I got some fabulous advice from ladies on this board earlier this week concerning my upcoming RE appt (and how to handle my high fsh)--may I ask for some more? My RE appt is in a week and to maximize every minute of it, I am wondering if I should be going there with some idea of what I want to do protocol-wise. I'm totally willing to listen to him and see what he throws out there, but I just don't know what to expect. I know I will get the DE speech, and that's fine because I have already been thinking about it but DH isn't on board with it yet so that's on the back burner for now. I know he will give me the doom and gloom speech--at least to some degree--probably depending on my current fsh state. And that's okay too. I don't think I want to go the IVF route, just haven't seen enough success for those over 45 to make it my first choice. I'm thinking more along the lines of what Pat did to conceive Spencer...good ol' fashioned drugs with good ol' fashioned BDing! LOL Any thoughts? Remember...I am 46...no time to waste, and DH has finally agreed to see a doctor after a year of wanting to try naturally only so I need to "seize the moment." So, if you all agree that this (injectibles with timed BD) is the best thing for me, then do I need to also suggest the actual drug I want to take? What determines the drug protocol they prescribe? You all mention different drug combos in varying levels...how do I know what will work for me? Obviously there's some trial and error at play, but I'm REALLY feeling my clock winding down and I just don't have months and months to play around with different drugs.

Any thoughts, suggestions, advice, comments, opinions???

Thanks whole bunches, guys! Just feeling really nervous about this appt next week.

Hugs,
Carol

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http://www2.fertilityfriend.com/home/9d98a

I would want to ensure that the clinic does some initial testing BUT that they are efficient and do not spend precious months doing test after test before they start cycling you. I am not sure IF you and your DH have had any testing but it is good to know up front if there are any impediments to a pregnancy and address those quickly rather than wasting months and money doing things which are not going to work. So... basic tests which can be run during one cycle are: All blood tests for hormone levels and antibodies, thyroid, prolactin ettc. Your DH should have an SA which checks for count, morphology and motility. A sonohystogram would be beneficial to check for open tubes and any possible fibroids etc. These could all be done within the same cycle. Then... I would suggest to skip the clomid and go to injectibles with monitoring. Do NOT do a long protocol where you are suppressed but do short protocols which are done within the same cycle and try and stay away from suppressants. As for what drug will work for you that is really trial and error. The injectibles all contain FSH but some of the drugs get their FSH from human sources (FSH extracted from the urine of post menopausal women) and others are recombinant FSH (Gonal-F for example). So those are the two classes of drugs.... there are also within each of those classes some drugs also include LH in the mix... so FSH/LH combination. So you will have to find out what type works best for you. It is important if you are doing timed bd to ensure you have a trigger shot and then bd the day of the shot and the next day. Your doctor will likely encourage you to do an IVF cycle and honestly, this may not be a bad idea as if nothing else, it will give you some good information about your egg quality and the fertilizability of your eggs.

Best of luck!!! Pat

Pat - AKA - Satie37

I have a quick question about the injectables you mention in response to Carol's email. Do injectables increase the risk for twins, like clomid pills? What are the pros/cons of using them?

Thanks! Lauri

each cycle and usually result in multiple eggs being released. When you have more than one egg being released it increases your chance of pregnancy.... like getting multiple cycles in one! So.... obviously increases the likelihood of a pregnancy AND reduces the length of time it takes to get pregnant. On injectibles you may release 12 eggs in a four month time frame whereas it would normally take a whole year to release the same number of eggs on natural cycles. Often injectibles will improve your hormone levels too and these supporting hormone levels are also required to sustain a pregnancy. Also with injectibles the amount of drug you are getting can be adjusted as the injectibles put FSH directly into your system rather than relying on your body's ability to produce FSH (as is the case with clomid/letrozole/femara/tamoxifen). When you are spending $ on injectibles doctors are also more inclined to monitor you closely and also provide you with supporting drugs such as trigger shots to time bd or IUI and also progesterone supplements IF you need them. This is an indirect benefit of injectibles. So those are the positives of injectibles.

As for your question on multiples.... if we were in our 20's or 30's with great egg quality then my answer would be YES that injectibles increase the chances of twins... however... that is not the case with women in their 40's... we are searching for at least ONE good egg and it is often a difficult hunt so it is unlikely that you need to be worried about multiples.

The downside of injectibles.... they are expensive (about $75/vial... I was using 4 vials/day) and unless you have insurance coverage you may run out of money quickly doing them. There are some ways of reducing the cost such as combining Letrozole with injectibles to reduce the amount of injectibles you need. Of course there is the whole routine of having to stick yourself with a needle every night and you may find that you put on a few pound with injectibles. However.... I did find that I had GREAT libido when on injectibles and I guess I should put that up on the PRO list rather than down here! LOL!

Hope that answers your questions....
~ Pat

Pat - AKA - Satie37

Get some base line testing and then procede to medicated cycles. There is also no reason you couldn't start an IVF cycle and see how you respond. If there are not enough follicles you could switch to IUI and not miss out on a cycle. As for DE seems like it is tough to get "everyone" on board at the same time. If "I" was ready my DH would like to move on to DE tomorrow. But I still need to try a few more attempts with my own eggs. I may not have many . . . but at least that is better than zero.
Jacquita 44 ttc #1