First RE Appointment

My first RE appointment was on Thursday. Her attitude is basically that I'm fertile until proven otherwise. At my age and with my CD3 lab numbers, she's anti-testing, anti-meds, anti-monitoring, and anti-trigger shot. Here are the details of the appointment, almost exactly as I posted them in response to someone else's post on the SMC Forum:

I had talked my OB into doing the CD3 bloodwork, which all came back great (FSH: 6.4, prolactin: 5.2, estradiol: <32, and my TSH is 2.5). I'm honestly not sure if the RE would have had me even do those tests had I not already had them done. She doesn't think I need to do ANY testing (other than CMV status and varicella immunity), and recommends I start with completely natural, unmedicated cycles, no monitoring, no trigger shot - nothing. She even recommends I go to a community clinic to have the IUIs done, since it's MUCH cheaper that way. There are several of these clinics in the Boston area where either an RN or a midwife does the IUIs, and as she put it, "There's no reason to have a board certified reproductive endocrinologist do your IUI. It's a very simple procedure that I could teach a med student to do in five minutes". It sounds a little harsh, but I honestly felt like she was trying to save me money. For her to do it, it would be $500-600 per IUI, and the clinics range from around $190-250. She said it's all about the timing, and as long as you get the timing right, it truly doesn't matter where you have it done or who does it. As for B2B IUIs... she said it's "tricky" (her word), that there's not a lot of good data for SMCs, that most data is with couples, so it's different. She said if money was no object, to do 2 because it can't hurt, but that she tells people to just do one per cycle. (That said, I'm still considering doing B2Bs if the place I go to will do it!). She also said trials show there's no benefit to trigger shots, especially if you're able to determine when you're surging/ovulating with charting and confirming it with OPKs.

Now, back to testing... I asked about doing an antral follicle count, and she said that with my numbers, there's no reason to do it, that it would basically tell me the same thing that I already know from the bloodwork - I'm still fertile. She asked me, if I were to find the man of my dreams and start trying to conceive, would I have an antral follicle count? No. So that's why, at my age, and with what we already know from my bloodwork, it's not necessary. She also said, after asking me some questions to determine any risk factors, that she doesn't recommend an HSG at this point, either. She said if 3 natural-cycle, unmedicated IUIs don't work, to meet with her again to discuss possibly trying Clomid.

I was starting to feel slightly not-so-good about some of the stuff the RE was saying, but as she explained/rationalized it, "Sperm is expensive, testing and monitoring is expensive, and raising a child by yourself is expensive". She basically said, save your money and put it towards other things in the future. I had explained I'd been researching and reading everything I could find about this stuff, and she cautioned me that sometimes it can be too much and you think you need things you don't. She described herself as a "minimalist, at least to start" in terms of testing, monitoring, drugs, etc. She just simply doesn't think I need any of that without PROOF that maybe I do. I'm 36 (37 in January), my numbers look great, so she said this is a good time to do this, that many women (SMCs-to-be) come to her at 42, and then sometimes it's more complicated. I've often heard on the SMC Forum that many REs tend to treat SMCs as if they have infertility issues since most of their clients do, but this particular RE seems to get it that I'm fertile until proven otherwise. And I think I'm happy about that!

I think with "younger" SMCs-to-be, maybe we really DON'T need as much testing and monitoring, etc., but we THINK we do because of all we've read and heard! So, I'm trying to stay positive - thinking that if my RE thinks this should be a piece of cake, I should think so, too! Not that I expect to get pregnant and have it stick on the first try - one of the reasons I'm considering moving my start-date up (from January to December, and now maybe to November!) is that I know the chances of it working right away are very slim. And maybe "piece of cake" isn't exactly the right way to put it - but I think we should at least give our bodies a chance to get pregnant without much - or even any - interventions, before stepping it up. There are lots of steps, so we DO have somewhere to go and something to try if we need to, we just may not need to!

Am I being TOO positive? I don't know. I've heard so many infertility horror stories (i.e. "They told me I'd have no problem getting pregnant, and look at me now, doing IVF with donor egg/donor sperm 3 years later!") that I don't know WHAT to think anymore! But I'm going to move ahead thinking positively that maybe, just maybe, I'll be one of the lucky ones and not have trouble getting pregnant in the usual 3-6 months... Here's to positive thinking!!!