Tuesday, August 25, 2009

Second Opinion

We went to see the new RE today. This is pretty much the opposite of our current RE - very to the point, and very experienced. My therapist called him "the grandfather of IF treatment in Austin."

After asking us a bunch of questions, he got right to the point and said he thinks me and clomid do not mix. He said, "There is something dysfunctional going on." Meaning it just doesn't make sense that I am ovulating early and having hot flashes BUT my lining is still okay (apparently hot flashes are associated with a thin lining).

So, now we have to decide what to do. We have four options: More natural IUIs, Fermara IUIs, injectible IUIs, or IVF. The RE was strongly in favor of injectible IUIs as our next step, because the odds of success are so much greater. Of course, Greg and I are very nervous about HOM and we expressed this, and the doctor said we could do a few more natural IUIs and see how that works, or even try Femara, but he wouldn't recommend anymore clomid cycles.

I asked him why injectibles have a higher success rate - he said "We really aren't sure. It is in part because of higher follicle production, but not completely."

However, there is the cost factor: $2000-$2500 per cycle. Ouch. And only Greg's insurance covers it, but I am not on his insurance policy and can't be until January. So, do we wait four more months so we can do them for free, or do we dish out the dough? We can afford it, but it would mean some major lifestyle changes. If we wait, we could continue to do natural or cycle IUIs, or try Femara. But, this RE only gave us 4% odds of natural IUIs working each cycle, and Femara a 8% chance. Injectibles have a 20% success rate.

A few other things I learned:
  • I need to cut back on my caffeine intake. My current RE said 200mg a day was okay. The new RE says I should only take in 100mg.
  • I also need to cut back on my wine habit. I told the RE that I have 1-2 glasses of wine on most days. He said it would be a good idea to cut back on that, and no drinking after ovulation.
  • This RE triggers when the lead follie is 22mm. My current RE triggers at 17mm! But, this RE said it could be because my current RE measures follie size differently.
  • He agreed that that cause of the miscarriage was most likely a chromosomal issue.
  • He recommends no more than 30-40 minutes of aerobic activity, 3-4 times a week. He said my 30 minutes at a heart rate of 160 bpm four times a week is "probably fine."

For now, Greg and I agree that we are switching REs if this cycle doesn’t work. And, we are leaning towards at least trying Femara. It’s less expensive, and there is a lower risk of HOM compared with injectibles. And, although the RE gave us those pretty crappy odds, Greg and I just can’t stop thinking, if it is just a CM issue, a natural IUI should give us odds similar to a “normal” couple TTC on their own – which would be 20%, not 4%. And if Femara would help up that a little bit more, great. Plus, we did get pregnant on our own without injectibles, so we should be able to do it again!


Lindsay said...

Wow, I really like your new RE. If it was me I would do more natural IUIs b4 going to injectibles while you wait for the insurance to pick you up. The way I look at it is you got pregant with the IUI before, so I don't see the harm in cycling with Fermera while you wait for the insurance. He sounds great. I'm glad you found him. I still have my fingers crossed for this cycle though!

The Browns said...

I am really glad that you had such a great appt. It sounds like you were really happy at the appt and you are feeling better now. Im so happy that you like this new doctor!

Silvina said...

I'm so happy that you like your new RE. He sounds really good and knowledgeable. It's so important to have a dr that we like and trust. I wish you guys the best in whatever decision you decide on. GL!

Life. Complicated. said...

Hi there! M&M on the Austin board used Femera for her success. Btw - Are you seeing Dr. V? If so, he is so awesome and I just love, love, love him.

Good luck with whatever you decide to do!

Kristen said...

Hey there! We are seeing Dr. V. That's great to hear about someone having sucess with Femara, thanks for letting me know!

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