Whew! What a whirlwind couple of weeks it has been! I've been working on this for awhile, but wanted to wait until the endocrinology work-up to post.
Let me start off by saying diamonds are a girl's best friend. Period. I am so thankful that another SMC was able to suggest this place to me. It's not an RE office, but the work-up so far is exactly the same. I think I'll stay there for now unless I end up needing IVF (knock on wood that I never do!). It was so nice to have people smile at me, congratulate me on the weight I have lost, and, most importantly, not flinch when I tell them I'm using donor sperm. The doctor wasn't exactly warm and fuzzy, but was full of information. He actually took my thoughts into account, which was beyond appreciated. He agreed to run male hormone levels, plus did a fasting insulin, Hba1c, and glucose. The hormones were actually dead in the center of the bell curve. The a1c was normal, and the glucose was 96, but the insulin was 36. So, I do have some insulin resistance, which could indicate PCOS may indeed be a part of the picture.
In terms of treatment, he thinks a low dose of Metformin may be helpful for me, but wanted to wait and see what the endocrinologist thought. He agrees that Femara may be the best ovulation induction drug for me. In fact, he said that many of his patients in my situation do better on Femara than on Clomid. He also uses it a few days longer, like CDs 3-10 instead of 3-7. I don't see the issue with this. I'm planning on doing a cycle or two of Femara plus a trigger shot, but after that, I don't want to BS around; it's on to injectables. I know that some women will try conservative IUI several times, but I can't see myself doing it over and over without getting aggressive. It's not just the financial toll; it's the emotional one as well. I couldn't go through 6, 10, even 12 BFNs without knowing I did everything I could to make that BFP happen. Oh wait. . .there I go again, getting ahead of myself!
Last week, I had a consult with a medical endocrinologist as well. She had no clue why my TSH is fluctuating so much, which makes me feel SO secure! But, she did repeat it again, and it is now 2.8. I'm still not comfortable with the level changing, so I will probably have to work on it on my own then call her and tell her what I want to do. (Why does every doctor appointment end up this way?) In other news, she agrees that Metformin may benefit me. She started me on 500mg/day of the extended release form, which is supposed to make the side effects a bit easier to handle (yeah right!). She said I could go up to 1,000mg a day if need be. It may help me lose more weight, and bringing the insulin levels down may help support the return of ovulation, or at the very least make the induction easier. How long I take it and whether I continue it during TTC/pregnancy is up to me and the OB/GYN. She said that there's as much research supporting continuing it as there is for discontinuing it. I would think that it would help prevent GD, or am I incorrect? I don't know enough about it yet to make a decision on what to do there.
I called Diamond with an update, and the doctor himself called me back (another plus) and let me know that he called in Provera for me with 8 refills, which I will keep taking on CD 21 for 10 days each cycle until TTC. The doc is fine with post-IUI progesterone, but still gave me the schpiel about how it really isn't needed...blah, blah, blah... All I can say is I hope that I will never need all 8 of those Provera scripts, if you catch my drift.
Things seem to be falling in place. I'll finish my program and hopefully pass my boards in May. I should be re-employed soon after that. The thought of being able to leave where I'm at for a new career and the prospect of starting a new family is so enthralling; I can barely take it! In the meantime, stay tuned for updates on my life, love (or lack thereof), and adventures in the kitchen. The Riveting Mama is in the game!