I was nervous all night, dreaming up bad images of today’s appointment. What if the doctor told me I had some weird, rare chromosomal problem? Or if he didn’t think we could start IVF when I want to? I just don’t want anything to delay this, and I don’t want any more bad news.

I walked in feeling a little flustered, with my list of questions on my clipboard and that article about oocyte maturity and an extended period between trigger and retrieval. I was as prepared as I could be, given the circumstance.

At first I let the doctor tell me about the lab results: everything was normal. Every single damn test we’ve ever run has been normal (and trust me, there have been a lot of tests throughout the infertility and then after the loss). I have no choromosomal abnormality, I have no blood clotting issues. And all of the other myriad things they tested also came back normal. I just nodded – relieved, but it was also what I had expected. I guess once I got there I didn’t really expect anything to be wrong… I must have gotten all the fretting out at night. I really don’t think they’re going to find some sort of smoking gun for my egg maturity issue, not with the tests that they currently run.

When we started talking protocol and what to do next time, that was my cue to pull out the article. I handed it over and said it was something that looked very promising. The doctor looked a little caught off-guard. He said, “It’s not often that I have a patient giving me an article to read.” But he didn’t look offended at all, just surprized that I did that much research. He read the article summary and flipped through the data and said it looks very promising – certainly something to try. We talked briefly about the risk of early ovulation, but we both agree that the risk seems small at 38 hours. He said when they first started doing IVF they experiemented with different time frames… 34, 36, 38. They settled on 36 hours as being having the most success with the lowest risk for the average patient. He said that maybe they need to change it for people like me, who do not fall into that average patient category. (So if this works I could be setting a whole new precident for people with my issue!)

He looked over my protocol for the last two cycles and said that it looked like the first one was a bit too high on stims, but the second cycle – the one I got pregnant on – looked good. I had a good response, and it worked. So he wants to do that same protocol with those same levels again – but with the 38 hour interval between trigger and retreival, in the hopes that matures more of my eggs. He mentioned that another option would be doing an antagonist protocol instead of the lupron (agonist), but he seemed satisfied with my response last cycle.

I mentioned starting BCP in November and his comment was, “Do you need BCP?” He said usually the pill is used for women who don’t ovulate regularly… I do, so I don’t really need it. I shrugged at the time, but after thinking about it I think I want to do the BCP again for two reasons: one, because it’s what we did last time it worked (and I’m loathe to change too much in the fear of totally screwing it up), and two because my cycles have been longer… and delaying the december cycle by a week could very well mean a transfer on Christmas day. Umm, I’d rather avoid that. So I think I’ll request to do BCP again, and I don’t foresee an issue with that – he made it sound like it’s up to me.

In order to get insurance pre-approval for IVF I’ll need a sonohistogram after the loss (to make sure there’s nothing left in there that could impede IVF) and my Day 3 bloods. Since I’m on CD4 today I had the bloodwork done today so that’s out of the way. The sonohistogram will have to wait until next cycle, since I’ll be away next week when it would be done. So next month I’ll call with CD1 and schedule that. The nurse said that “most women say it’s not as bad as an HSG,” that there’s not the same pressure – but it’s the same catheter. I twitched at that. The pressure didn’t bother me… it was the goddamn catheter that killed me. Oh well, hoping for a better experience this time?

And once that’s done it’s a case of waiting for insurance to kick in (Nov 16, remember) and we’ll be doing stims and retrieval/transfer in December! 2 months left to wait!