RE Consult

Junebug060609 · July 2013

Just a forewarning to those reading, there will likely (hopefully) be PgAL'ers and PAL'ers chiming in on this thread.

This afternoon was the consult with the RE. Overall it went well. They were pretty optimistic, which I haven't been in months...so that was good to see.

They said my CD3 (ish) numbers looked good. They loved my FSH of 5.2 Smile . Of course they went over my pregnancy and OB history...which includes a hysteroscopy and fibroid removal prior to all my pregnancies. When they heard the word fibroid they wanted to do a u/s on the spot. Lucky me, dildo cam! They found one small abnormality (8mm) that they want to investigate via another hysteroscopy (yeehaw!). The good news from that u/s though is that I looked great for follies! Right side she counted 20. No idea what normal is, but the RE had a huge smile on her face and said that was great. On the left she was able to answer my question about whether I'd ovulated. Yup. Huge freaking CL cyst...and about 5 follies visible in that ovary (more were probably obscured by the cyst). Doctors orders to DTD tonight. Best doctors orders I've ever gotten Wink

Basically the plan moving forward is: DH does SA, though they are just doing it to cover all the bases as they know we can conceive. I get to do another hysteroscopy (and D&C if they see stuff they want outta there) and then they were suggesting clomid (and potentially IUI with that, but I need to check with insurance as I don't think they cover IUI or IVF...they should cover the meds and the procedures though).

Decision time, and I'd love your input. Quick background for those on mobile who don't know my situation. I'm 36. DH is deploying for six or so months in November. I've been back on TTCAL since late November, seven plus months.

Option 1 for hysteroscopy: In operating room. Pluses: If there's an issue, quite likely there is a small fibroid given my history, they remove it on the spot. General anesthesia is also a plus. Minuses: I'd have to be on BCP for a cycle so they can make sure they aren't doing in post-o...which would mean missing a TTC cycle before he hits the high seas.

Option2: Hysteroscopy in doctors office. Pluses: No BCP and no missed cycle TTC. Minuses: If there is something to be removed a D&C will need to happen anyways.

Thoughts???

ETA: Anyone know how to indicate on FF that u/s confirmed O?

Poppy715 · July 2013

I have no idea which is the better option for you. Ill let others chime in on that one. But I'm so thrilled with your results and appointment! So much great news. And yay for follies. I'm do happy to hear all this June!!

I'm sure you are happy to be moving things along and finally getting some proper answers.

Mrsbtobe2012 · July 2013

Can I second everything Poppy said?

Also, I feel like if it were me I'd choose the first option. It may delay you a cycle but everything would be done if needed... Instead doing the procedure and then waiting for a surgery if needed then waiting to heal from it etc.

Sorry I'm mobile so format may be weird.

Junebug060609 · July 2013

I should also note that him leaving frozen sperm before he goes to sea isn't an option for us if insurance won't cover IVF or IUI (I'm like 99% sure that they don't). We don't have the finances to pay for that OOP.

The doctor threw that out when I voiced concern about missing the cycle for the OR option. If insurance covered it I'd be game, what the hell else is my ute doing if I'm not pregnant when he leaves, right? ...though it would lead to some questions from the family if the EDDs are suspect, lol.

katib77 · July 2013

They can't do the hysteroscopy on like cd5-10 so as not to have you on BCP but still do it with anesthesia so they can get whatever they find? That's annoying. But given history and such I'd still probably do that just so you have your best chances for the following cycle.

As for IUI out of pocket, we did that for the first four of five IUIs we've done (I just recently got different insurance that has *some* coverage). Total it costs $850 if using clomid and $1500 using follisitm because of the extra U/Sounds. I'd talk to your insurance and find out if they do not cover IUIs if they also don't cover the B/W and U/S that cycle because that's where the cost really is. I know gals that insurance doesn't cover the procedure but covers the monitoring...in which case the IUI itself with sperm wash and IUI is about $400.

Again - with YH deploying I'd do the IUI if you can swing the cost no matter if it's total OOP or just partial simply because of the higher chances than TI with clomid.

And as for "normal" count for AFC on cd3 I was told 12 on each ovary is optimal a while ago. If you had 20, it's not PCOS-like but more than good so I'd be pleased. Since I'm 35, my AFC has gone down from 11 to 12 on each side three years ago to now having about 8 on each side the last two cd3s they've looked (Jan and April).

Junebug060609 · July 2013

OMG, I totally forgot to add in one important detail about the appointment!

I knew going into the apt that it was going to be in the same building as where I found out about my last loss. I knew it quite likely was going to be on the same floor even (I found out at a Peri apt and peri's and RE's kinda go hand-in-hand). Dude, it was the SAME SUITE. Same *** waiting room. First time I'd been there since finding out about the loss. A few deep breaths and a couple quiet tears and I pulled it together. Told myself I have to face this and that this is a step to getting a happy association with that building.

I'm just thankful it was a different exam room.

ETA: I also asked the age-old question on TTCAL. How frequently does she recommend DTD during FW? Her answer: Daily has a slightly higher success rate, but it is negligible. She recommended EOD.

Junebug060609 · July 2013

katib77:
They can't do the hysteroscopy on like cd5-10 so as not to have you on BCP but still do it with anesthesia so they can get whatever they find? That's annoying. But given history and such I'd still probably do that just so you have your best chances for the following cycle.
As for IUI out of pocket, we did that for the first four of five IUIs we've done (I just recently got different insurance that has *some* coverage). Total it costs $850 if using clomid and $1500 using follisitm because of the extra U/Sounds. I'd talk to your insurance and find out if they do not cover IUIs if they also don't cover the B/W and U/S that cycle because that's where the cost really is. I know gals that insurance doesn't cover the procedure but covers the monitoring...in which case the IUI itself with sperm wash and IUI is about $400.
Again - with YH deploying I'd do the IUI if you can swing the cost no matter if it's total OOP or just partial simply because of the higher chances than TI with clomid.
And as for "normal" count for AFC on cd3 I was told 12 on each ovary is optimal a while ago. If you had 20, it's not PCOS-like but more than good so I'd be pleased. Since I'm 35, my AFC has gone down from 11 to 12 on each side three years ago to now having about 8 on each side the last two cd3s they've looked (Jan and April).

That's a good point. I need to not only ask them if they cover IUI, but if they'd cover u/s and such associated with it. If it's only $850, we might be able to pull that out of thin air somehow (no idea how...).

Not sure if it makes a difference for follies, but I'm not on CD3 today. I'm on like CD15 or so, ovulation apparently happened sometime in the last 24hrs based on their observations and my OPKs.

katib77 · July 2013

Junebug060609:
katib77:
They can't do the hysteroscopy on like cd5-10 so as not to have you on BCP but still do it with anesthesia so they can get whatever they find? That's annoying. But given history and such I'd still probably do that just so you have your best chances for the following cycle.
As for IUI out of pocket, we did that for the first four of five IUIs we've done (I just recently got different insurance that has *some* coverage). Total it costs $850 if using clomid and $1500 using follisitm because of the extra U/Sounds. I'd talk to your insurance and find out if they do not cover IUIs if they also don't cover the B/W and U/S that cycle because that's where the cost really is. I know gals that insurance doesn't cover the procedure but covers the monitoring...in which case the IUI itself with sperm wash and IUI is about $400.
Again - with YH deploying I'd do the IUI if you can swing the cost no matter if it's total OOP or just partial simply because of the higher chances than TI with clomid.
And as for "normal" count for AFC on cd3 I was told 12 on each ovary is optimal a while ago. If you had 20, it's not PCOS-like but more than good so I'd be pleased. Since I'm 35, my AFC has gone down from 11 to 12 on each side three years ago to now having about 8 on each side the last two cd3s they've looked (Jan and April).
That's a good point. I need to not only ask them if they cover IUI, but if they'd cover u/s and such associated with it. If it's only $850, we might be able to pull that out of thin air somehow (no idea how...).
Not sure if it makes a difference for follies, but I'm not on CD3 today. I'm on like CD15 or so, ovulation apparently happened sometime in the last 24hrs based on their observations and my OPKs.

Then maybe there's a little confusion. Did they not see 20 follies, but a follie that measured 20mm collapsing (having ovulated in the last 24 hours)? Because then your RE telling you to get busy makes sense. If they saw 20 follies *after* you ovulated they I'm totally confused. I thought you were talking about AFC.

ETA: I had a 16mm on my right on cd10 when I had my saline sono on Wednesday - which makes sense since I usually ovulate on cd13 and follies grow 1-3mm a day. So it will be 19-25mm by tomorrow when it most likely ovulates, and that's a natural non-treatment cycle.

Junebug060609 · July 2013

katib77:
Junebug060609:
katib77:
They can't do the hysteroscopy on like cd5-10 so as not to have you on BCP but still do it with anesthesia so they can get whatever they find?  That's annoying.  But given history and such I'd still probably do that just so you have your best chances for the following cycle.  
As for IUI out of pocket, we did that for the first four of five IUIs we've done (I just recently got different insurance that has *some* coverage).  Total it costs $850 if using clomid and $1500 using follisitm because of the extra U/Sounds.  I'd talk to your insurance and find out if they do not cover IUIs if they also don't cover the B/W and U/S that cycle because that's where the cost really is.  I know gals that insurance doesn't cover the procedure but covers the monitoring...in which case the IUI itself with sperm wash and IUI is about $400.
Again - with YH deploying I'd do the IUI if you can swing the cost no matter if it's total OOP or just partial simply because of the higher chances than TI with clomid.  
And as for "normal" count for AFC on cd3 I was told 12 on each ovary is optimal a while ago.  If you had 20, it's not PCOS-like but more than good so I'd be pleased.  Since I'm 35, my AFC has gone down from 11 to 12 on each side three years ago to now having about 8 on each side the last two cd3s they've looked (Jan and April). 
That's a good point. I need to not only ask them if they cover IUI, but if they'd cover u/s and such associated with it. If it's only $850, we might be able to pull that out of thin air somehow (no idea how...).
Not sure if it makes a difference for follies, but I'm not on CD3 today. I'm on like CD15 or so, ovulation apparently happened sometime in the last 24hrs based on their observations and my OPKs.
Then maybe there's a little confusion.  Did they not see 20 follies, but a follie that measured 20mm collapsing (having ovulated in the last 24 hours)?  Because then your RE telling you to get busy makes sense.  If they saw 20 follies *after* you ovulated they I'm totally confused.  I thought you were talking about AFC.
ETA:  I had a 16mm on my right on cd10 when I had my saline sono on Wednesday - which makes sense since I usually ovulate on cd13 and follies grow 1-3mm a day.  So it will be 19-25mm by tomorrow when it most likely ovulates, and that's a natural non-treatment cycle. 

I may be using the wrong terms, new to the RE thing...

When they looked at the right ovary it looked like a chocolate chip cookie. They counted the chips [black circles, I think immature eggs] and found 20. On the left side they found 5 and a mongo one they said was the cyst from ovulating. The mongo one was easily 5x the size of the others.

toomanycats1 · July 2013

So glad your appointment went well! Not sure which option is best for you. If it were me, I would go for option 1, because then at least it's all over with in one shot. You have short cycles anyway, so it's not like you'll be out for months. If you don't want to take the hormones that are in the BCPs, perhaps you could use condoms instead for that month? I would kick myself if I went through the procedure in office and still ended up having to go in for surgery, plus that would make your wait longer since you might not be able to get booked in at the hospital right away. Hopefully some of the other ladies that have been through something similar can weight in.

Sorry you ended up in the same waiting and it brought back old memories. Life really can be cruel sometimes. ((hugs))

So glad room the RE thought it looked like you O'd though! Maybe you'll get lucky and this will be your month anyway, and all the surgery worries won't matter.

I'm definitely keeping my fingers crossed for you!

WifeofaComposer · July 2013

That sounds like a great visit!!!

As far as your options go, if it were *me* choosing, I'd opt for the doctor's office. I wouldn't want to take BCPs. Best of luck!!

mightymousy · July 2013

*siggy*

I'm so glad the appointment went well for the most part hunny! *big hugs* I'll let the ladies with more knowledge on the subject weight in on your options, but wanted to say I'm glad your RE was so encouraging and that you're coming up with a game plan if it works out financially/insurance wise I think IUI might be a great idea considering your time constraints. I'm determined for you to get KTFU before he deploys lol! Get it on tonight!!!

buggirl72 · July 2013

I am so glad you had such a good appointment!

I'm with katib on being surprised they cannot just schedule the surgical option between CD5-10 without making you go on BC. If you go with option 2 and they end up having to do the D&E, does that mean you end up losing that cycle?

I know it is tough to skip a cycle, especially with his deployment coming up but if it will improve your chances of conceiving then I lean towards #1.

Junebug060609 · July 2013

mlal78:
Sounds like it was a good apointment June, I am so glad!I am not sure which ruining my excitement, DH.I would choose.nbsp; Option one sounds like a quicker resolution if there was anything that needed to be removed, but I would feel the same as you about going on the BC and losing a cycle.I agree with Katib, why could they not do it cd5 ish when you know you are not post o?

I believe the reason for the bcp is that their OR is really busy and to get it done in the next cycle [given my time constraints] they couldnt guarantee it would be early in my cycle. She did say though that after the procedure I could stop them, so maybe it wouldnt be a whole cycle I would miss...or maybe I misunderstood that...

DH was no help when I discussed it with him. No opinion it seemed and he was in a pissy mood. Thanks for ruiming

Junebug060609 · July 2013

Veganlady:
I would be reluctant to take the BCP. I figure our hormones are borderline out of whack anyway, why add more to the problem. Would other BC or abstinence be ok?
If you go hysteroscopy in the office and it turns out that a hospital procedure is necessary, is there time that you could still only miss one cycle? I guess I'm wondering if you have anything to lose with the office procedure, maybe some time to gain?
Great appointment! Love to hear docs giving good news
Also, you have a nesticle! Was that always there?

I didn't know about it until you mentioned it. Cool!

I'm leaning more and more towards the OR option. If there is an issue, it can be resolved on the spot, and I'd likely only be put back a couple weeks or so...which would actually give us just as many cycles as we would've had otherwise. We are currently slated to miss a FW at the very beginning of October bc of the move (we'll be on opposite coasts). This could potentially push that to where we'd get that one back. I guess we could potentially be missing one right (as in days) before he leaves though...

Junebug060609 · July 2013

eme520:
Glad to hear that your CD3 bloodwork looked good and you are happy with your appt. I agree with veganlady, are there other options you could use rather than BCPs? I'd hate to throw things off hormonally when your H is going to be deployed in November. Also, what are the chances they think the 8mm "thing" is causing any real problems? I might lean more towards the office option and defer going under general anesthesia, especially if they are insistent you use BCP for the OR option. That's a tough choice, I hope you get some answers either way!

They really didn't know what the chances are that it was an issue. Given the size, I'm thinking slim, but they don't want to go forward with things like clomid and the like until they know the ute is in good shape. The reason I'm leaning towards the OR option is that given my history (I've had uterine fibroids removed previously), chances are it will be something they'll want to remove. An added bonus to them doing a hysteroscopy is that they should be able to at least get a peek at the openings for my tubes and confirm they are clear. They should be, but who knows what's happened in there with my three pregnancies...

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