That plan has changed.
Dr Dub is an older guy. He's been in the Reproductive business for a long time. It didn't take him long to realize I had been in the ring for a long time too (going on 6 years this year). I started out by giving him a full run down of my fertility history. Then we got down to business. In all of my years of seeing REs, I can't believe none of them ever spelled out things for me the way Dr Dub did today. He didn't sugar-coat anything, and he treated me like what I am, an infertile pro. So he didn't waste time going over the information I already knew from my own past experience.
He was quite unimpressed that Dr D had "lost" my images because he really needed to see them to get a better idea of what the inside of the uterus looks like, specifically the endometrium. He says it is possible there are endometrial growths in the uterus that can inhibit in implantation. If I have any, we will want to take care of them. He also had wanted to see the extent of the scar tissue around the ovary and fallopian tube.
But all of that aside, Dr Dub laid it all out on the table for me.If you have endometriosis, you most likely have PCOS. Now here is where I got new information that I had never heard before. Typically women with PCOS have it because they are insulin resistant. He drew me a picture of how insulin is supposed to work in a normal person, and how it works in patients with PCOS. Basically I don't use my insulin correctly and it affects my hormones and this in turn affects my eggs by either making them unhealthy or by killing them off before ovulation. If the egg is dead before ovulation, all that is left is a fluid-filled sac, or cyst. Sometimes they don't go away, so they build up and build up, which is how you get polycystic ovarian syndrome. He put together all of the pieces of information that were missing from my puzzle.
PCOS and endometriosis contribute to low estrogen and low progesterone. So you have to fight to get a good egg, and then you have to fight to make that egg a comfy place to hang out for 9 months.
When he started talking about insulin resistance, I told him my older brother is a Type 1 diabetic. He shook his head. Then he asked if I had gotten gestational diabetes. We kind of chuckled when I told him I had and that my sister had too. He told me I have what is called "thin PCOS" where my sister has "thick PCOS" because her cycles are irregular, and mine are not.
So my PCOS/Endo issues combined with my husband's low morphology pretty much leaves us with only a couple of options, IUI, IVF, IVF w/ICSI. Dr Dub wants to start right away with a medicated cycle, but not with chlomid or letrozole, he wants to do it with FSH and HCM shots. I told him the injectibles made me bat chit crazy and he said, "Really?! But you handle chlomid fine?" (That is the 3rd dr who has said that to me.) He said usually the chlomid is what makes us women wacky.
He said chlomid has a half life of two weeks, so he never lets patients do more than 2 cycles at a time because it takes an extra month to get the chlomid out of your system. You don't want to build it up too high, or it becomes detrimental.
I told him we had done a cycle with two shots of FSH and one shot of HCG, and I went psycho on my husband. As I finished telling him that, I started to smile and said, "We had done 6 rounds of chlomid by the time I went crazy." Dr Dub laughed and said, "It was the chlomid. It wasn't the shots."
I had never put that together until today!
He answered the questions Dr D wouldn't or couldn't. like why is my estrogen so low: PCOS. How do we fix it: Metformin.
It was a nice, long appointment, and I felt so comfortable talking to Dr Dub. I liked that he didn't treat me like a newby, and that he could tell I had some experience under my belt. I walked out of there going, "Crap! Now what do I do?" I was going to go with Dr H, and since I am on CD1, I was going to call him today to set up appointments for monitoring. But after meeting Dr Dub, I think I want to start the metformin tomorrow and have him do the hysteroscopy.
I don't really have a big plan set out this time. The only thing on my plate right now is metformin, hysteroscopy, and possibly IUI with FSH/HCM.
It is so weird being where I am mentally right now. I'm looking at doing things I didn't think I wanted to do ever again, but that was because I had my information mixed up. It was the chlomid, not the shots. I just kind of feel like I am floating through all of this information and the decisions that need to be made.
I am supposed to hear back from his office on Friday, so I think I will discuss which way to go at that time. I know he already laid out three battle plans for us, but I want to see if we can tweak them just a bit.
Holy cow. I'm getting back on the horse. And not even the pony. Oh no, I'm getting on the brumby. We're headed for the big leagues.
|Getting on the Medicated IF Horse|
|What has this world come to?! This is all so surreal and crazy!|