Our appointment with Dr S was awesome. This was the first real appointment Ryan attended with me. I cautioned Ryan that Dr S was a very busy doctor, and we'd be lucky to have 5 minutes of his time.
I was so wrong. Dr S came in, jumped up on the table, and proceeded to answer all of my questions, explaining things in detail. He was in with us for a long time. It was really great.
What tests do we need to repeat?
In a way, he'd like us to repeat most of them. The Day 3 blood test was done by my primary doc in August 2009, so that one is still valid (I never recorded those results on this blog, but the FSH was 6.6 in that round of testing).
He'd like a Day 5 ultrasound (to verify my ovary's are healthy and cyst-free), and a new sperm analysis. However, these can be completed during our first treatment at the end of the summer.
In the meantime, I have to re-do the HSG. The one test I'd been dreading. It's not the worst thing in the world, I just had a really bad experience last time. I'm hoping this time is better.
What tests other tests should we do? MTHRF? Postcoital? Immune Issues?
The doctor has no reason to believe I have a blood clot issue, but he noted my concerns. He suggests we continue with treatment for now, but leave the option to test for this open in the meantime.
Dr S believes postcoital tests are old news. He feels they don't give you much information, and said most IVF centers have gotten rid of them altogether. Besides, most issues that are discovered with a postcoital test are eliminated by doing the IUI.
As far as immune issues, this was a big subject of debate in the late 80s, early 90s. The immunity treatments are super expensive, and there is some doubt about how much good they do.
Dr S suggests I continue on with the treatment we have planned. He said that these treatments are just as effective for people who have "unexplained" infertility as they are with people who have an identified problem.
Is there any value to doing a monitored, 'natural' IUI cycle?
A young, very fertile couple has a 20% chance of conceiving in any given month. Ryan and I have not been able to conceive for nearly 7 years. According to Dr S, this history indicates we have less than 1% chance of conceiving on our own. An IUI increases a couple's chances of conceiving by about 2%. So, if we were to do a 'natural' IUI cycle, our chances would be less than 3%
On the other hand, the chance of conceiving using Gonal-f injections is about 16%. Combined with the IUI, that puts us at 18%, which is nearly as high as the 'young, fertile couple' described above. Upon hearing this, we opted out of doing a 'natural' cycle, and decided to go with the Gonal-f.
How can we control the amount of medication to reduce the chances of multiples?
He plans to use low doses to avoid this issue. He feels the chances are small. Don't quote me on these percentages because I didn't write them down, but I believe he said the chance of a singleton is around 78%, the chance of twins is around 18%, and the chance of triplets or more is 3-4%. So the risk is there, but it's small.
Could we switch to IVF mid-cycle if there are 'too many' follicles and, if so, what is the cost?
Yes, that can be done, and the cost is approximately $7000(!!!).
Does he feel a medicated IUI treatment plan would ultimately be successful?
He was confident that we are great candidates for a medicated IUI. He thinks we should try this for 4 or 5 cycles, and feels we are likely to be successful (although this is infertility we're talking about, so who knows!).