I'm happy to announce that we have a plan in place! I know, I know....you were thinking I was going to announce that I was pregnant, but hey--at least these are baby steps (so to speak) and if we can't get the prize at least every step closer we make to achieving our goal causes us some excitement (we'll take whatever excitement we can get).
Jon had his Varicocele surgery over 5 weeks ago. At the 12 week mark (early February) we will learn the fate of the outcome when he does his repeat swim test. The urologist was very excited to speak to me after the surgery because he said with a little smile on his face that he's fairly optimistic that we will see improved results because there were "a lot of veins down there". My impression is that once he was able to evaluate the issue during the surgical procedure he was able to understand the full magnitude of the problem and from his perspective, it was likely a big problem and one that necessitated surgery to correct.
Early February is going to be a very nerve-wracking time for us because if there are improved results it means that what we've been hoping for since April of 2011 will likely become a reality very soon (I get chills even just thinking about it). If it doesn't show any improvement it is going to be a devastating blow to our hope and we're going to feel defeated.
If the latter is true then we will need to explore next steps. We have 3 options:
1. Do nothing and hope for the best. I have a pregnancy success rate of 7% thus far (based on my own personal experience) so at some point we will get pregnant, but it's just a matter of when. The average "healthy" couple has a 20% pregnancy success rate which means it will take me nearly 3 times the amount of time for us to fall pregnant compared to a fertile couple. My success rate is actually probably a little lower it's just that there was a break in there when I got pregnant so my denominator (# of cycles) is smaller.
2. Pursue Intrauterine Insemination which my Reproductive Endocrinologist (RE) said has about a 20% success rate (so it improves our chances to that of a healthy fertile couple). If this seems low then you must keep in mind that these statistics are based off an "infertile" or "sub-fertile" population (our Urologist called us "sub-fertile"). Fertile couples don't always pursue IUI, and a fertile female that does is likely using a sperm donor and is over the age of 35 (advanced maternal age). Couple pursue IUI because they're struggling with infertility issues and in our case, we are likely only dealing with male-factor infertility (MFI). IUI allows us to control the MFI issue by "washing" the sperm just prior to the IUI procedure and only pulling the healthiest and best sperm and inserting it directly into my uterus (so essentially giving the sperm an extra boost to get to where it needs to go). Because we are controlling MFI through IUI my chances could likely be higher than the typical couples who do IUI since there are no other infertility issues with us to deal with that are deemed uncontrollable during IUI procedures. That being said, I would like to go on a medication called Clomid which stimulates the ovaries to help enhance ovulation and also produce extra eggs. If I do produce extra eggs this will only further increase our chances of success. It also increases my chance of having twins. Clomid is a risky drug to take and should only be taken under the supervision of a doctor who will monitor you to check for cysts because it can also wreck fertility if taken for too long. Therefore, it is recommended that you take it for no more than 6 cycles. Most people who pursue IUI will do it in conjunction with Clomid since Clomid increases your chance of success, but most will only try it for 3 cycles and if that doesn't work they move on to IVF. IUI costs $2,500/cycle at the RE office and about $350/cycle at the OBGYN office (although I think there are extra costs in there if you want to be monitored on Clomid because it requires the use of an ultrasound).
3. The last option is IVF. IVF success rates are typically very high (over 50%). It is expensive, invasive (you take more drugs and shots to perfectly control ovulation time), and time-consuming (many doctor visits). The cost of IVF at the RE office I go to is $9,800 and the average cost of drugs that you may or may not take depending on your infertile issues average about $3,000/patient.
If you recall from some of my earlier posts, I wrote off IUI and IVF for various reasons. I did not want to pursue IUI because I thought it was too expensive at the RE office given the "low" success rate. I did not want to pursue IVF given how expensive it is and the risk I play of messing with nature because if my body doesn't want me to get pregnant, I shouldn't try to manipulate it. We don't know what the consequences (the side effects) will be. If my body doesn't want to get pregnant then there is a reason for that and I need to listen.
However, as we surpass the 1.5 year mark with still no successes I start to toy with the idea of what will happen if Jon's swim test doesn't show improvement? Would I really be content with "doing nothing" any longer than I already have been? Wouldn't it be exciting to pursue an intervention and help us feel more optimistic for our future? Doing nothing would mean I would get pregnant "for free" and I was hesitating throwing my money around just to control my destiny. I wasn't sure I wanted to operate that way.
However, my health insurance offers up to $8,000 lifetime benefit to pay for IUI and IVF. To me, that seems like a game changer. Suddenly IVF doesn't sound so bad. Also, learning that IUI was considerably cheaper at an OBGYN with (what I'm learning are possibly) comparable success rates to the RE office, I have to wonder---what's the harm in trying IUI?
For both IUI and IVF, I would not take these decisions lightly. I have scheduled a consult visit with an OBGYN that came recommended to me at my home clinic to at least discuss health outcomes and processes. If he won't monitor me on Clomid then I don't want to do it with the OBGYN, but I'm assuming that he will do it because I'm told he practices evidenced based medicine. In January, we will be going to this consult and learning more about the process and then waiting for February to see what Jon's results show. If Jon doesn't show improvement and we decide to pursue IUI for 3 cycles then I would like to start it as soon as my next cycle starts during February or March.
If IUI does not work after 3 cycles we will then reassess how we feel about IVF. I would consult again with my RE and ask him all of the concerns and ethical implications I have about IVF. Knowing that I have $8,000 to cover IVF makes me feel like it could possibly be an option, but not one I want to think too carefully about right now.
Those are my updates. I will post again in early January after we meet with the OBGYN regarding IUI.
I hope everyone has a great Holiday :)
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