Wednesday, November 28, 2007

RE visit (backtrack to 10/18/07)

We had our RE appointment on 10/18/07. I believe that I was 14DPO at that point, but I already had had 2 BFN's and my temperature was dropping, so I knew that it was another failed cycle (#10). I came prepared with about 1.5 pages of questions (typed), my lab results, and all 10 cycles of temperature charts.

The waiting room of the RE's office is kinda fancy with full length glass panels and doors, instead of a plain door like all the other offices in the building have. It looks nice, but doesn't exactly feel discreet. Not that we need to be discreet, though...right?? The office is located just off the elevator, on an upper floor of a medical professional building. S had already described it to me as he had been there twice already to give samples for semen analyses. As we walked through the door, I was really surprised to see a familiar face sitting behind the receptionist desk. "Is your name T___?" I asked. When she answered in the affirmative, I reminded her that we had worked together at Dr J's office way back in 1994. I was 19 years old, summer after freshman year of college, and had worked as a receptionist. T__ was a transcriptionist. She is a lot older, more like my mother's age, but I had always liked her. I reminded her of my old last name and we started reminscing about some of our other co-workers as well as Dr. J, our old boss. T___ looks great; she literally has not aged a bit in the 13 years since I last saw her.

I gave T___ my basal body temperature charts to give to Dr. G. When we were called into the consult room about 20 minutes later, I was happy to note that he had reviewed them in detail. Right away, he didn't like the fact that my ovulation day has been variable from CD15 to CD26. He also saw that I had made notations for "acne" on the days when my skin flares up with a pimple or too. So he was immediately suspicious for PCOS. He asked me about the excessive hair growth thing. The truth is that I do have a few coarse hairs that crop up under my belly button and chin, and even a couple dark (but not really coarse) ones around my areolae. At the same time, I feel like almost every woman that I know (or see) has something similar (or plucks/waxes to get rid of them). So, I have never been 100% certain about what is normal and what is not. Meanwhile, S and I answered lots of other questions about our medical histories, etc.

Right in the middle of the consultation, Dr. G wanted to do an ultrasound on me. I was glad that this was included since we were paying out of pocket. Sure enough, I had lots and LOTS of cysts. Like...over 20 on each ovary, in the typical "strand of pearls" configuration. I apparently also had increased ovarian stroma which is also typical. Dr. G thought that my endometrium looked unusually thick, too. (What did he expect at 14DPO???) Because of this, he wanted me to get a saline sonohystogram at some point in the near future.

Next, we reviewed the results of S's second semen analysis. We were really disappointed that there had been no improvement; in fact, things looked quite a bit worse:
  • Concentration: only 9 million/mL (!!) (down from 25 million/mL in June)
  • Volume 2.8 mL (down from 4 mL in June)
  • Total count: 25 million (this is down from 100 million in June)
  • The motility was OK...
  • But unfortunately the morphology was unchanged at only 1% by Kruger strict criteria.


Based on my apparent polycystic ovaries, Dr. G wanted to start me on metformin. I kinda questioned him on this since I obviously ovulate every month even despite polycystic ovaries. How then would metformin help? He didn't have a specific answer but implied that perhaps my ovulation would be "better." He also said that studies have shown that women who are undergoing stimulation for IVF actually have higher rates of pregnancy if they are on metformin. This isn't due to better ovulation (as these women are getting other meds for stim anyway), but seemed to be an indepedent effect.

His overall strategy is for me to start with metformin alone for 1 cycle. During that cycle, he wanted me to get a saline sonohystogram on CD7-10 to re-evaluate my endometrial lining and rule out any endometrial polyps. After that cycle, I would start with Clomid IUI. Meanwhile, he would refer S to Dr. B, a urologist who specializes in MFI.

I was surprised to hear him recommended IUI instead of IVF with S's morphology issues. I had previously been pretty sure that our counts and morphology put us into the "immediate IVF with ICSI" category. Dr. G said that it might come to that, but he wants to try IUI for 1 to 3 cycles first since it is so much less invasive (and less expensive).

I left the appointment armed with a prescription for metformin and a renewed sense of optimism...

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