He confirmed that I hadn't O'd and said that my ovaries might prove problematic. He also added (I should say now that we have suspected this all along but this was the first time a doctor had been brave enough to come out and say it) that because DH's two SAs were so poor, the combination of the two of us means that we probably won't have much chance without assisted conception. He then asked what our concerns are/would be with IVF. I said mainly the cost and the wait. He agreed that with our planned move back to the States (in about 14 months) we wouldn't make into the three year wait list-- which is the shortest one around here on the NHS. IVF here is a lot cheaper than in the US, so we might begin talking about coming up with the money and trying to convince our GP to cover the cost of the drugs.

Then we talked about what would be our next immediate option. He seemed fine with us trying clomid for another two cycles, one at 50mg and one at 100mg, although he didn't seem to have high hopes that it would work. However the way the pharmacy gave me the clomid, I either have three cycles at 50mg, or one a 50mg and one at 100mg, so if it does work at 50mg I don't have to up the next dosage. He also gave me a prescription for enough provera in case it doesn't work. He also suggested ovarian diathermy and said that it shouldn't be any problem to get it done quickly (meaning no waiting list), although he isn't the one who does it. He made a face and said that unfortunately, injectibles are not an option at the moment because this trust (Americans can substitute HMO there) doesn't pay for them, but there are two REs (!!) coming to the clinic full time in August and he is hoping that they will put pressure on the hospital and the policy will change.

He is doing a full thyroid work up on me and a GTT and he is going to ask the lab about the possibility of testing for IR since some research suggests that people with IR will still show normal glucose levels. He was not opposed to anything we suggested, just thought that it would depend on what the lab could provide since it is not a research facility. We also talked about metformin, but he said that he didn't know enough about it and endocrinology is not his specialty, but that when the new doctors come in August, I will be able to talk to them about it. The impression I got was that they are both women. I also got up the courage to ask for another SA for Jon since it has been three months since the last one and he has been diligently taking his vitamins and, except for his birthday, avoiding alcohol. It turns out that the reason we haven't heard from the urologist is because he has been on sick leave and the gyn was happy to order another SA.

So it was a bittersweet appointment. It was really hard to hear that I am now probably on the IVF track. I have known it was coming for almost nine years, but it is still hard to cope with. At the same time, it is so nice to have a doctor who admits ignorance and who is willing to talk and explain things, and might even try to get around the system for you. As I said to Jon, I am really bummed that his specialty isn't RE because he is really nice to talk to and we both like him. Plus he has a really nice nurse who liked my tattoo. Hopefully the new REs will be just as nice.

So we have a new plan of action. July will be 50mg clomid. August will be 100mg. Then we will hopefully see one of the new doctors and discuss the various merits of ovarian drilling and metformin. We have talked a bit about the IVF/ICSI thing and we are undecided. I didn't really want to go that route, but I am willing to try once. I just don't want to waste precious money that we could use for an adoption on too many failed IVF cycles. At least with adoption, the bulk of the cost comes when you get the baby and it doesn't feel as much like gambling. For now, though, I am trying to concentrate on the clomid, metformin, and diathermy. Maybe one of them will work before we get to the IVF bridge. Who knows, maybe the next SA will come back better and I won't feel so forced in this direction.

Hope everything is going well for everyone else. At the very least, I get to start a new cycle soon and that is always good.

Kim