Re Consult #1; or, Decisions, Decisions

Thanks so much for all the support and well-wishes you left on my post yesterday. It means the world to see the faith you all have in this process and where I'm going. On my better days I feel the same way, and on my worse days it's good to have reminders that there are people out there who believe this can happen for me.

So...on to the appointment recap!

I guess I'll start by saying that Dr. Man (at NY.U) was very nice and approachable, as well as direct and informative. He wasn't a major cheerleader but he gave us the information he has at this point about our situation, ventured some supposition into what might be going on, and laid out some possible options for the future.

The first bit of (good) news was about my CD 3 bloodwork from a few days ago. My FSH was 5.2, which Dr. Man said was really good and an indicator that I've got lots of healthy eggs. He didn't tell me the estrogen number (and I forgot to ask) but that's probably just as well, because that's less for me to google.

We discussed my cycle history. I told him the lengths of each of my fourteen cycles of TTC and whether I had confirmed ovulation or not on any of them. Dr. Man also said that given the amount of time we've been trying, our likelihood of success without assistance in any given month is about 3%, a disappointing statistic to say the least.

He did an ultrasound and said that my uterus looks good, my lining is thick, and my ovaries look healthy. He showed me the corpus luteum on my left ovary where I ovulated over the weekend (And btw, this totally confirms my little theory about my ovaries. Last cycle I ovulated from my right ovary about 5 days late. In the cycle I got pregnant, the same thing happened. And now I had normal--for me--day 21 ovulation from the left ovary. I think that right ovary is a lazy slacker!)

Thanks to my somewhat irregular cycles, Dr. Man suggested I may have some (mild?) form of polycystic ovaries. He emphasized, however, that he didn't want to call it a "syndrome" because I *am* ovulating most months and that cysty ovaries at the start of a cycle are quite common and don't mean there is anything wrong with the way my body is working (he feels that women are overdiagnosed with what can be a relatively normal condition). He doesn't want to run the tests for insulin resistance because he thinks I am basically normal, and as I'm not overweight, not terribly hirsute, and have no family history of diabetes, he doesn't want to needlessly worry me. He also believes the link between PCOS and miscarriage has not been adequately proven (or not proven at all). He thinks I have lots of good, healthy eggs that take a bit longer to pop out and that we can shorten that time and give me more chances to get pregnant each year.

He ordered an HSG for next cycle, even though he said he doesn't think we'll find any major abnormalities of my uterus or tubes.

He also ordered Lawyer Guy an SA (of course) and confirmed our suspicion that the pregnancy means he definitely has sperm, but it might be of borderline quality, which would help account for our difficulties.

He ran us through our options from least to most invasive and expensive. I know you're all familiar with them, so I won't bore you with the recital. He stressed that he's willing to go at our pace and according to our comfort level, both emotional and financial.

He also told me that I can do a clomid cycle with or without insemination next month even though I'll be getting an HSG, which was good news, as I'd assumed October was out for any treatments given the additional testing I'd need.

I asked him before we finished the consult if he was optimistic about our chances of getting pregnant, and he said he was. He said egg quality was the toughest thing to overcome, and that we seem to be okay in that regard.

It was an intense morning, and Lawyer Guy and I did some talking afterward. I liked all the nurses we met and found Dr. Man approachable and professional. He wasn't super warm and touchy-feely, but he was good about giving us information and data and talking us through different possible actions to take based on that data.

I think Lawyer Guy was a little bummed by Dr. Man's professional caution. Some friends of ours were told by their RE at their first appointment, "We are going to get you pregnant," and LG mentioned to me he was hoping to hear something like that. But I don't fault Dr Man from holding back from that kind of enthusiasm, especially because we don't know anything yet about how I respond to medications or LG's sperm quality. When put to the point, he seemed optimistic, so that's good. But LG's desire for a more aggressively optimistic doctor is something for us to keep in mind as we continue our search.

Lawyer Guy didn't want to talk about any of the specifics of treatments until after our meeting with Clinic #2 on Friday, which I can understand. We'll make our decision that night and get set for what comes next.

But of course, I've done some thinking. I'd like to start with a clomid cycle in October, especially because we've got to put treatments on hold for November and December in anticipation of my sister's wedding. If LG's sperm numbers come back good, then I think I'd like to try clomid with intercourse; if they're borderline or bad, then try an IUI.

We have unlimited IUI coverage with our insurance and zero IVF coverage, so doing a large number of medicated IUIs makes sense for us, until we just can't take anymore. And then we'll need to think hard about IVF and adoption and how we want to use our money. But we're not there yet.

I guess I'm feeling cautiously optimistic right now. I entertained a brief daydream about giving birth to twins and holding them at the hospital after the consult, which is positive. I also recognized that I am sad to be here. Part of me secretly hoped we'd show up and Dr. Man would say, "Are you crazy? You're not infertile! Get outta here!" But we're going to make the best of this, and maybe even get some twins out of the bargain.

RE appointment #2 coming up in two days, and then we'll really be able to make some decisions.