RE update

PoeMasque · December 2016

so we finally saw the RE today. He's very nice and my SO really liked him. He said that unless my CD21 progesterone comes back low we are "unexplained" and basically have a 1% chance of conceiving on our own.

His office requires everyone to be on birth control for a month prior to IVF, so there's no way to get us in for a January cycle. They don't do any IVF cycles in February, so that puts us out to March. I'm super pissed because it took us TWO months to get to this appointment, but he made some comment about how easy it is to just pop in and see someone anytime.....which just made me angry and completely not trust the whole office.

our plan at this point is no interventions this cycle (if they'd kept my original appt we could have done clomid this cycle), clomid and IUI next cycle for $500 - no ultrasounds, then birth control all of February with IVF in march.

I feel like I should be happy that we have a plan, but I'm too pissed about waiting for this first appointment. I seriously cannot figure out why we had to wait so long....why wouldn't they have seen us even two weeks earlier to get us in for a January IVF? Ugh.

vlagrl29 · December 2016

I'm sorry for your frustration! I'm sure it feels like its moving so slow. Why the birth control - whats the point of that? I'm also sorry for the unexplained and 1% - that would be kind of deflating. I would just take this next cycle easy with the no interventions that you mentioned.

thistle8677 · December 2016

@PoeMasque that seems like such a harsh diagnosis to make about only 1%. I'm so sorry you're having to go through more red tape. We were told that the IVF process would be a 3mo process start to finish depending on how many eggs were retrieved. Oregon Reproductive Medicine also does a month on birth control.

It's so much to take in and it's so emotional. I'm thinking of you and I'm sorry you have to wait longer. It's not fair.

PoeMasque · December 2016

@vlagrl29 without a month of suppression one of the eggs would become the "lead" follicle and actually hinder the growth and maturity of the other eggs, so it's a good thing, although irritating to have to wait.

@thistle8677 thank you, I will be thinking of you as well and hoping for a sticky bean this time. Who would have thought our journies would have turned out this way?! I remember when I was just a newbie on here

liljoy-2 · December 2016

Yeah, with unexplained or "severe endometriosis" in my case, the chances they gave me were also about 1% naturally, and 5% with IUI and 20% with mini-IVF, 50% with standard IVF

All these low probabilities are really depressing when heard the first time, but these are the odds, I guess.

And about the wait, the first clinic I wanted to go to near me put me on a 1 year waiting list!!! The other two I contacted had a 2 month wait, so yeah they are very busy!!

jennh75b · December 2016

Very sorry for your setbacks @PoeMasque - I'm still rooting for you from afar!!!!!!!!!!! It's nice to have a plan in place. Hugs.

Hopefulmommy1980 · December 2016

@poemasque I am sorry that you are having to wait so long.

waiting sucks so bad

KLake42 · January 2017

I might be delayed also, since my wife's baseline revealed what might be a cyst on one ovary. She's getting blood work today, and we'll know then if it's creating estrogen-- that would mean it's a lead follicle, and would pretty much absorb all the ovarian stims, and make the IVF pointless. Which requires us to wait about a month. Poop.

One thing I've learned from all these lessons in patience-- make sure you continue living your life while you wait. Plan a weekend getaway, or take a class, or do *something* fun.

We have a couple staycations planned later in 2017 (around nerd conferences that are local), and we'd schedule a weekend away if my wife's work situation weren't totally up in the air (we think she's about to be laid off, maybe today). We've earned enough miles to travel wherever we want, after using a miles rewards credit card for all fertility expenses, but we don't have the money to afford a hotel!

PoeMasque · January 2017

@KLake42 im so sorry to hear you might be delayed. It's never a good feeling to think you're finally on your way only to have the brakes applied. Fx the cyst isn't a problem!

after so many months of zero success we are pretty good at moving forward with life. We will be going to the coast for the weekend for my SO's bday next weekend and we are still planning on visiting family in WI in the fall. We are lucky that we live in Oregon and have lots of great hiking and coastline within an hour or so. We haven't had money for big trips since we bought a house, so that's not really new for us

I'm waiting to hear back from the RE about my progesterone levels, I would have heard back today but we got about 4" of snow overnight and it's still coming down (we NEVER get snow here so everything is shut down). If my levels are low we might actually wait until May to do IVF so we can give clomid a chance for at least 3 mos. if my levels are fine we will stick to IVF in March.

dragonette505 · January 2017

@PoeMasque What about estrogen priming? That's much shorter than bc, I believe... only from ov to af.
I had a similar issue with a clinic... delays and then the clinic shut down for a month, which in NYC seems insane. I quickly got an appointment with another clinic and we got started right away... I now have 4 embies on ice and I'm glad I jumped ship.

PoeMasque · January 2017

We actually found out that my progesterone is high enough for O, but too low for a mature egg, which should be easily fixed with clomid. would have been nice to have known all of this months ago....but we are electing to do 3-4 cycles of clomid/IUI first now. If that doesn't work we will do IVF in may.

Momifbysea · January 2017

@PoeMasque I think we may be on a similar schedule as you regarding the IUIs and IVF. Do you know what prep is for the IUI, as far as advance timing needed beforehand? Our next RE appointment is 1/26 which would likely be my O day or 1 day prior, so I'm wondering if I would have to wait until Feb to take the Femara first. I am pretty sure I'll have to wait but do RE's ever do IUI without you having taken meds first? My follicles were 4 and 5 so I would think there's a shot without the Femara route.

PoeMasque · January 2017

@Momifbysea you can do unmediated IUI, the pregnancy rates are dismal though. You have to start meds around CD3 so it's too late for this cycle for you. Maybe see if they'll give you progesterone for your literal phase? Won't hurt

SP128 · January 2017

@PoeMasque Sounds like you have a solid plan : )

Momifbysea · January 2017

@PoeMasque thanks for the info and FX for you with your plan!

Momifbysea · January 2017

I wasn't sure where to post this since I'm not in TWW but wanted to share that all of a sudden I'm on for IUI this cycle! I called RE nurse yesterday (CD4) to ask if I could do first IUI unmedicated just so we didn't miss a cycle since our next appt isn't until 1/26. She asked what CD I was and when I said day 4 she called in Femara rx for me and I took it last night. I was initially really nervous to take it given it's off-label use (since it's indicated for breast cancer treatment) and the warning on the bottle about not trying to get pregnant but am now feeling good about it, having read how commonly it is used for fertility. So we shall see. Next step is I'm to test for lh surge starting day 12. But since I ovulate typically day 12 or 13 I think I'll test starting CD11 so I don't miss it. After surge they will schedule me for the next morning for the IUI. I'm excited that this happened so quickly and feel better with a plan.

vlagrl29 · January 2017

@Momifbysea - that's great you are getting on it this cycle. Looking forward to hearing how it goes. I'm also scared to take medications. That progesterone pill was absolutely horrible. My OB said if my progesterone comes back low next month we can look at suppositories or creams but she warned me they are more expensive which is why they go with the pills first.

Momifbysea · January 2017

@vlagrl29 good to know on the suppositories versus pills. On a separate note, I'm feeling it's a little odd they don't do an ultrasound before the IUI to make sure things look good but I'm not a doctor...

KLake42 · January 2017

@Momifbysea I think ultrasounds are expensive, and I expect they only want to do them when necessary. Femara helps, but doesn't run the risk of extremely high order multiples the way other drugs do. So they may opt not to do the ultrasound because they aren't worried about that risk.

I did a ton of IUIs, most of them with femara. I did experience a side effect (which is rare, happens for about 10% of those who take it) of joint pain. If you find that you're feeling achey, be sure to take things easy as far as exercise goes.

Momifbysea · January 2017

@KLake42 I wondered why they wouldn't do ultrasound to monitor as far as correct timing. I guess they figure doing it the morning after the OPK surge is sufficient? Sorry to hear you had the joint pain from it. If you don't mind my asking, are you moving away from iui's now? Has your RE recommended IVF? I have been reading a bit about mini IVF and plan to ask RE about it as it sounded more promising for older women like myself.;-)

PoeMasque · January 2017

@Momifbysea yay for starting already!! I agree with the pp, but (of course) have to add that the research says IUI the day after positive OPK is best practice. You would need a trigger shot if you weren't doing OPK because you can't predict O via US, it only tells you that follicles are growing or that they've ruptured. The research actually shows that there's no reason to even do a trigger shot, the numbers are similar for OPK vs trigger, so it's not actually recommended to trigger anyway (the caveat being that ~30% of unexplained IF may be linked to LUFS which can be fixed by trigger, but that's a bit of a rabbit hole)

Momifbysea · January 2017

@PoeMasque so thankful for your clinical knowledge on this! The IUI is new territory for me! Now as far as best time to BD, I don't want to mess this up. Our RE gave us instructions but if I surge on Monday morning then he can't come with on Tuesday morning so will have to bring his sample Monday for them to store until Tuesday. So I guess we back up BD time from Monday to be safe? If we do the night before he does his sample wondering if count or quality would be lower? Would it be ideal to have a skipped day in there? Sorry for all the questions- here I had just gotten the hang of the Advanced Digital OPK and now I have new things to learn, lol!

PoeMasque · January 2017

@Momifbysea theres no problem with back to back days (you can BD the night before IUI for example), but if you're wanting to BD and provide a sperm sample on the same day, I would have him do the sample, then BD after. one of the nurses I work with insists that my SO needs to "store up that sperm!", but research just does not back that up. I humor her and just nod my head.....haha

liljoy-2 · January 2017

Hi there, I feel like I may have said this somewhere but I did take both Clomid and then Femara for mini-IVFs. Clomid tends to get one more follicle than Femara (per my RE) but I didn't tolerate it well and only had one mature follicle on it anyway that I lost to ovulation. I liked Femara better (no side effects) but I'm sick of the IVF injections already ugh...
As with regard to abstinence before IUI, REs say 2-4 days and anecdotally my DH count was way better with the 4 days rather than 1 or 2.

KLake42 · January 2017

@Momifbysea
I'm done with IUIs, and done with IVF using my own eggs, after I had two IVFs canceled for poor response. My ovaries seem to have aged prematurely, and I would likely have had trouble if I tried in early 30s.

So my next step is reciprocal IVF using my wife's eggs, my uterus!

Momifbysea · January 2017

@KLake42 I understand. Hopefully the reciprocal will be the answer for you! I was doing some reading on AMH which has given me hope. Apparently AMH can indicate better or poorer response to interventions like IUI and IVF. Mine is 3.754 and RE said anything over 1 was good, so here's hoping. Of course my RE reminded me that quantity is not the same as quality and that the latter is more tied to age, so trying to stay realistic...

PoeMasque · January 2017

@Momifbysea my AMH was only 2.46 and the RE said that was completely normal and didn't signal looming menopause, so 3.75 is awesome. As I understand it AMH is ovarian reserve (are there eggs left to push out) and FSH is quality of egg.

KLake42 · January 2017

I don't recall my AMH and FSH numbers. I believe they were both in the "yeah, that's kinds of crappy" range.

My wife's numbers are normal though!

liljoy-2 · January 2017

Momifbysea That's a good AMH for your age! Do you know your FSH too? With these numbers you would be a good candidate for IVF I think. There are lots of ladies in their early 30s and older with lower AMH (that most of the time signals diminished ovarian reserve) that have trouble growing eggs during IVF.
I couldn't find definite research on AMH=quantity and FSH=quality, I think both of them together with the age give an estimate of the IVF/IUI success. I have good AMH and FSH towards the upper limit (above 10 is not good), but I think this is because they took out more than half of my ovary during lap surgery, so less follicles there. However, I've just been through another IVF egg retrieval and I over-stimulated like crazy. I got 21 eggs, more than what women in their 20s get, go figure!

Momifbysea · January 2017

@bestofjoy that's awesome on your eggs, wow! As for my FSH, it's 6.98. I'm hoping IUI works so we don't have to do IVF. Money would be an issue! Anyway, I'm writing this from the fertility clinic parking lot so I better go in for IUI #1!!!

PoeMasque · January 2017

Fx @Momifbysea !!!!

Momifbysea · January 2017

Ok that IUI was so easy! Now for the hard part. What to do while waiting?!?

laurad75 · January 2017

@Momifbysea Yay! So glad the IUI went well. It's crazy how quick and easy it is. The waiting is the worst. Get yourself a pineapple and enjoy some of that the next several days. Be sure to eat the core which contains bromelain and is supposedly good for implantation.

Be sure to keep busy the next couple of weeks and focus on other things besides TTC (easier said than done obviously). And finally...do what you can to not look for symptoms. They mess with the head.

vlagrl29 · January 2017

good luck with the IUI @Momifbysea Fx it sticks. Isn't modern medicine awesome - good to know its there if we need it

Momifbysea · January 2017

Thanks everyone for your well wishes, the support feels awesome and we are hoping and praying!

PoeMasque · January 2017

@Momifbysea if you figure out how to not go bananas during the TWW let me know......I'm only 4DPO and already feeling like it will never end!! FX for both of us that meds/IUI works!

SP128 · January 2017

@Momifbysea @PoeMasque FX that this is your cycle!!

Momifbysea · January 2017

@SP128 thanks!

@PoeMasque doing okay with distractions so far, busy at work so that helps! But I have 13 more days to go...we will be in touch a lot during this I'm sure. How cool that our timing lined up?

PoeMasque · January 2017

@Momifbysea are they testing your progesterone in a week? I go for mine of Friday and am so scared it will be below 12, which basically means BFN.

DeeVeeZee · January 2017

GOOD LUCK LADIES FX for you!

Momifbysea · January 2017

@PoeMasque yes, RE wrote the order for me today. He said I could get it done anywhere but I realized I have no idea who to call for that type of thing at the medical center. FX for good results for you!

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