We met with Dr. Y last Thursday to lay out a plan for optimizing our chances of conceiving Number 2. Reading between the lines (or listening to what he was saying point blank, in some cases), here’s what I learned:
Dr. Y still very much considers us to be infertile.
As predicted, he said our most recent AMH and FSH results are not significantly different from the previous ones. He described them as “holding steady,” but said that “there is only so much we can infer” from this. Despite the fact that we conceived spontaneously after similar test results two years ago, he didn’t seem to think we should wait long for another spontaneous conception, instead advising us to move forward right away. I think I heard him use the expression, “lightning could strike twice,” to refer to the possibility of another spontaneous conception, which didn’t exactly instill confidence. I shouldn’t have been surprised by this, but I was, which led me to my second – somewhat surprising realization:
I had stopped thinking of us as infertile.
Despite the dozens of times I’ve uttered “…if we’re fortunate enough to have another child,” I apparently had started to believe that it would be easier this time around. For one thing, SO MANY PEOPLE have insisted, “now that you’ve had one, your body knows what to do”, or “you’ve cleared the pipes”, or whatever. And even though I’ve politely replied that I’m pretty sure that’s not how it works, I’ve privately hoped that it will work that way, at least for us. Judging by my internal reaction to Dr. Y’s comments, I had actually started to believe it!
Not much new is known about DOR or available treatment options since the last time we were here.
We asked Dr. Y about any new studies relevant to DOR, poor responders, etc., and he told us there had not been much done, except for some mouse studies. (He didn’t say which one, but I did a quick PubMed search, and the most credible-looking – i.e., the one published in English, in a scientific journal whose reputation I know to be good – is this one, which says that treatment of mice with androgens enhances ovulation.) I asked about the low-stim protocol he had me on before and he said that my local clinic had a lot more data (though they haven’t published anything) showing that the low-stim protocol is “no worse and probably better than” high-stim for poor responders.
Dr. Y does not think we’re good candidates for IVF, but is willing to try if we want to.
This really wasn’t a surprise either. Given how IVF went the first time, we had little reason to suppose that it would be any better now. He said there was “probably little change in the probability of success” from IVF this time around versus last time, but that some people “need to try it to be able to close this chapter” in their journey. He also doesn’t recommend trying Clomid or Menopur shots with IUI, since I was such a poor responder last time.
So if he doesn’t recommend spontaneous conception, IVF, or medicated IUI, what did Dr. Y recommend we quickly move on to, exactly?
Natural cycle IUI.
To be fair, he didn’t actually say he doesn’t recommend spontaneous conception, just that he thinks we should move quickly to maximize our chances of conception. (I actually think he is assuming – correctly – that we will consistently try for natural conception regardless of whichever high-tech options we might also entertain…) Since stims do little for me, he doesn’t think they are worth the trouble or cost. He also knows that all the other bits seem to be working – or at least worked once. So with the aim of maximizing the probability of pregnancy at a minimal cost, he recommended up to three tries at natural cycle IUI, possibly proceeding to IVF if IUI doesn’t work (assuming we’re comfortable with the unfavorable odds we’ve been given on the IVF front!)
Lastly, I asked whether he thought I should resume my regimen of supplements that I was taking last time, and he said to go for it. I actually have mixed feelings about this. Since being barraged by fallacious, often sanctimonious, and occasionally dangerous “natural is best” claims surrounding pregnancy, childbirth, and parenting, I’ve become wary of all things unsupported by science. In Dr. Y’s words, “there is no data showing [the supplements] work, but it worked for you before and you have nothing to lose by trying again.” Taking the supplements again feels hypocritical to this scientist…but I guess I’d rather be a pregnant hypocrite than the alternative.
So now I’m back to my regimen of charting basal body temperature, peeing on OPKs, drinking nanogreens and wheatgrass juice, and taking a laundry list of supplements (including DHEA).
Once I get a positive on the OPK, I’m supposed to call Dr. Y to schedule my natural cycle IUI for next month. I’ll come in approximately 2 days before my expected ovulation day for an hCG trigger shot, and then again for insemination. Giddy up!