next steps: IVF

got my period on friday (in the midst of an amazing new orleans trip... i barely even noticed/cared) so i went to the doctor this morning. i told the nurse that i wanted to talk with one of the doctors about next steps instead of just plunging ahead with another IUI cycle. she brought in the big guy -- the director of the whole fertility institute, the guy who's written up every year as one of the best doctors in the city. i haven't interacted with him until today. of course i was already spread-eagle on the exam table when he walked in and introduced himself, but i guess he used to seeing women like that.

he looked over my file and did the sonogram and told me that he thinks it's time for us to move on to IVF. three unsuccessful IUIs now that i'm 35 and it's been almost six months since my surgery (which means the endometriosis could come back) indicated to him that "time is of the essence." the sonogram showed that i already have two follicles developing, one in each ovary (again on day 4... this is another early, early cycle); that in combination with the fact that they need to order some more medications for me in order to do IVF means we can't do it this cycle. but the doctor said that's actually better. he wants to start "fresh" next cycle.

BUT -- this was the best news i've heard in awhile -- we are going to do one more insemination this cycle with NO DRUGS. since there's already two follicles and he wants to get as much of the hormones out of my system as possible before IVF, he said we'll just monitor my cycle this time and give me a little "boost" just before ovulation and then do IUI again. then, if it doesn't work this time, we'll be all set to go with IVF.

i talked to the lady in billing and she said they'll double check with my insurance company but it looks like we'll have to pay $5,000 out of pocket. not exactly pennies. hopefully my in-laws will put their money where their mouths were a few months ago when they said they'd help us out. i don't want to ask them directly, because it's not that we can't afford it on our own, but they certainly have way more money than we do and if they're willing to invest in the future of their family tree who am i to say no?

so what happens with IVF that makes it so different from IUI, you ask? a quick overview of the procedure, as I understand it:

1) follicle stimulation and ovulation induction: this is pretty much what i've already been doing, except i will probably take a lot more hormones because they generally want a lot more eggs to develop for IVF than when you're just doing IUI.

2) retrieval: when the eggs are ready, they take them out of the ovaries before they ovulate themselves. this is a minor surgical procedure that involves a hollow needle inserted through the pelvic cavity to draw the eggs out. most people have local anesthesia and sedation for this procedure, though i've heard of some people having general anesthesia... not sure why.

3) sperm & egg party: then they get the sperm -- same procedure as before, obviously -- and they prep it for insemination. but now they try to make the fertilization happen in incubators instead of in my uterus. they put the eggs and sperms together and monitor them for a couple of days and hopefully (usually) some or all of the eggs will get fertilized. they like to have between 2 and 4 fertilized eggs for optimal results.

4) transfer: then they put the fertilized embryos (suspended in fluid) back into my uterus, and hope for the best. this is usually a couple of days after the retrieval. it seems like this procedure is much like the IUI procedure: a catheter through the cervix, shouldn't really feel like much of anything. and then... the wait.

clearly it is more invasive and intense than IUI, but that's why it's more effective. not that it's a given that it will work. they say there's a 20-25% success rate for women aged 35-37. i am hoping i'm still close enough to fall into the "under 35" statistics, which are 30-35% percent. either way, i think the doctor is right that we don't want to waste any more time. i like this plan, and i think i'm ready for all of this. and i am SO PSYCHED to not have to give myself shots this cycle but to still be able to try the insemination one more time. who knows... maybe we'll be surprised and won't even have to worry about IVF after all.