RE Part Two

We had RE part one last March, which resulted in 10 vials worth of bloodwork, an HSG, a hysteroscopy, and a D&C. Suffice to say, I was ready for anything when we went into our meeting today.

In comparison, it was exceedingly chill. They didn’t even weigh me. *shakes tiny fist* All that low-carbin’ for nothing.

Granted, last time we went in to figure out what was wrong (Hint: starts with a ‘p’ ends with an ‘cos’). This time, we knew and we were ready to move to the next step.

No bloodwork was scheduled, no more tests, just a quick overview of their process, how he thinks we should proceed from here, and then to call their office the first day of the next cycle we want to try. Easy peasy.

They have no requirements for banks, although he recommended NW and Seattle based on previous experiences the office had had with both. We should get ICI vials because their office will wash it anyway. And we should put a lot of thought and time into the donor selection process, but should definitely pick someone over six foot. Which made me laugh.

He also said we could just do ultrasounds to pinpoint ovulation and otherwise do the cycle natural, wherein I spoke up about my problem with anovulatory surges – that is, I’ll have every symptom of ovulation and an LH surge, only no temp rise. But a few days or a week later, same symptoms, plus temp rise, plus period two weeks later. Of course, this isn’t every cycle, because that would make it too easy.

Anyway, I explained this to him, especially as part of the reason for wanting to do IUIs in the first place, and he still said that we could do ultrasounds, then trigger when the follicle is 14mm+, or we could go straight to clomid/letrozole and trigger.

The problem with just ultrasounds is there is always the chance I won’t ovulate in a timely manner and we’d have to skip a cycle. In my last five cycles, I ov’ed late three times – once after a false surge but three days later, once after a false surge but over a week later, and then this last time because well, I had pneumonia. Not a good track record. So ignoring that last one, that’s still 2 out of 4 times. IDK if either would count as “late” and I should have asked exactly what he defined as “late.”

But would a trigger shot fix this? I have no idea. He sounded confident, but that was contingent upon follicle size, which honestly I don’t know what’s going on with that during these false surges. I need to do some research on this.

Or we could go straight to what would definitely make me ovulate, which would be the clomid/letrozole route. I’m leaning this way right now, but we have two months to decide. It would take the guesswork out of it, and I am absolutely done with guesswork.

But should we? Clomid sounds like a beast to be on, plus there’s the added bonus of a higher twin rate. Twins already run in my family, so that makes me nervous. And the doctor sounded confident that we could probably get good results with just monitor and trigger. I don’t want to use a mallet to do what a hammer could do.

Aggh. How do you guys make these decisions??

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7 Comments

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7 responses to “RE Part Two

  1. It’s hard when you get to the point where you have to consider drug therapy. My 3rd clinic (the one I loved and actually got me pregnant) uses tamoxifen rather than clomid – similar or better results plus no lining issues like clomid creates. Here (at either of the clinics that triggered me) I’ve always waited until follicle size was ~18mm. I found mine were more likely to be mature if they didn’t trigger too early. Good luck!

  2. A trigger shot basically uses HCG to activate your LH receptors (it’s like a super LH surge when it comes to forcing ovulation – it’s a high dose). I think that’s what they use to fix anovulatory issues.

    Your RE triggers much sooner than mine does. Mine waits until there’s a follicle that’s 18+mm.

    I honestly was 100% fine on Clomid. I think I may have gotten two hot flashes in two cycles, which were more “warm-flashes” where I felt warm, not hot enough to strip at work or anything or to feel very uncomfortable. Letrozole has fewer side effects, but costs more (54 vs 9 without insurance).Letrozole has given me 0-side effects.

    If you’re paying for your donor sperm (btw nwcryobank is the cheapest I’ve seen), you may want to treat as aggressively as possible, to ensure as few tries as possible. That’s become my approach, but it’s totally your decision. There are a ton of unknowns in treating infertility.

  3. A good friend’s RE said that he wouldn’t do an IUI without clomid or femara, because of the costs associated – he thinks it’s way too expensive and time consuming to try natural with IUI, especially factoring in the cost of donor sperm. He’s pretty naturally minded, so it surprised me that he said it.

    As for me, Clomid has had relatively minor side effects. I can tell that I’m slightly more cranky. The first round I got terribly constipated from the pills. This round I have been eating bran muffins, prunes, and a fiber drink, and it’s working out okay.

    We worry about twins too. I guess we’ll just cross that bridge when we come to it. Honestly, I’m starting to think two babies for the price of one might be worth the pain of carrying them at the same time!

  4. AmyApplesnail

    My RE was also a pusher of au naturale. Before we decided to use a known donor and at-home AI, we assumed we would go with IUI. Because I had been diagnosed in the past with PCOS (and un-diagnosed by my RE more recently), I also jumped right to asking about Chlomid. I think it is totally understandable for us to want to go big or go home when we start factoring in the cost of each in-clinic attempt… My friends went right to IVF so they could take most of the guess work out. In the end I guess it will come down to how confident or risky you are feeling, but also consider how much you trust your RE. He SHOULD have your best interests in mind. I trusted mine so much that when he said we might as well just try naturally at home because there was nothing obvious standing in our way, we simplified our TTC plan to the bare bones. No word yet on whether this was a good idea or not :p

  5. Our doctor is also a big supporter of trying natural cycles first, too. I’m happy with this since 1. it’s cheaper and 2. I would rather not have to mess with the fertility meds if I don’t have to. She actually recommended doing 5-6 natural cycle IUIs before discussing adding meds, but was also understanding of the expense so said she would work with us if we changed our minds. I’m also pro natural cycles because I was concerned about missing a lot of work for the additional appointments required to monitor a medicated cycle. All that being said, since you have already done a few at home insems, maybe it would be better to add at least the trigger shot. In the end, if you choose to go with adding Clomid or the like, and it affects you negatively, if there had to be another cycle you could always change your mind, switch meds, or go back to natural! In the end, you know your body the best and have been tracking and monitoring everything, so I’m sure you’ll make the best decision for yourself! I’m glad the appointment was otherwise way less stressful that you were imagining!

  6. One hammer could turn in to five hammers… One mallet beats five hammers…

  7. After a year of yo-yo’ing back and forth between specialists, doctors, RE’s, and hospitals I have finally come the the realization that nothing works…….. And also that everything works….. Yes. That is exactly what I meant… Nothing and everything….. At the same time!!!! So, my advice is to give it your best chance. Try the trigger, and if offered, take the chlomid… Especially since you have had issues thus far…. You will always second guess any decision you make, but trust in your journey and take a moment to realize that every decision made helps the learning curve. We are rooting for you guys so hard over here and support any decision you guys choose…. How wonderful to have such amazing advice from those who have been there and done that! This community is truly amazing! Decisions are hard, discovery is inevitable….❤️

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