I do have high hopes for upcoming cycles though! On Tuesday my husband and I went to a fertility clinic talk. There are two fertility clinics in my city and we had visited the other one (which is attached to the local university) a few weeks before. The university-affiliated clinic is fairly new, and their information talk was pretty generic. In a some ways, the talk was a bit like what we imagined a timeshare selling meeting would be like. We both walked out of there feeling a bit weird about it. But at the other clinic, the one we visited on Tuesday, we had a better experience. When we pulled into the parking lot at 5:58pm there was only one other car, which was strange. Then we walked in and were welcomed by the founding doctor of the private clinic, who then informed us that we happened to be the only couple who had RSVPed (which is unusual because the month before their informational clinic had been packed). Luckily, this meant he would give us a one on one fertility consultation in his office instead of the planned powerpoint. What a score for us! Usually the first consulation is $250-$300 so this in my mind was like winning a generous prize.
We sat down and told him a little bit about our history (PCOS. Trying to conceive for 5 years, the past 2.5 of which I've been on clomid with good ovulation - according to my testing with LH strips and basal body temperature charting. I've never had any tests done, and haven't been monitored while on clomid. We got pregnant on our first clomid cycle and had a miscarriage at 9 weeks. Since then we've had no luck, and have tired metformin for 3 months with no ovulation, and femara/letrozole once, which was a terrible experience). He then gave us a short but informative information about how a typical cycle works and all the components (FHS, GnRH, estrogen, LH, progesterone, HCG, etc.) which was a good refresher.
Next, we went over the typical evaluation of infertile couples and talked about testing and research studies (we really liked that he has a long history in academia and was very up to date on scientific research and studies). One thing he mentioned that was good to hear is that if the total motile sperm count is over 20 million then things are OK, according to some studies. Also, he told us that clomid, unlike femara/letrozole, is a drug that stays in your system for a long while (about 60 days), so if you don't take breaks in between cycles it may build up. This was news to me. There was a lot of information given, which was great!
The main takeaway that I came out of the meeting with is that we have a good chance of becoming pregnant again, and there are some fairly easy next steps for us to take, even before we would go down the IUI/IVF road. Next steps include:
- Testing!
- AMH to determine my ovarian reserve (I am extremely curious about this!). This test is $75 and not covered by insurance
- HSG testing, done during cycle days 5-12 to look at internal reproductive organs and make sure everything looks OK. He wants to make sure that nothing is in my uteris that is acting like an IUD (cysts, part of a miscarriage, etc.). This test can be done as an xray or ultrasound, is $1100, and not covered by insurance, so I will pay out of pocket.
- TSH testing for my thyroid. I've had this done in the past, but not in the last two years, so I'm going to get this done at soon at my yearly physical. This should be covered by insurance, so I will save $100.
- Prolactin testing. I've had this done in the past, but not since 2008, so I'm going to get this done at soon at my yearly physical. This should be covered by insurance, so I will save $100.
- Pre-diabetes testing, for glucose, taken while fasting. I've also had this done in the past, but I'll get an updated test at my yearly physical. This should be covered by insurance, so I will save $40.
- New cycle procedure!
- I'll continue on clomid, but my dose may be changed (safe use is from 50mg to 250mg a day), taken on cycle days 3 through 7. $11.25 at Costco, out of pocket.
- Estrace will be taken on cycle days 8 through 12 at 4mg a day ($7.85 at Costco, out of pocket). This will help produce a nice uterine lining.
- Then I'll have an ultrasound to monitor how the cycle is going. They'll look at my lining, to make sure it it thick enough for an egg to implant, my follicle count, and the size of my follicles (generally follicles grow at 2mm a day and are good to go at 19 or 20mm. The ultrasound will be $250, out of pocket.
- Ovidrel will then be taken (an HCG boost) to promote the follicle release. Intercourse should be had at the time ovidrel is taken, as well as 38 hours later, when the egg has been released. This medicine is $85 at Costco, out of pocket.
