RE appt today

I have an appt with my RE today. After several rounds of clomid and then femara, we are ready to move on to IUI. We've talked about this a lot and know it is what we want to do. But still I'm nervous and hesitant. Logically I know that it will likely be a while before we actually do the IUI and that we've been in this for a long time already, but emotionally it feels so sudden and like such a big step.

I think my hesitation is also due to my fears that it won't work. The planner that I am, I'm already thinking through the next several steps. DH and I both don't feel comfortable with IVF and the idea of having our embryos just hanging around. So right now our plan is that if IUI doesn't work, we will move on to adoption. But then this feels so final as well. What if it doesn't work? Will I be able to face our options then? As we get closer I already have had some different thoughts in my head about IVF. For example, would we think differently if we agree to eventually transfer all embryos? But then wonder I if these second thoughts are just my way to find a rationalization for something I'm not that comfortable with. I know there is a big difference between IUI and IVF both in terms of intensity of the experience and everything entailed. But still I lump them together. The funny thing is, I don't think my worries are that related to the real concern of multiples. I know DH is worried about that. I'm more focused on the fear of what if it doesn't work and what do we do then?

On another note, there is one reason I'm looking forward to this appointment. At our last appointment, she told me it would help if I lost weight, even if I lost 10 pounds. Well, I did that. Actually, I lost 15 pounds since then, but stress-related eating due to a busy period at work and Halloween candy put me back at a net of 11 pounds. I know other people have noticed. Let's hope my dr does as well.

Insurance

We are in the open enrollment period for benefits at work. So we have a chance to decide what insurance plan is best for us. I'm trying to figure out what would be best for us.

I work for a very large company, and we are fortunate that we have 3 options. They have varying levels of premiums, co-pays, deductibles, and co-insurance. If our medical expenses for next year are about the same as they were this year, then one option is much cheaper. The disadvantage of that plan, though, is that it has the highest out of pocket maximum, so in the worst case scenario, we would end up paying $2K more than the other plans. So we have to decide how we feel about that risk.

But here's where it gets even trickier. None of the plans pay for the treatment of IF, but they do pay for the diagnosis of it. Our expenses this year were exclusively for diagnosis (they all have the same prescription drug plan so I'm not including costs for cl.omid or fem.ara in figuring this out). But, assuming we are not successful this cycle, we are going to start getting more aggressive and will start IUI. So we will move from diagnosis to treatment as our major contributor to costs.

I can also get a health savings account where basically I can put some of my income in an account specifically for medical costs (and this is good for fertility treatments) without paying taxes on it. But this amount does not carry over at the end of the year, so if I don't use, I lose it. Since this account can be used for IUI and IVF, my first inclination is to put a lot of money in there and save on taxes. But assuming I'm not pregnant now, I hope to do one IUI cycle before the end of the year. And then of course we have no idea how many cycles we will need.

What would you guys do in this situation?

Another month

Another month, another set of hopes dashed. I guess I shouldn't have really expected anything since we had to forgo the meds these past two cycles due to bad timing. But what is left if we don't have any hope?

I'm feeling very conflicted right now. Our RE has said we can move forward as we wish. She gave me a prescription for fem.ara saying we try that for a few cycles and then move on to IUI whenever we want. On the one hand, I'm scared to move on to more aggressive measures like IUI. It just seems like things will get much more complicated much more quickly. I'm anxious and scared and worried about it. On the other hand, part of me is thinking that I just want the next two cycles of fe.mara to hurry up and get them over with so we can move on to IUI. But if I really wanted to start with IUI, there is nothing stopping me.

Except for me. There's the dilemma.

RE update

Some thoughts from my most recent RE appt:

1. Apparently my diagnosis is “ovulatory infertility,” which, when she described it, sounded an awful like unexplained infertility. She doesn’t think the male factor is that big a problem given hubby’s second SA results. Even though the lab that did the test called his motility and morphology “low”, she thought it was pretty normal. So either the first SA was a bad test or the vitamins he’s been taking have worked. As for me, she is concerned about the variable length of my cycles and short LP phase which would indicate not very good ovulation. She doesn’t think I have endo and as for PCOS which she previously thought I had, said I have only a mild variant of it.

2. Her clinic recently moved locations to this brand new facility. Still part of the same university hospital, but in a different location. Actually, the hospital converted a shopping mall to a medical clinic where the big stores on the outside on the first floor are still retail (so you can move straight from your OB appt to Babies R Us…less helpful if your visit is for IF). The inside of the mall on the first floor are hospital administration offices (billing, etc). The second floor is where all the clinics are, plus a bagel shop. This was quite a strange experience although it seems to work. I was tempted to stop by Michael’s on my way out.

3. This new clinic is all state of the art. Very high tech. The doctor spends the whole appointment typing away on the computer, which is kinda weird but then you can see the impact when she can easily review your status and know your whole history at the follow-up appointment. And I like the online system where you can message your doctor. But sometimes all these high tech goodies really seems unnecessary.

For instance.

When you show up at this clinic, instead of checking in with the nice ladies at the front counter, there are automated kiosks like you see at airports. They check you in, verify your current contact information and insurance, and can take any co-pays by credit card. It does not seem to me like these functions take all that much time or the lines are so long that taking this function away from real live people saves all that much. Especially since the next thing you do after using the kiosk is talk to the lady at the counter. She gives you the medical info sheet to complete and--get this--a buzzer! to let you know when the nurse is ready to see you. You get the fantastic experiences of both an airport and an overcrowded restaurant all before someone starts shoving things into your private parts (which, if you think about it, kinda goes with the airport theme).

4. Since I’ve had 3 unsuccessful cycles on clo.mid and this cycle I appear to have O’d without clo.mid, I had some blood drawn to check my progesterone levels. My temps definitely indicate I O’d on my own, but hopefully this will confirm that. The next step is to schedule an HSG for the first part of my next cycle.

5. She gave me a prescription for letrozole (Fem.ara). I’m a little worried about using a drug off-label. Need to learn more about this. I'm especially worried that it might cause birth defects.

6. When they designed this new clinic, apparently they thought people have gotten larger because the chairs are super wide. The chairs in the waiting areas seem normal enough, but once you are in the treatment rooms they get oddly wide. Not wide enough to be called a bench. Only one adult could sit there, or two little kids. But you can’t really sit there comfortably because they are so wide that the arm rests are too far apart.

7. She said we could go straight to IUI if we wanted, but since I’m young there is no need to rush and we can give it a few tries on another drug. I at least want to get the HSG done before we start with IUI.

8. She also said I could stand to lose 10 pounds to help with my ovulatory infertility. Ugh, I’ve been trying, really.

9. This appointment was both frustrating and encouraging. I left feeling like I had a plan and might see a baby at the end of this relatively soon. But frustrating because she took my diagnosis away! Unexplained IF is not fun at all (not that any IF is any fun).

9. I asked my hubby if it was weird to give the semen sample in a dr office, but not specifically about showing up in a OB/GYN's office. While I was sitting in the waiting room, a man shows up by himself and checks in. Why else would a man be at a women's health center by himself? The entire shopping mall clinic does have other offices, but this section was at the end and most definitely focused on women's health.