He explained that in 60% of women with PCOS - Clomid doesn't work... which we are in that category. My testosterone levels went very high in the initial stages of that cycle so that was why I was unable to ovulate on that drug.
He told us that the body makes 2 types of hormones involved in the ovulation process - FSH (follicle stimulating hormone) and LH (??? = testosterone) - basically raised levels of LH puts the break on ovulation in general. FSH is the accelerator - Clomid causes the body to produce both hormones... and in my case stimulated the LH a bit too much.
We talked through the differences between several drugs, drug combinations, and the procedures of IVF and IUI. We are all on the same page that for now we'll try an IUI cycle with Gonal F (a pure FSH drug) and see what happens. We talked about combining the Gonal F with Lupron (a drug that stops your body from making LH or FSH naturally) but for this first round - we're going to opt to just do the single drug therapy. If we see that my testosterone level is rising on the first ultrasound - there is a drug that he can give me to stop it... but we'd have to cross that bridge when we get there.
Of course we will start with a lower dose of the Gonal F and see where we get after 4 days on the injections. Basically though, any more than 4 follicles (we can give special permission for up to 5) and they'll cancel the cycle. With the high rates of multiples - 25-30% twins, 10-15% triplets, 5-7% quads or higher... he won't do the IUI with any more than the 4-5 follicles.
He said that 85% of people in our situation get pregnant within 3 IUI cycles... and thinks that we should opt for that. We are in for the first round and will reevaluate then to see what we want to do next. With IVF the stats are a 65% pregnancy rate with the first cycle if you do a 5 day embryo transfer.
He broke down the costs with us as well - and if we have success within the first or second IUI - we will have saved quite a bit of money...
The only brake on the process right now is the fact that I'm still running a fever continuously. It's been 5 weeks now... and still running the same low grade fever. It's hanging in between 99 and 100... so we talked to him about that as well. He told us that you can't do an IVF with a fever because it will cause the embryos to not be able to implant, and can cause the same problems with IUI...
He is running a CBC, and a couple of other tests to see if we can find out what is causing the fevers. His thought is that if my white blood cell count is high - then I need another round of antibiotics to bring down the count before starting a cycle. If the other tests come back elevated - they will show some sort of chronic inflammation... and he'll put me on Celebrex for a month - then recheck the labs.
I should get the results on the blood tests on Thursday or Friday - and from there will have a little more clarity of what the plan will be.
- We'll start some antibiotics
- We'll start Celebrex for a month
- We'll order the Gonal F injections and start the cycle
I think that overall John and I both feel better about how things are going, and have a better understanding of what we are doing and why. Sometimes it's just nice to be able to sit down with the brains behind the staff and understand what it is that he's thinking.
The funniest part of the visit was the look on John's face when the doctor gave us the stats on the multiple births - and informed us that there is a lady in the hospital right now waiting to have sextuplets... HA!