Overwhelmed after RE Appt (XP CAL)

[ldubhawksfan]

Hi ladies.  I found my way over to the dark side, but Haffey had a chance to check in on 3T & IF yet. Good to see all the familiar SNs. I was hoping to get some insight/opinions from you knowledgable women, or just someone to listen.

Just a refresher, I started with a RE for all our testing and then they ended up being OON, so we were switching.

We had the followup with our RE that ended up not being in network.  He said the only problem seems to be my lining (this was confirmed with an US on O day last cycle. 6.7mm when the minimum they consider is 8mm), so he wanted me to just take baby aspirin to try to improve blood flow to my ute and call him in 3-6 months.  I left feeling very disappointed. 

The appointment with our new RE that is in network a few days later.  He is far more aggressive.  He said that typically he would recommend to start with an oral ovarian stimulating drug (read clomid), which is what I kind of figured the next step would be.  But he said he doesn't think it would be a good solution for me with my already thin lining since clomid competes for estrogen (what builds up your lining), which is why one of the side effects for clomid is lining thinning.  He would prefer to go straight to injectables because it doesn't compete for estrogen, and he has the most control over the dosage and can make adjustments through the cycle.  He also said that since follicles growing are what secrete estrogen, part of the treatment is promoting stronger follicle growth to produce more estrogen which should make the lining grow more.  And his practice is that if you are going to that much trouble (and cost), he always encourages IUI.  Whoa!!  I'm in shock of the jump.  And then I got the sticker shock of the price breakdown for an injectables IUI cycle.....serious whoa!  And this is with IF coverage (anything in his office is covered 50%, but the lab is out of network).  He was a great doctor and I really like him.  And I understand why he is all in.  As he said, his goal is to get us pregnant and graduated back to our OB.

So now DH and I are totally overwhelmed.  Although I don't know if I'm quite ready to just into IUI, I'm open to the treatment in the coming months.  DH is not quite to that "desperate" point where he is all in on treatment yet, so logically when there is no transition to IUI, he is a bit put off.  I think he is worried about feeling not involved since it's not about sex at that point.  We need to be on the same page, so I don't think we will have solid direction for awhile.  It's also scary that nothing is guaranteed, and it could take several cycles ($$$$).

I know none of you can tell me what to do, but I'm interested in what some of you that have started down the road of IUIs think.  Is this nuts to go from 0 to 60?  I feel like I'm being a little impatient, but my gut tells me that we would be at this point even if we wait another 6 months on our own.  While the dr acknowledged that technically we got pregnant just under the year mark (11 months), he said that since a majority of that time I was charting and hence confirming good timing every month, along with all of our other testing coming back totally normal, he felt confident that intervention is justified.  I think if we put off the IUI for a cycle or two, I will try adding acupuncture in the mean time.  We have the funds for a few cycles of IUI, but I'm a cheap ass, so the idea of spending it in such large chunks is jarring. I plan to ask about femera and estance tomorrow, but I think because if my FVL, he didn't want to prescribe estrogen.

What do you ladies think??!!

[bluefairy5]

It's definitely an overwhelming position to find yourself in. My RE didn't push us from TI to IUI very hard, and in retrospect I wish he had, honestly. But that's just me and my situation, with the benefit of hindsight.

One thing to be aware of is that the IUI process typically does not take sex out of the equation. Even with MFI, my RE always had just BD in the week leading up to O (stopping 3-4 days before presumed IUI), as well as the evening and morning after the IUI.

That's really tough that the lab's out of network for you. I can imagine an injects IUI involves slightly more b/w than oral meds IUIs. I can see why it wouldn't make any sense to try Clomid, though, with the lining issues.

Good luck, with whatever you guys decide. But if you're anything like me, once the ideas start sinking in, you may find yourself getting more comfortable with the idea of IUI more quickly than you imagined you would.

[tumbleweed]

Is there any chance that you could get a lab order that you take to an in network lab? It would be an extra step for you after each visit, but it might save you a lot of money. Just an idea, if you live in a town with say, Quest or LabCorp labs that are in network. Some REs let you do labs elsewhere to stay in network.

[tumbleweed]

Also, depending on your age, my answer would be different about how aggressive to get and how quickly to jump to IUIs.

[NariaDreaming]

agree with seeing if you can get orders to go to an in-network lab. The only issue may be that they need results faster than an in-network lab can provide. My RE usually needs BW results by 1PM to make the call to adjust med dosages.

[sammae]

I'm glad you found an RE that you like. Honestly I don't know how much harder this would be if I was sketched out by the RE.
Last year when we went to the RE for the first time we ended up taking a looooong (10 mos) break because we were most likely looking at a jump straight to IVF and neither of us was ready for that. In fact, at the time we were against IVF, thinking it was ludicrous to spend that much money TTC> HAHAHAHAHA. Sometimes you need to take a step back and let your brain and heart catch up with the process.

Someone else mentioned age and I think that's a really important part of this too. I wonder if we didn't have DOR issues pushing us to get things done quickly if we would have tried IUI first just because.

There are so many factors in making this decision. I hope you guys are able to come up with a treatment plan that you are both comfortable with.

[ldubhawksfan]

Thank you all for your input. I'm 30 and DH is 34, so we are still relatively young. And there is no MFI. My lining is the only thing identified with the testing, and my FVL just throws a wrench in things, but isn't contributing. Honestly, I know that I'm being a bit impatient. It's hard to know there is an issue and not to try to address it though.

I think we will need to step back for a bit because DH seems quite off put by the idea, so we are very different pages. I hope we can have some good conversations. Thanks again for all of your input.

If we do move forward with it, I will definitely ask if I can at least do some if the lab work with quest (in network). That is a great idea. The lab basically charges $100 for every test, regardless of what it is (except $400 for the 2 sperm washes), including the HcG. So stupid!!

[daydreamsam]

I am sorry this is so overwhelming ((hugs)). I was really shocked when my RE recommended that we go straight to IUI when we first started treatment. DH was completely against it and I thought that my RE would just recommend some oral meds and we'd just HIO, so I pumped the breaks and asked for medicated TI instead. I knew that the chances weren't good of it working but DH and I both needed some time to adjust to the fact that we needed serious help conceiving. After two medicated TI cycles I was chomping at the bit to do IUIs and DH was more comfortable with the idea. Perhaps you both just need some time to ease in to it and should ask your RE about medicated TI instead of IUI to start.

[joy]

::hugs:: ldubhawksfan. This is overwhelming. I have no advice to give as I'm at the beginning with you (actually behind, I'm still in the testing phase) but these ladies gave you great things to think about.

[lilyharper]

ldubhawksfan I hope you don't mind my two cents.

I don't think you're being impatient. You may feel more comfortable starting off with a less invasive option (injectables sounds scarier than they are) so I would ask if femara is an option for you. It's an oral medication like clomid but doesn't wreck the lining. The reason they generally suggest iuis is it ups the chances (not much if there's no mfi, but hey, who doesn't like an assist?) but see if you could cycle without it. It took my DH a long time to really fully come around (even though he willingly participated) to realize that we needed medical intervention. Is it really the idea of iui that is offputting to your DH or the idea of the medication?

[bandm14]

I'm so sorry you are feeling overwhelmed. I think it's totally normal to feel that way, especially when you and YH are on different pages. I can really relate, because it sounds similar to how DH and I left our post-testing RE appointment. We went in after finding out that the only major issues were a blocked tube and slightly high TSH, and the RE started talking about IUI right away (albeit with Femara, not injects). We walked out and I was on the fence, but MH was decidedly against taking that step right away. He was so put off by it that we ended up doing 3 more cycles completely naturally before he agreed to calling the RE to start meds. My first cycle of Femara, we just did TI, and then went to IUIs the second cycle.

I know it's a lot to take in, and I know how it feels to have your husband be pumping the breaks as soon as you get a plan suggested by your RE. That being said, if I could do it all over again, I would have pushed harder to start right away with IUIs. While we were doing our last natural cycle after the RE appointment, I ordered What to Expect When She's Not Expecting on Amazon and MH finished it in a few days. I think it really helped him to not feel as scared about all of the treatments, and normalized his feelings while also giving a scientific reason why "just keep trying" isn't the best plan if you want to get pregnant. I'd recommend the book for YH, no matter what you decide to do from here.

And on the subject of injects-- prior to my new RE appt this week, I would have said to ask your RE about Femara because it is supposed to be better for the lining than Clomid. But (and I just posted this in another thread, so sorry if you already saw it and I am repeating myself), I had a really interesting conversation with him about Femara vs. injects. Obviously Clomid has the issue of thinning lining, but I always was under the impression that Femara was fine on lining. He said that it still impacts the quality of the lining by blocking estrogen, and that injects don't do this-- so the result is a better thickness and quality lining. Just to give you a reference point, since I don't know if your RE talked in terms of statistics, but my RE said that we would have had an 8-10% chance each cycle of Femara +IUI, but he believes a 25 % chance each cycle with injects + IUI. That is obviously a huge difference, so we are planning on 3 more IUIs with injects if this cycle doesn't pan out.

Given your lining issues, and what I know about injects, I would go for it if I were you. That being said, you have to be comfortable, and YH has to be on board. If the idea of stair-stepping treatment is easier on you both, then maybe ask about TI first, but if you are spending the $$$ on meds I feel like it would be good to give yourself the best shot of success by doing the IUI as well.

I know none of this is easy. But we are all here for you. Good luck!!

[Ann612]

**warning, BFP mentioned**

I don't have a lot of good advice, but I must say I found your post very interesting. I have also been told on a number of occasions that my lining is not where they would like it. Specifically, when I get the ultrasound done about a week after O day, my lining is typically around 7mm, when they also like to see 8mm (this very thing actually occurred the month I got my BFP). When this occurs, they typically just up my progesterone doses. No one has ever mentioned the baby aspirin, but this makes me want to ask about it.

[bandm14]

Jan 18, 2015 14:19:31 GMT -5 @ketchup said:

Jan 18, 2015 14:15:34 GMT -5 bandm14 said:

And on the subject of injects-- prior to my new RE appt this week, I would have said to ask your RE about Femara because it is supposed to be better for the lining than Clomid. But (and I just posted this in another thread, so sorry if you already saw it and I am repeating myself), I had a really interesting conversation with him about Femara vs. injects. Obviously Clomid has the issue of thinning lining, but I always was under the impression that Femara was fine on lining. He said that it still impacts the quality of the lining by blocking estrogen, and that injects don't do this-- so the result is a better thickness and quality lining. 

I learn so many damn things by going here. 

I'll have to thank my RE for all his science-talk that I can now share with you guys. He even drew me a little picture of the pituitary gland and ovary, and how the FSH and estrogen create a feedback loop, and wrote in how Femara and injects each affect the little system. It was pretty adorable (my new RE is kinda sexy, amiright BunnyBerry ?? )

Edited bc I made a scary smiley by accident.

[remylove1011]

If TI is an option you could discuss your chances with this versus IUI. I'm in a similar boat to you of jumping right into treatment. We were told at our first appointment to do an IUI. I had a bit of a struggle with why I needed to do treatment for me (Femera and trigger) when I O on my own and everything looks good. RE explained chances with and without. For us, we decided to jump right into treatment, but I think it's ok to take some time to decide. Also I don't think it ever hurts to ask a bunch of questions! FX that you are able to come up with a plan that you are both happy with.

[flippinchica]

Siggy warning, BFP mentioned warning










Obviously I don't go here but I wanted to chime in since I had a similar issue. Like you the only issue that came out of my RE work up was that the lining was thinner than he wanted to see it. Mine wasn't quite as thin as your was (it was 7.5) Since we confirmed the issue when I was already mid cycle he said why don't we try vaginal estrace, a trigger shot, TI and progesterone supp after O. Luckily this worked for us. If it didn't he wanted to move forward with Injects + TI basically for the same reasons your doctor is recommending. Other than cost I was very concerned with the risk of multiples with that protocol.
I can see your doc's point in that IUI will give you a better chance then TI and if you are going to spend that much time, effort and money might as well go whole hog but if you aren't comfortable it isn't something you have to do (especially with no MFI). Sorry for busting in and I hope this is helpful.

[juneroses]

I think the ladies here have some great advice. I've kind if gone down the slower route - 2.5 years before going to the RE, 4 times with Letrozole & TI, one Letrozole & IUI, one month break, now preparing for IUI #2 with increased letrozole and preparing to ask for a trigger.

Looking back, I know I made the right decision for where I was mentally at the time....but after 3 years with no pregnancy, I'm wishing I had been ready to take more aggressive steps, sooner. My RE wants to ride out 3 tries with letrozole, iui, and barely any monitoring, then jump straight into IVF. I'm having to fight to get stronger steps for the iui, in hopes of upping my chances there.

That said, if I had gotten pg on my 4th try of TI and Letrozole, I would have thought the slow approach was 100% right for me. I would think about your comfort zone, try to push out of it just a little... then just embrace your choice, whatever it is. What ever you decide, it is going to be what was best for you physically & emotionally.

[ldubhawksfan]

Jan 18, 2015 14:19:31 GMT -5 @ketchup said:

Jan 18, 2015 14:15:34 GMT -5 bandm14 said:

And on the subject of injects-- prior to my new RE appt this week, I would have said to ask your RE about Femara because it is supposed to be better for the lining than Clomid. But (and I just posted this in another thread, so sorry if you already saw it and I am repeating myself), I had a really interesting conversation with him about Femara vs. injects. Obviously Clomid has the issue of thinning lining, but I always was under the impression that Femara was fine on lining. He said that it still impacts the quality of the lining by blocking estrogen, and that injects don't do this-- so the result is a better thickness and quality lining. 

I learn so many damn things by going here. 

Seriously!!! Thank you for this bandm14. The blocked estrogen description sounds familiar. He was a very thorough and descriptive dr, but he went so fast my notes have gaps!

Thank you ladies all for your input and advice. I still don't know where we will go from here, but there is a lot more to chew over with DH and I think I will definitely get him that book. Thanks again!!

[Deleted]

I was pretty overwhelmed when my RE sent us straight to IVF from Femara plus trigger and TI. But at my age it made sense. We ended up doing 1 IUI with injectables which was BFN. I'm now waiting to start BC pills for my first round.

If you're not comfortable, the Femara plus trigger and meds for your lining issue sounds perfectly reasonable. I would also ask if they can send your labs to an in-network facility - my office was very careful about that for me - didn't even have to ask!

It's tough choosing which option is the right one, but FX that you get your BFP soon!

[BunnyBerry]

Jan 18, 2015 14:25:53 GMT -5 bandm14 said:

Jan 18, 2015 14:19:31 GMT -5 @ketchup said:

I learn so many damn things by going here. 

I'll have to thank my RE for all his science-talk that I can now share with you guys. He even drew me a little picture of the pituitary gland and ovary, and how the FSH and estrogen create a feedback loop, and wrote in how Femara and injects each affect the little system. It was pretty adorable (my new RE is kinda sexy, amiright BunnyBerry ?? )

Edited bc I made a scary smiley by accident.

I refuse to comment on whether he is sexy but let me just say that clearly bandm14 has excellent taste. And if I ever seem to be informed on anything IF related it's most likely due to his amazing doodles.

[laurensc927]

I'm late to the party and you've already gotten great advice so I'm just here for support. I will say that my RE didn't give me a TI option and went straight to IUI as well. She also didn't give us a "diagnosis" per say. At the end of the day you need to feel comfortable with your treatment plan, you don't want to feel overwhelmed going into it.

[tptbabe]

I'm sorry you're feeling overwhelmed It's completely normal to feel that way though, it's a big step!

If you're not really ready to jump into injects/IUI, then maybe bring up vaginal estrace or Viagara? Both can help with lining issues.

[lillee]

It's hard to hear treatment plans that are more aggressive than what you are ready for.
My RE said without male factor, an IUI has only a slightly better chance than TI cycles. I would recommend going with the treatment plan that you and YH are comfortable with. I would just be honest with your Dr and say you are not ready for IUI yet and wanted to try something more conservative. I really think it's important to be comfortable with the treatments.

We have been very conservative with IF treatments. I started with just acupuncture after my year mark before making my way to an RE. My first RE wanted us to go straight to IVF which I was not ready to hear. My 2nd RE was a lot more conservative and had us start with Femara and TI, then on to injects and TI, then an IUI, now IVF. I had asked for an IUI cycle because I wasn't ready to move on to IVF even after that was the 2nd Dr to recommend it for us. I don't regret taking our time and doing less aggressive treatments before moving on. I think if we started with IVF I would have wondered if we could have done something more conservative.

[snd1231]

Ok so this is my two cents. If you are feeling overwhelmed and rushed into a more invasive option after a few days I would do what some of the PP have said, see what your DH and then the RE thinks about Femara for inducing O, Estrace (estradoil) to increase lining and TI to ease both you and DH's mind and try a more HIO method at first. I will say that I have still had lining issues with Femara. I can't take Clomid due to other health issues. But Femara still does affect the lining although it does not affect is as much as Clomid does. I have also heard the injects are much better on the lining but they require more $$, monitoring, and labs. In the end it boils down to what you and DH feel comfortable with.

[ldubhawksfan]

Thanks again ladies. I plan to ask about the femera and estance option, but at this point, DH is really against it. He is set on is trying on our own for another 3 months because that is what the first RE said. Well he said we could do IUI but he won't be a part of it. It's caused a lot of hard discussions already. I wouldn't be ready to do anything for at least one cycle, but as it stands, I guess we are still on a holding pattern for a few months. I'm really disappointed, but it is what it is.

[lilyharper]

ldubhawksfan I'm sorry you're both at different pages. That's really tough. *hugs*