Thursday, November 29, 2007

Cycle 11

I started metformin ER on the last night of cycle 10. I was supposed to start at 500 mg per day, and then increase by 500 mg every week until I reached a goal of 2000 mg per day. However, I tolerated the 500 mg dose so well that I decided to go ahead and ramp up my dose every 3 days. I did have some GI upset when I first got to the 2000 mg dose, so I took it back to 1500 mg for a few days and then I was able to go back up. I have been really surprised how few side effects that I have had. I do tend to have a rather strong stomach, so I guess that's part of it. Metformin is the only thing so far that has been covered by my insurance. I hope my insurance company doesn't think that I'm diabetic now!

On CD8, I went for my saline sonohystogram. Dr. W, who is a new (female) partner in the RE's office, performed the ultrasound. I was kinda hoping that my cysts had disappeared, but there were still lots and lots on each ovary. My endometrium looked good, and there was no sign of any endometrial polyps. This lovely experience last about 3 minutes and cost $450.

We had pretty good timing, and I ovulated on CD16. (Which was pretty good, but I had ovulated on my own on CD15 the month before without metformin). I had a little bit of hope (which I kept trying to squash lest I be disappointed) that maybe metformin alone would do the trick and I would finally end up with the elusive two lines. I tried not to get obsessed, but I did anyway.

During this cycle, S had his urology appointment with Dr. B. Apparently, Dr. B specializes in male fertility and vasectomy reversals. The entire experience of was really disappointing. S has a very tight schedule in the afternoons, and he only had between 1 PM and 3 PM free from work. His appointment was at 1:30 PM. (I came along for moral support and because I wanted to hear what the urologist would say.) Luckily, the medical office building is only a few minutes from his workplace. Right away, the receptionist told us that Dr. B was in surgery and she didn't know when he would be back. Well, the doctor didn't arrive in the building until after 2 PM, and there was another patient in front of us.

At about 2:23, we went to the receptionist and told her that we would need to reschedule. At that moment, Dr. B came out and said, "Let's go!" Of course, at this point we have less than 20 minutes until S would need to leave to get back to work. Dr B spent way too much time asking questions that were already answered on the questionnaire, and going over the semen analysis out loud. At the same time, he didn't offer any theories as to why S might have the morphology problems and borderline counts. He examined S for just a moment. I even went into the exam room for this part, and commented on the orchiometer (the set of "balls on a rope" of various sizes, that the doctor can use to estimate testicle volume). Then, during the exam, Dr. B made these comments about how S's testicles were really great in size, definitely on the top of the end of the range. Afterwards, S and I both thought that he probably says this to lots of guys... to try to make them feel better even despite their lowish sperm counts!

Well, Dr. B didn't feel much except "maybe" a varicocele on the left side. He recommended an ultrasound ($300), bloodwork (I haven't priced that yet), and then a followup appointment. Have I mentioned yet that the appointment itself was $300 for about 15 minutes? If we end up doing varicocele surgery, that usually runs about $3000. Argh. I have done the research and it seems like varicocele surgery has iffy results at best, especially if the varicocele is small. We have several couples as friends who have dealt with infertility stuff. Two of the men have undergone varicocele surgery, and both said that nothing improved afterwards. Finally, Dr. B recommended that S consider trying some supplements. He gave us a bottle with 6 or 8 sample pills in it. S did end up ordering it... and it's almost $300 for just a few months' supply. That is OK with me, but I wonder if Dr. B is getting a kickback.

Dr. B also made some comment that he was "impressed" that Dr. G was recommending that we do Clomid/IUI instead of proceeding to IVF with ICSI. It wasn't clear whether he meant "WTF is Dr. G thinking?...your morphology is bad!" or "Wow, I'm surprised that Dr. G is potentially giving up over $10,000 in case these two get lucky with the IUI."

Well, by the end of the cycle I tested twice (10DPO and 13DPO, I think) and I had two BFNs. By 16DPO, my temperature dropped and a new cycle began! And now I am almost caught up to the here and now...

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