be seeing someone ASAP because I was getting worse.  The RE checked my lungs and prescribed me a Z-pac so I don't have to go see someone else.  Did I mention that I really like him? So now we have a plan and I have antibiotics!