Today was the big day, my first fertility appointment with Dr. C. Tony and I got to the doctor's office right around 10 am. We didn't have to wait long before a nurse came to get me for a vitals check. I'm still alive if anyone's wondering. After going over my chart and blood pressure and stuff she took me back to the waiting room to wait for Dr. C to be free.
A few minutes later they came to get us and showed us to Dr. C's office. He talked to us for a little bit and went through my symptoms and history. Then came the fun part (sarcasm). The actual exam. Tony and I were shown into an exam room and I was told to undress completely and put on the gown. I'm still surprised that the gown was actual cotton and not those HORRIBLE paper things!
While I was changing into my fashionable exam gown Tony and I had a discussion about if I should remove my socks. I only mention this because Tony told me they'd left me booties to put on. When I glanced back at the table I realized he was talking about the stirrup covers! Haha. Once the doctor came in he checked my lungs and did a breast exam. Then he began the ultrasound.
I really couldn't tell what was up on the monitor. It all looked like a grainy set of three circles within each other. I learned that I have a tipped uterus which can complicate fertilization. My Mom also has a tipped uterus, I wonder if it is genetic. Next he proceeded to check my ovaries and confirm my diagnosis. He also took the vaginal wand and turned it this way and that to see if I had any pain, I didn't which I would assume is a good thing. But man, it felt really strange!
After that I got dressed and we headed back to Dr. C's. office. He broke it down for us and even drew out a diagram of what exactly is happening with PCOS. Next came our initial plan of action and some options. He gave us two different options, one of them with two versions.
The first version of option one was to take a medication called Femara. Femara is actually used for breast cancer but this is an off label use, its supposed to balance the excessive testosterone levels. After taking this for a cycle of on certain days I would have to have IUI or intrauterine insemination. This is exactly what it sounds like, place sperm in vagina. Yup.
The second version of option one was to use injectable fertility medications such as Follistim at a low dose. Then I would have to do the IUI. If I didn't ovulate the level of medication would be raised and we'd start over.
The success rate of the two options above is about 14%. Yikes. Not very reassuring.
The second option was IVF or in vitro fertilization. In this there would be two separate procedures. The first would be a minor surgical procedure to retrieve eggs. They would then implant two fertilized eggs. The odds of this are 75% with a 40% chance of twins (and a tiny percent chance of three,)
Next they moved us on to see the nurse in her office. Sarah was very nice and very patient. She broke down all of the options in more detail and answered our questions. She then gave us the run down on what happens next. She also gave me a cheat sheet so I don't forget anything, love that!
First I have to have a period. A bad period as Dr. C explained it. They gave me a prescription for Prometrium 200 mg. I will be taking two of these at bedtime for twelve days. This should induce a uterine lining spring cleaning of sorts. It was suggested that I stock up on ibuprofen because I'm going to need it in 10 to 20 days.
As soon as my period starts I have to have a blood test for ovarian function. This part's kind of cool. The day my period starts I call this company and they will set up a test between days two and four. Then, this is the cool part, they come to me where ever I am to administer my blood test! They come to me! To my work, to my home, where ever. Awesome!
Sometime after this I have to go and get another blood test performed for insulin resistance (called DHEA-S), Prolactin (this is a hormone dealing with ovulation), testosterone, and a pregnancy test (just to be sure.) This will give us a baseline and guide for how much of what to give me to create an ovulation.
Sarah then sent us to the billing specialist who broke down what my insurance benefits are and estimated costs for each service. My insurance is apparently pretty awesome and they cover 50% of everything up to a $10,000 maximum lifetime benefit. This will give us two shots at IVF and possibly part of a third.
The cost from the fertility specialists fees of IUI verses IVF are pretty close. IUI is about $619 without the medications. IVF is about $691 without the medications or the hospital fees. The hospital fees are estimated at about $3,000 and $2,500 for the medications. So the difference between the two services is about $3,000, and 14% verses 75%.
IVF is clearly the better option. I had been anti-IVF based on the cost estimates I found online. But here's the thing... The odds of success are so low with IUI that it seems a safe bet that I would have to have multiple treatments. That's multiple rounds of medication, multiple office visit fees, multiple IUI fees. And the odds are so low!
IVF is what I would like to do. Better percentages, but also a risk of multiples. And I have to confess that I've always loved the idea of twins. But the idea of actually having TWO BABIES AT ONCE is a little scary. But Tony and I both would like more than one child and if we did end up with two, we'd be done.
Now here's the big issue. What can we actually afford. We aren't exactly rolling in money and this damned economy really doesn't help in Tony's line of work. Things are better now, but the past two years were a little rough. There will definitely be some serious number crunching in our near future.
I'm hoping we can get a little help coming up with this money. Somehow. There are no payment schedules, it has to be paid within thirty day. But again, we have to sit down and talk. I had to rush to work as soon as my appointment was over so we didn't really have any time.
We have a lot to talk about. A lot to think about. But Dr. C said our chances are very good...
On a side note, the entire office staff was so nice. We were at the office for nearly two hours. They were very through. Very professional. I never once felt rushed, or like they were thinking about their next appointment. We had their whole focus while we were in front of them. Tony liked the office staff too, he said it was an improvement from his doctor's stuck-up staff, haha!
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