We had a consultation with the RE regarding our options should this next cycle not be successful. It was a bit overwhelming. We really have several different options and no one option is necessarily the best option.
1. We can continue with the same protocol. It appears that I am responding well to the clomid. However, the RE believes that there is a small possibility that underneath it all this drug might not be our best option. This particular medication works by tricking they hypothalamus into releasing more hormones that tell the pituitary gland to drain more LH and FSH that then causes the ovary to produce more eggs and more follicles. So with this drug success is dependent upon the quality of the FSH being produced by my body. Therefore, if the quality of my FSH is below optimal, then the quality of the eggs contained in the mature follicles may be less than optimal. And unfortunately the only way to evaluate egg quality is through IVF. The RE believes that our chance of success with each cycle would be between 10% and 25%.
2. We also have the option to use another drug called letrozole that is similar in nature to clomid. However, there might be a chance that my body would react differently to this particular drug. The RE again believes that our chance of success with each cycle would be between 10% and 25%.
3. We could move onto injections. The injections, unlike the previous drugs, rely on synthetic FSH to cause the ovary to produce more eggs and more follicles. Therefore, we are not dependent upon the quality of the FSH being produced by my body. The chances of the egg quality being optimal increase with the use of injections. The greatest downside to the use of injections is the cost. We would be spending a substantial amount of money each month simply on the cost of the medication. The RE believes that our chance of success with each cycle would be between 20% and 30%.
4. We could move onto IVF. We are nowhere near pursing this option at the moment. So we will just leave this section blank!
5. I call our final option "The Elephant in the Room". There is a possibility that I have endometriosis. This is a condition in which tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body. The endometriosis, depending upon its severity, can unfortunately lead to problems with fertility along with a wide-range of other problems. There is much debate in regards to how endometriosis is actually correlated to fertility problems. I have always experienced symptoms that are indicative of endometriosis. I made the decision about eight years ago to go on BCP in hopes that the BCP would suppress any potential endometriosis. I was on continuous BCP. This means that I very rarely allowed my body to shed the lining of my uterus or have a "period". The BCP were a life saver. I regained my life. I came off of the BCP in October 2010 in anticipation of trying to get pregnant. I have been fortunate since that time to not experience any severe symptoms of endometriosis. I still have somewhat painful periods but the pain is no way at the level it was prior to being on the BCP. The only new symptom I have is significant back pain leading up to the days before my period. The RE has recommended a laparoscopy because there is still a chance that I could have endometriosis. There are many women who have this disease and have little to no symptoms of it. The laparoscopy is an outpatient surgical procedure in which the RE would insert a camera through a small incision in my abdomen to get a clear view of all my reproductive organs. If there was evidence of endometriosis, then the RE would remove as much of the endometriosis as possible. This procedure would be covered by my medical insurance.
Now you can understand why my brain hurts!
We have decided that if we do not get pregnant on this current cycle then we are going to move forward with the laparoscopy.
This was not an easy decision. It has actually been a topic we have been discussing since we began this journey in January 2011. Our RE had actually suggested we do a laparoscopy prior to doing any cycles. We disagreed with this assessment at the time. I do not make light of any surgical procedure. However, we feel that our next best option should this cycle not work is to move forward with the injections. Because of the cost associated with the injections we want to be 100% certain of what is going on with my reproductive organs. And the only way the RE can get a clear picture of my reproductive organs is through the laparoscopy. There is also a possibility that if I were to be diagnosed with endometriosis then my medical insurance would subsequently cover infertility treatments. This would mean that the injections would be covered and the costs associated with each cycle would be significantly decreased. I also understand that there is a strong possibility that I do not have endometriosis. That would be wonderful. If that ends up being the case, then Kara and I are prepared to move onto the injections with hopes that we get pregnant very quickly.
We are both hoping that none of these options actually need to be used in the coming months. We are instead praying with every ounce of strength that we can muster that we get pregnant this cycle.
Mary
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