We go to a practice where the doctors are all board certified Reproductive Endocrinologists. They did a residency in obstetrics and gynecology and then went on for a fellowship and further study in reproductive endocrinology. They only do fertility related services. There is a lab on site, although blood work is sent out.
The office is completely void of references to babies and pregnancy. Thank God. Apparently I'm not the only one who would rather not be reminded of it. It does not feel 'clinical' at all. The walls are covered in warm, textured wall paper, the waiting room furniture was picked from a modern decorating magazine, and I have never seen an issue of Parenting magazine on the table. Even the exam rooms aren't cold and uninviting. There are no pregnant ladies in the waiting room.
We tend to nickname everyone, our doctor included. We call her Dr. No Funny Business (Dr. NFB). She is smart, explains everything she sees and what treatments she wants to do, and answers all of our questions. We really couldn't be more pleased with her or the nursing staff. The nickname Dr. NFB is because she is all business. I never have to prepare any small talk topics in advance and she answers our questions honestly.
If details make you squirm in your seat, skip this rest of this post. You were fairly warned.
Because we don't know what is wrong, our current treatment plan is just to improve our odds of conception. For a 'normal' couple, each cycle carries a 20%-25% chance of conception. Once we hit the year mark our odds of conceiving with no assistance dropped to 3%. Enter: fertility doctor. A combination of Clomid and intrauterine insemination (IUI) improves our chances to 10% per cycle. I think the easiest way to explain this is to walk you through one of our cycles:
- CD1 (cycle day 1): call office and schedule an appointment
- CD2: Scan and Script. Ultrasound to make sure I don't have any ovarian cysts. If there are no cysts, Dr. NFB writes a prescription for Clomid
- CD3-7: Take Clomid to increase the number of eggs produced. Normally, women produce one egg each cycle. Clomid works by blocking estrogen receptors thereby causing the pituitary gland to produce more follicle stimulating hormone (FSH). More FSH = more follicles. Each follicle contains one egg. Doses start at 50mg.
- CD12: Scan and Stab. Ultrasound to check the follicle count and size. If one or more are considered nearly mature (around 19-20mm), they give me a 10,000mg human chorionic gonadotropin (hCG) injection to force ovulation of all mature follicles. This is not a small needle. You should have seen Chris's eyes the first time they stabbed me in the back with it. If the follicles aren't big enough, they don't trigger with the hCG and we come back the next day for another scan.
- CD13: Assuming we 'triggered' yesterday, we drop off Chris's donation at the lab at 7:30am and return at 9:00am for an IUI. In that hour and half, they do a sperm "wash" to isolate the best of the bunch. The IUI bypasses the treacherous journey through the cervix.
- CD28/29: either I'm pregnant or not. If not, rinse and repeat.
Are you thinking, "Damn, that's a lot of doctor appointments?" Yes, yes it is. Minimum is three appointments per cycle. Luckily for us, Chris pretty much sets his own schedule and I just leave work when I need. They don't know, I don't tell.
At this point, we have completed that schedule three times and are part way through the fourth. The first one resulted in a miscarriage at 5 weeks. It was very early, but still, we thought maybe it was finally our turn. This will be our last IUI attempt. We are crossing all our fingers and toes that this works because the next step for us is IVF. IUIs are a cake walk compared to IVF in terms of medications, procedures, time off work, expense, and emotions.
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