Today was my follow-up appointment for my D&C and laparoscopy with my RE. I was annoyed because they hadn't gotten my blood work results from the lab, but they were able to call over and get them faxed. The downside was that the insulin levels weren't included. They had the glucose and HCG levels, but no insulin results. My HCG was 10 on Wednesday and my fasting glucose levels were well in the average range (83). My RE checked the incision and everything is healing well. I find it pretty funny I didn't think anything of it or flinch when he moved my underwear down to check the smaller incisions.
We talked about a timeframe and I am supposed to call the clinic on March 24th (4 weeks post D&C) and tell whether or not I have gotten a period. At first he talked about waiting 6-8 weeks after surgery to see if I got a period, but he changed his tune. If I haven't gotten my period in another 2 weeks he will put me on Provera to induce it. I am hoping it comes before then so that I won't have to use anything, but who knows. He first talked about Clomid alone and using OPK's to monitor, but as soon as I asked about IUI's, he was totally willing and said it wasn't a bad idea. Often times, Clomid changes your cervical mucus, so the IUI would bypass that problem.
I reminded him of the meds I have from our IVF cycle that never happened, and he then said that we could try two months of Clomid with IUI's and then move on to injectables if we don't get a great response. He reiterated that OHSS is not something I want and is very dangerous. Women with PCOS are very prone to it and that risk would be increased with injectables. I guess you can even get it with Clomid, but it is rare.
He then wrote me a script for Metformin. I don't have to green light to start taking it until he gets the insulin levels, and he doubted I would demonstrate insulin resistance. I also don't want to start taking it before going on vacation. I signed a waver about using the drug "off label" and will start when we get back. I am supposed to call the clinic when I get back to be sure.
The pro's of this visit/good news:
If I were to ovulate this month we can try and don't have to use birth control. I'm not really counting on it, but good to know.
The full pathology report from the tumor/cyst was fine. Although what I had was rare, it was completely benign.
Even with one tube it is possible to ovulate from the other ovary and get pregnant. Something about transmigration (he explained it and I understood, but I can't repeat it). My RE treated a woman who had one ovary on one side and one tube on the other and was able to get pregnant.
We will do an IUI the first cycle and don't have to just try Clomid. My insurance covers IUI's which is great. Also, we will do 2 IUI's per cycle.
We won't be looking at the same "game plan" as previously and could move on to injectables after 2 months of trying Clomid.
My RE is as confident as I have seen him about me getting pregnant. He seems to think we will be successful quickly, but never gives percentages or absolutes.
The cons/bad news:
I will be going on Metformin and am terrified of the side effects and how it will affect me.
More blood work: HCG repeat (until it is below 5), testosterone, and DHEAS levels.
IVF is still a possibility in the future.