We went back to the RE on January 2nd. After my last post, I called every fertility clinic within a 3 hour drive of our new house hoping someone could get us an earlier appointment. The very next day, one clinic called me back and has been incredibly nice, helpful, and accomodating! I was supposed to ovulate on December 31st or January 1st, so I was worried that we'd miss even trying this cycle, but it was worth it. We got in one bout of sex on the morning of December 31st first thing in the morning, and then my ovulation prediction kit (OPK) turned positive that day, so it was pretty good timing overall, and he still got his 48 hours of abstinence in (barely!).
It was a full 2 hour drive to the doctor's office, so it will be a long trip for monitoring appointments, but I have such a good feeling about the doctor and his staff that I think it will be worth it. I fully believe this clinic is going to help us get pregnant, and that's such a good feeling!
First, they gave my husband another sperm analysis. His numbers were TONS better than last time! I told him to prepare for a slightly lower count because he abstained barely two days (I think 48 hours is probably close to exact) but it was over 75 million count, 79% motility. We still don't know morphology (I'm not entirely sure if they're going to check that at all) but the motility alone is a HUGE improvement - over it's more than 200% better! So my husband is pretty much still crowing about his awesome numbers. Considering he took it pretty hard that the only detectible source of issue was from him, I'm thrilled he got his mojo back. He's convinced the training he went through trashed his numbers and that was our only issue - I think we've still got some issues to overcome, and the vitamins may have had something to do with the improvement, too. Thankfully, he agrees that it's time to let medicine help us achieve this goal.
Then the doctor did an ultrasound on me. My husband offered to wait in the hallway, but I really appreciated that the doctor encouraged him to stay and learn. Everything looked great with me, apparently, and the doctor confirmed I had ovulated the day before. The doctor took the time to point everything out on the monitor to us so we could understand what was going on.
We talked about probabilities, costs, and such. We discussed our insurance and how to manage expenses through covered treatments. We also talked about how to balance our desire to be pregnant and not spend tons of money with a very strong adversion to having a multiple pregnancy - just ONE baby at a time, please!
So here we go! Our rough plan:
Cycle #0 - I am currently in the "two week wait" (aka 2WW) from when I ovulated on New Years Day. I will likely be able to test this coming weekend, and assuming it's a failure like the last 16 cycles, we will move on to a treatment cycle. We have about a 5% chance of success.
Cycle #1 - if I get my period as expected on January 15th, I will call the office to let them know that we'd like to move forward with an unmedicated IUI. I will then call with a positive OPK, which will likely be January 29th or 30th, and go in the next day with my husband for an interuterine insemination (IUI). They'll have him give a sample, wash it so that only the moving sperm are left and that they're in a fluid that makes them most capable of insemination. They will then put me in stirrups and using a catheter, insert the sperm directly into my uterus. This will give us around a 10-15% chance of success, but it keeps the risk of multiples (twins or greater) to the same risk as the general population. This will cost us around $650 total and one trip to the clinic.
Cycle #2 - we'll likely do another unmedicated IUI. Again, another $650 and one trip to the clinic. We will again have about a 10-15% chance of success.
Cycle #3 - we'll likely move on to a medicated timed intercourse (TI) cycle. We will order enough meds for 3 months, since the pharmacy is a mail order pharmacy. Starting on CD 1 (the first day of my period), I'll call to schedule a monitoring appointment on CD 3. I'll go in, they'll do an ultrasound and take bloodwork, and then I will start Femara daily for 5 days, followed by 2 days of injectables (Follistim, I think... maybe Gonal-F. I don't remember). Then I'll go in for a monitoring appointment to see how big my follicles have gotten and how many we have to work with. If there's 3 or less mature follicles, we'll trigger ovulation with another shot and have lots of sex. This would cost us approximately $200-300 since much of it is covered by insurance, and there will likely be 2-4 visits to the clinic, though my husband won't have to go to the clinic. We will have about a 10-15% chance of success, and a 20% chance of twins, and a 1% chance of greater-than-twins (also called "higher order multiples" or HOM for short).
Cycle #4 - we'll might do another TI cycle, but will probably move onto a medicated IUI. We'll follow all the same procedures as Cycle #3, except we will likely have some medication left over from our previous cycle, and my husband and I will have to go in to the clinic for the IUI like in Cycles #1 & #2. This will cost us probably around $1000. We'll have about a 20-25% chance of success, and a 20-30% chance of twins, and a 2-3% chance of HOM.
Cycle #5 - Same as Cycle #4. Will cost around $1000. We'll have about a 20-25% chance of success, and a 20-30% chance of twins, and a 2-3% chance of HOM.
Cycle #6 - Time to reassess - maybe one more IUI, maybe discuss moving on to IVF. If we do another IUI, it will cost around $1000. We'll have about a 20-25% chance of success, and a 20-30% chance of twins, and a 2-3% chance of HOM.
So there you have it! We're looking at spending close to $5000 over the next 5 months if we don't get pregnant on any of those cycles. It makes me sick to think about the other ways we could have used that money, especially if it all fails.
However, as a statistics nerd, I had to crunch the numbers - with all cycles combined (am I the only one who thinks of "Captain Planet"?), we have greater than 60% chance of getting pregnant over the next 6 months. That's pretty awesome! That's the same chances as your average couple just starting to try in their first 6 months. I feel hopeful again!
(If you're wondering that calculation, it's a variation of Bayes' Theorem - you add your chances together, then subtract the result of your chances of not succeeding multipled together - so in this case, if we take the low end rate of success, my success chances are 5%, 10%, 10%, 10%, 20%, 20%, 20% respectively each cycle, so then I would say (0.05+0.1+0.1+0.1+0.2+0.2+0.2)-(.95*.9*.9*.9*.8*.8*.8) = 60%)
Also over the holidays, we moved into a new home. Our new home. We own it! It's really even more exciting than I expected. We painted our two guest rooms this week, and I even dared envision one of them as a nursery. Here's hoping!
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