K to IUI: So long, sucka. Oh, and thanks for the OHSS.

So, my much anticipated consult with the new RE was today. It went really, really well. I really liked Dr.G - he seemed very kind. Unlike Dr. D, he looked me in the eye the whole time we talked. Also unlike Dr. D, Dr. G made me feel as if he had all the time in the world to talk to me. I hadn't realized until today how important that quality is.

He seemed very positive about our plight, and could see no reason why we shouldn't have hope that IVF might work for us. He said he thought it would be unwise to continue with IUIs, as I've proven that I'm prone to OHSS. He was very surprised that no one at my previous clinic had mentioned the idea of converting our long-ass hyperstimulated cycle to an IVF cycle. He said that they do not, as a rule, perform "follicle reduction" procedures at the new clinic. In fact, he has never performed one. Ever. They don't 'believe' in them. Rather, when someone over-responds the way I did, and produces a shitload of mature follicles in an IUI, they either convert the cycle to an IVF cycle.....or they cancel it.

He told me that in their practice, I never would have been allowed to stim for 65 days. He said he would have called a halt to things at 17, 18, or perhaps 19 days, if nothing was happening, and induced a period. Then we would have started all over again with a different dose, different drug combo, or something else.

He basically said that he thought further IUIs would be a waste of time for us, because it would be highly likely that I'd end up over-responding, and end up converting the cycle to an IVF cycle anyway. Why not just do an IVF cycle in the first place, is the logic, I guess.

His opinion was that it would be better to do IVF, and then if I end up with severe OHSS, we'd do the retrieval, cryopreserve the embryos (assuming there were some of high enough quality) and do a frozen cycle once the OHSS had resolved on it's own. (Much like the experiences of our good friend Samantha) According to the good Dr. G, I can anticipate success rates of around 20% for an IUI cycle, 50% for a fresh IVF cycle, and btw 35 and 40% for a frozen cycle. So, a frozen cycle still holds more promise than IUI, any way you slice it.

Another interesting tidbit he offered is that for those prone to hyperstimulation, he likes to use a generic form of hCG, rather than the Ovidrel variety. Ovidrel apparently only comes in a pre-measured, pre-filled syringe in pre-determined amounts - 10,000 somethings? ius, maybe? I dunno, but since hCG is often the catalyst that propels someone into hyperstim mode, he likes to use less than the traditional dose - not as much as comes in the Ovidrel one-size-fits-all shot, but juuuuust enough to get the follicles to do their thing and release the eggs. The generic form can apparently be ordered up in whatever size dose he chooses. Probly cheaper too? A girl can hope.

The other good news, financially, is that at the new clinic, one is not precluded from participating in shared risk if one has previously gone through an IVF cycle. This is not the case at my previous clinic. I thought that seemed unfair, and apparently the new clinic shares that perspective.

Dr. G said he thought it made perfect sense to use the rest of our insurance money towards the purchase of a single IVF cycle - why in the world would we leave that money sitting on the table if we didn't have to? If the first cycle works, great. If it doesn't, we will essentially have used the first cycle as a diagnostic tool to better understand if IVF is a good choice for us. We'll have more information, based on my response, and the outcome, to decide if it will be advantageous to proceed with shared risk.

I told him my only worry about proceeding at this point is that we were trying to plan a vacation the second week of September. He first said that he thought we could definitely get in a cycle before then. Then I think he realized that I'm coming from a place of having stimmed for SIXTY FIVE DAYS, and he said that of course, the safest course of action - in terms of not interfering with our vacation - would be to wait and start the BCPs and Lupron in August. Then, I suspect he saw the look on my face, and he hastily added that of course, waiting and treading water for the rest of the summer might be, emotionally and mentally - not the wisest choice. Ha! I told him I wanted to start right away, and that we would take our chances with the vacation situation!

He said worst, worst case would be that I could end up with severe OHSS and end up in the hospital, which would of course preempt our vacation, if the timing lined up with that week. But of course, there's really no way to pinpoint the timing, bc we don't yet know exactly when we'll start the cycle, we don't know exactly how long it'll take to stim, we don't know how bad the OHSS will be, we don't know the exact timing btw retrieval and transfer, etc., etc.

I'm really inclined to book the damn vacation, and pray for the best. But, does that create even more pressure when that's the last thing we need? I don't know. I just feel like I'm so sick and goddamn tired of putting every fucking thing in our lives on hold in order to accommodate infertility.

At any rate, I now have in my hot little hand a doctor's order for some pre-conception genetic screening bloodwork (apparently the new clinic does a more thorough genetic screen than my previous clinic), a scrip for Provera to induce a period once they get the results of the genetic screen back, and the business card of the nurse who has been assigned to my case. I'm to call her as soon as I've completed the blood work. She said it takes at least 2 weeks to talk to the financial coordinator and get all the insurance details squared away (that seems a little ridiculous to me - 2 weeks, for cripes sake? but, I'll deal with it, I guess.) Then, I assume that after my period arrives, I'll have a baseline sonogram and bloodwork, and then be cleared to start the BCPs (there's something so totally demented and twisted about taking birth control as a part of this process, don't you think?)

The ONLY thing I'm apprehensive about, as far as treatment goes, is those damn intramuscular shots. I've only had to contend with the subcutaneous variety thus far. I could be remembering this wrong, but I think Dr. G said today that the Lupron was IM? I hadn't realized that, until now. I knew that the infamous progesterone-in-oil shots were IM. Dr. G said I'd be looking at around 3 weeks of PIO shots??? Good God. I can't imagine how sore my ass will be after all of that.

So, anyway, it feels good to be almost out of limbo, and be working towards a specific goal again. I'm thinking I'll probably go to the lab sometime this week and get the blood work out of the way. The sooner we get this show on the road, the better. I'm dreading the lab though - is it me or is going to one of those places somewhat akin to spending your afternoon at the DMV? If I didn't know better, I'd swear that LabC0rp and Quest Diagn0stics were both government agencies.