Friday, April 23, 2010

RE visit

As planned, MM and I had a sit-down appointment with our RE today, our first in over a year. I posted a few weeks ago here about the fact that MM wanted to talk with the RE about the possibility of doing more IUIs and how much it might increase our chances of conception.

As usual, our RE was running behind schedule; we waited 35 minutes past our appointment time, despite being told at check-in that he was no more than 5-10 minutes behind. But also as usual, once we got in to see him, he took his time and discussed everything with us in detail and answered all our questions.

When asked what he would estimate our odds of conception to be currently, TTC on our own, he said he would estimate 5% per cycle. (I actually thought it was more like 2-3%, so I found this encouraging.) He noted that the chemical pregnancy I had in July/August of last year, which was the result of a break cycle, at least let us know that things are "working behind the scenes." In other words, MM's sperm are able to reach and penetrate my eggs, so there is no problem with sperm functionality and no problem with my cervical mucus. (He already knew my tubes were clear from my January '09 HSG.) The most likely barrier to pregnancy for us is the quality of my eggs, which is a result of my age. Poor egg quality (and the resulting genetic abnormalities) is the most likely reason I had the early miscarriage.

MM asked him for some "hard numbers" about what he thought our odds of conception would be with IUIs and stims. He estimated between 10-15% per cycle, noting that, at my age, the stimulation portion of the cycles is probably of greater benefit to us than the actual insemination.

We did remind the RE that we do not wish to do IVF, and he respected that. His only comment about the (relatively low) success rate of IVF at my age was that it doesn't take into account the possibility of future FETs from the eggs that would be retrieved. My lack of ovulatory issues and previous good response to stims would likely mean that he would be able to retrieve a better-than-average number of eggs. However, in looking back at my initial baseline u/s, we both noted that one of my ovaries (the left) is behind my uterus and thus inaccessible for egg retrieval, so that would almost certainly adversely affect the number of eggs that could be retrieved.

He told us that his recommendation would be to try 3-4 more IUI/stims cycles. We left the office without committing to doing anything, planning to call the office on my next CD 1 if we choose to go forward.

MM and I talked briefly after leaving the office, and we've agreed to go ahead with the 4 more IUIs for which our insurance will pay 50% of the cost. So I may be back on the treatment roller coaster here in the next few weeks.

Of course, today is CD 27 for me, and we did have well-timed intercourse this cycle, so I suppose it's not impossible that I am currently pregnant as I type this. Normally AF would be here, or close to arriving, by CD 27, but I do know from my OPKs that I probably ovulated a little later than usual this month, so I'm not feeling particularly optimistic about the fact that AF is not here and does not seem to be on her way yet. If I get to CD 32 (next Wednesday) and still no AF, then I might get hopeful.

So that's where we're at. Assuming I am not currently pregnant--and given what happened in July/August last year, I will be checking a HPT even if/when AF arrives--I will be back on Cl.omid and shortly.


  1. I don't recall how many follicles you had in previous cycles, and I also know you aren't asking for advice, so forgive me if this is unwanted. But I just wanted to say that perhaps if you only had 1-3 follicles in previous cycles you could request upping the doses of meds. I had 4 negative cycles with 1-3 follicles, and no known problems. Since the extra follicles greatly increase the chance of conception and don't really increase the odds of HOM by all that much (especially if your problem is older eggs which don't make good embryos), then trying to get a few more follicles into a cycle seems like it would be a good way of hedging your bets.

    I kind of saw it as a way of doing several "break" cycles at once. If you have a 5% chance of getting pregnant each cycle on your own, and you have 5 follicles, I'd call that a 25% chance for one stim cycle. Not that I'm a doctor or that's statistically accurate, but I'm just wondering if you're considering that.

    Sorry if it's unwanted advice, and good luck if/when you start on your next stim cycle.

  2. sunflower, thanks for the advice. I welcome all ideas when given in the spirit of helpfulness that yours were! ;-)

    We did talk about being "more aggressive" with my dosing this time around, since I have been producing 1-3 follicles without results. And FWIW, my RE agrees with you that the chances of HOM for us, given the likely quality of my eggs at my age, is not high (less than 1%, he estimated).

  3. Hopefully, the plan won't be necessary, but I'm glad you and MM were able to move forward with your RE.

  4. Your appointment sounds like it was encouraging. Wishing all good things for you from here forward!

    You mention that if you decide to move forward with treatment that you will be more aggressive with dosing. I agree that this is a good idea. I have unexplained infertility/poor egg quality/advanced maternal and my RE was conservative on the dosing side. I produced 1-3 follies for 3 IUIs without success before deciding to move on to IVF. Looking back I wish we would have known to push to increase the meds. Perhaps we would have avoided IVF.

    Good luck!


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