We have a plan

Our rescheduled appointment with the RE was this afternoon. I really like our doctor and have heard nothing but good things about his clinic. . . but again today, we had to over 30 minutes past our appointment time to see him. This on an afternoon when the scheduler told me on Tuesday he had nothing else set! Clearly that was not the case--or things were set after our appointment--because I saw him coming out of a treatment room prior to seeing us and he got buzzed that his next appointment had arrived shortly after sitting down with us.

I supposed it's a good thing to have a RE who is in demand, but neither MM nor I are patient people by nature. And being a lawyer in private practice who must account for her time by the billable hour has not made me more patient or tolerant of waits! Couldn't help but that I wasted 0.6 hours of billable time. Dumb, I know. Anyway.

We finally got in for our consultation, and we were both pleased with the way things went. MM's repeat S/A was much better: way fewer "round cells," a concentration of 95 million sperm/ml (can't remember his total count, though), and morphology of 10%, which the RE said was fine. We discussed our options. Well, to be more accurate: I told the RE that I had researched our options and asked him to tell us what he would recommend as a first step for treatment. (MM hardly said anything, and most of what the RE said confirmed what I'd already read. Nothing like having done your research!)

The end result is that I am going to start Clomid this coming cycle if I am not already pregnant. (And I have no reason to believe that I'm pregnant; I have zero symptoms, and in fact, we had less sex this cycle than usual, especially during my fertile window.) We will do a HCG trigger shot and IUI. Although I don't want to waste any more time than necessary, we're not ready to jump right into IVF. . . and it doesn't make sense for us to do so, given that we are "unexplained" and probably "sub-fertile" rather than "infertile," according to the RE. Plus insurance will pay for a portion of IUI and nothing for IVF.

He wanted to wait on giving me injectibles until he sees how I respond to Clomid and said that he would be concerned about the risk of multiples with MM's high sperm count if I responded too well. So he would like to start with a Clomid cycle to see how my ovaries react.

MM was very pleasantly surprised to hear about his good S/A ("super," as the RE put it) and was encouraged because he felt that the doctor sounded confident about the chances of getting me pregnant. He is optimistic that the IUI and Clomid will work on the first try and we won't have to pursue any other treatment.

Of course it'd be great if this works on the first try, but I'm realistic and like to look ahead and consider the "worst case scenario." We've agreed that if I am not pregnant after two cycles of just Clomid and a trigger shot, the RE will add injectibles to the mix.

The nice thing about using only Clomid and a HCG shot is that the entire cost of the IUI, including drugs and monitoring, won't be costing nearly as much as we thought: the full, cash price would be just under $1000, and we'll be paying less than that because MM's health insurance will pay for 50%. . . and 50% of a lower rate at that because it's insurance.

We're too late to have a 2009 baby, but I'm hopeful that I can still be pregnant before I'm 39 and a mom before I'm 40.