Why hello uterus, I've missed you

Whew! It's only 2 pm as I'm starting this post, and I feel like I've lived through an entire week since I woke up this morning. Yes, today was The Appointment.

Hoo-ha, meet the new RE. Mr. RE, this is my hoo-ha. A pleasure, I'm sure.

I drove into Seattle with the morning rush. Actually it wasn't so bad. On the way in, I turned up my music REALLY LOUD (which I can't normally do because of my pint-sized passenger) and belted out the lyrics to the Missy Higgins CD that my friend Al had made for me. It was kinda like having her with me for moral support -- thanks Al, I love you! As I drove and sang (using the word "sang" loosely) I could feel my body buzzing with emotion and anticipation. I tried to identify the individual thoughts and feelings, but I really couldn't. I was a giant mess of nerves... leaving Bean home with this babysitter for the first time, wondering how our appointment would go, contemplating whether or not we'd end up with a baby at the end of it all.

The first thing I had to get over was the fact that this clinic is very different than our last one. I loved my RE in St. Louis, and he's the standard by which all others will be judged. I'm sure it's some sort of psychological defense mechanism that I remember only the good things about our last experience with the doctor; the rose-colored glasses of the mind. Going into this office, I was struck by how hard core it seems. Everything from the giant official logo on the building to the super-professional waiting room and fancy offices overlooking the water. This is Serious Business here.

DH met me there and we patiently waited to meet Mr. RE. (Sorry, I have no creative nickname for him like others do for their doctors. If I think of something more amusing I'll be sure to let you know.) Apart from enjoying the comfy chairs and beautiful view, we were assaulted by a constant stream of offensive lite rock ballads from the early 1990s. I sang along with every single song, from Michael Bolton to Whitney Houston, and we pondered what it says about me that I knew all the words. DH and I were both in agreement on that: nothing good. Nothing good whatsoever.

But despite the less-than-happy reason we were there, it's always a nice treat to see DH in the middle of the day. We sat and talked and laughed while we waited... we are truly in this together. As I looked at the other couples, I felt a little guilty knowing that we had a child at home already (although I'm sure some of them did, too). No matter what happens this time, I'll be spending my life with my soulmate, raising our son. God willing, we'll have family vacations and baseball games and high school graduation and grandbabies one day. That blessing wasn't lost on me. Secondary infertility has been very different than primary for me so far... I'm sure I'll have more to say on that subject in subsequent posts.

We finally shook hands with our new hope for the future, Mr. RE. We sat down together, and he rendered useless all the time we spent filling out a huge packet of paperwork by asking us to give our history. He struck me as a very sharp man, he was very "quick" with everything (not like rushing us, more like he was processing things in his head very quickly) as we talked history and treatment planning.

In the middle of our consultation, my cell phone rang. Fearing it was the babysitter, I grabbed it from my purse and looked at my caller ID. It was one of the moms from preschool. I was hoping she was calling because she wanted to get together today, and as I would learn when I listened to her message on the way home, I was right! My insides did a little jig of happiness seeing her name on the small screen... and if you've read this post, you understand why. As stressful as the day was, there were a lot of good things happening too.

How did the meeting go? As good as these sorts of meetings can go, I suppose. We discussed what worked and didn't work in the past. He gave me an ultrasound to check out the old uterus and follies. (Hi ladies! It's been a while!) He saw a small fibroid on the outside of the uterus, which he said was a non-issue at this point, and remarked that otherwise my insides are "beautiful." Spotted one dominant follie on my right ovary... hopefully I'll be popping that baby off next week. Who knows, maybe I'll get pregnant and not need to return to the office. HA HA HA! *snort* Excuse me while I recover from a fit of laughter...

He agreed with me 100% that it may very well be the mild endo that's creating a hostile environment for implantation, despite the assurances from my previous OB/GYN and RE that it was not. His suggestion was that we reduce the amount of Follistim this time (to aim for 1-2 follies instead of the 2-3 I got last time, lessening the chance of multiples) and then proceed with an IUI. He wants to do some CD3 bloodwork when my next AF arrives, but he said that he expects everything to come back normal, and if it is, we can go ahead with treatment that same cycle if we are ready. As in: JULY! NEXT MONTH! Otherwise we can think about it for a while longer and give him the green light at any point in the future.

Regarding the breastfeeding issue... this is what I was most nervous about. He did raise an eyebrow when I mentioned I was still nursing. I shared with him that it's infrequent and quick these days, and I would like to proceed with treatments without weaning. He said "on the record" he would advise me to wean first. Mainly because prolactin, a hormone associated with breastfeeding, can inhibit conception. He said if we are investing so much in a cycle, he wants us to have the best shot possible. Which of course I entirely agree with. However, he is willing to go ahead if that's what I want. He suggested that we do some additional bloodwork to check my prolactin levels, and if they are very low, he doesn't see a problem with the Follistim + IUI protocol. I was satisfied and more than a bit relieved with this answer.

He also recommended doing back-to-back IUIs, when you get to meet Turkey Baster two days in a row at ovulation time instead of once. This of course doubles the cost of that portion of treatment. Our previous RE said that when he reviewed the literature, he saw no increased success with the back-to-back approach, and so why make the cycle more expensive that it already was? With him we only did one IUI each time. This doc did admit that the research in medical journals was split on this issue. But his argument was that (again) you are already investing so much in the cycle, what's another $350 to put twice as many soldiers in position? I could see his point if we were doing IVF, which is a lot more expensive and would require financing for us anyway... but an extra $350 is a lot for an IUI cycle, I think. Still undecided on this.

After the appointment, I kissed DH goodbye, called the babysitter to confirm things were a-okay, and hopped over to where Jen works nearby so we could grab some coffee together. When she suggested this last week, maybe it was because I was sappy from AF hormones, and maybe she just wanted an excuse to take a break from work anyway, but I was really touched! As we ordered, she insisted on treating because of my difficult morning, and it was wonderful to debrief with someone who had not only been-there-done-that with IF, but been-there-done-that at this same clinic.

I am such a lucky girl to have these people in my life.

I'm still a swirl of thoughts and emotions, and unfortunately DH is going to be working late tonight to make up for the huge chunk of time we spent at the doc, so we can't compare notes for a while. But so far, here are my thoughts.

1. I think the appointment went just as well as I could have hoped. Other than finding out I was indeed correct that our new insurance is a bastard and won't cover ultrasounds or bloodwork, so each cycle will be twice as much as they were in St. Louis. But everything in Seattle is twice as much as it was in St. Louis, so really that shouldn't be a shocker.

2. The RE and I were on the exact same page as far as treatment planning goes. I'm pretty sure I could be an RE right now, if I could just get past that whole cutting-up-a-cadaver thing to get a medical license.

3. Seeing as the cost of one (yes ONE) cycle is $1500ish, are we ready to start immediately? The chemical pregnancy in December has given me just enough hope to wonder if we should try longer on our own first. I think 51% of me is ready to give it a go, but the other 49% is pretty convincing too.

4. If we do go ahead, do we do one IUI per cycle or spend the extra $350 to do back-to-back IUIs? I'm leaning towards one, especially if the problem is endo/implantation and not the performance of DH's little men.

5. Am I willing to risk the chance of multiples at this point? If we have twins on top of a two-year-old, with no family within 2200 miles to lend a hand, we will be SKEE-ROOED.

I'd love your thoughts, as always. You are so wise!!