Wednesday, November 17, 2010

Things to think about

Today I had my annual "WTF do we do now" appointment with my RE.

It went, I'd say, pretty well. Any appointment during which both patient and doctor laugh several times and doctor tells patient "I love you" (not in a molesty way, more in a "Oh my gosh you are so funny. I love you and your jokes" kind of way) and the speculum is warm is a decent one. Hell, any appointment that doesn't end with the two of us in tears and him saying "I'm so sorry" is a decent appointment.

I'd say you've probably been seeing too much of your RE when the fact that he is feeling your naked boobs and sticking fingers and other things into your va-jay-jay doesn't make you feel the slightest bit uncomfortable.

I digress. Once I was fully clothed again we discussed options. There are, it seems, several, when we're ready:
  • Try with no intervention (save folic acid and aspirin, and upon confirmation of pregnancy, lovenox and prednisone). We have not tried pred with any other pregnancies, but I have recently been diagnosed with another autoimmune condition. It could possibly increase the odds of success, but it could do nothing. Pros: cheap, easy, and involves lots of monkey loving. Not invasive (unless I, um, let Hubby invade...... never mind. TMI). Cons: Could lead to another miscarriage.

  • IUI. Pros: Increases the odds of pregnancy, and is relatively inexpensive (around $400). Minimally invasive. Cons: Does nothing to decrease the odds of miscarriage.

  • IVF. Pros: has been shown to increase the odds of success in women with RPL. Cons: Expensive (upwards of $18k with my clinic's shared risk program). Time consuming. Highly invasive.

  • Embryo adoption. Pros: Increased odds of success (around 40% for women with RPL). Somewhat inexpensive (around $4500). Less invasive than IVF. Cons: A year long waiting list (which I am now on, just in case). No biological link to the (prospective) child.

  • Surrogacy with donor eggs and hubby's sperm. My cousin, who has had two easy pregnancies resulting in two healthy babies, has offered many times to be a surrogate for us. Pros: Genetic link to child for both of us. 70-80% success rate. Cons: Missing out on the pregnancy (she lives in NY; we're in the midwest). Logistics. Cost (at least $12-13k; could be significantly higher) - we'd have to go through the adoption process and pay for either IUI or IVF (which would add significantly to the cost), depending on her comfort level. Could be highly invasive for her.

  • Surrogacy with my own eggs and hubby's sperm. Pros: Increased odds of success, but not as high as with donor eggs. Genetic link to child. Cons: Cost - would be at least as expensive as an IVF cycle, possibly more. Logistics. Missing out on the pregnancy.

 The fact that we have so many options - not even including the adoption option - is both great and overwhelming. They all seem so out of reach, and yet so close. My head is swimming. And I don't even have the hubs to run it all by. He is out of town until tomorrow, and regardless, he has made it clear that for him, being on a break means not even discussing options. I am trying really really hard to respect that.

In the absence of Hubby's opinion, I totally welcome any thoughts you might have.


  1. Wow, so many choices it can be promising and daunting at the same time. I might start with an IUI because it increases your chances and isn't too invasive. I never had that option because my endometriosis is too advanced. Good luck and come to Canada if you do IVF. The cost for a cycle is around $8,000.
    Good luck!

  2. Oh Canada! Hubby and I have seriously discussed moving there someday (especially with the recent election results in the US!) Every Canadian I've ever met has been awesome. I'm not sure what a single IVF cycle would cost at my clinic but the shared risk program covers 2 or 3 fresh cycles, plus unlimited froezen cycles, so it's not a bad deal. Just way, way expensive!

  3. Hi honey, from my own experience I was really against IVF when I started just doing IUI's. They were so easy and inexpensive I just thought I'd keep doing them until I got pregnant. That said, we only did them because we had issues on my side- and sperm ones on DH's. If we hadn't had those we may have TTC on our own a little longer. I'd choose IVF as it does have a good chance of decreasing the odds of miscarriage. But perhaps a bit more of Option #1 before that!!
    This is such a hard decision, but I think if I know you, you would like to go through the whole pregnancy yourself if you can? Which is why I say IVF.
    Loving reading your blog no matter what you decide :)

  4. Or come to Australia - IVF Is MUCH cheaper and you get a stack back from medicare...

    I think the only wrong decision is to do nothing at all. Why don't you start with the least inexpensive/invasive and work your way up?

    maybe make a list and cross them off as you go. Hopefully you only need to go through the first few.

  5. Lots and lots of options... your head must be spinning. How long until you can discuss the options with the hubby?
    If it were me... I'd make a concrete step by step list. We're going to do this on our own until a certain date. Then we are moving on to the next step and try that until a certain date. And so on. I like a plan.

  6. You really do have a lot of options... Just checking, but the prednisone would apply to all of the options (except surrogacy), right?
    If you do IUI would that involve injectibles too or just the IUI? My RE seems to think that doing injectibles would decrease my odds of miscarriage, so I'm intrigued.


  7. I'd like to know what the newly diagnosed autoimmune condition is. Personally I would go for option 1, as you have proven you can get pregnant. Option 1 is currently what we are doing. Note - you should really start prednisone at the start of your cycle, before you get a positive.