Monday, June 20, 2011

Whatta to do???

So many decisions in an infertile's life!


I just got back from the doctor and am pretty disappointed... hmmm... make that bawling uncontrollably while feeling like I have no idea what to do or where to turn.  My CD2 baseline ultrasound revealed my very PCOS ovaries remain after only 2 weeks of Metformin.  I know this is to be expected as it takes time for Metformin to work its magic, but it is still a blow.  The main blow is the advice I got after this was found:  To take three months off TTC in order to quiet my ovaries with Metformin & birth control pills.


This is such a blow to me as I was so mentally prepared to go all out this month - Clomid, injections, IUI.  And now, I have to wait again?  My fertility nurse is very supportive and stressed the entire time that she is giving me options and that I am in the driver's seat.  She was wording things so carefully as to not influence me, but basically, it seems that I would have a better shot at successful IUI after my ovaries were quieted for a few months.


Still, then I begin thinking of the fact that this is prime time for TTC as a teacher as it results in perfect due dates and a better window in which to manage the stress and appointments.  In the same way, I now find out that it is prime time per our insurance as I have met my deductible and they will cover everything 100%.  Well, everything may be an overstatement as I am always unsure of what exactly they cover as their policy is to cover diagnostics, but not treatment.  I assumed that once I was diagnosed as PCOS, the coverage would stop, but they covered all three ultrasounds last month, all blood tests, and all meds except for Clomid.  I know that we will have to fork over some money and am completely realistic about this, but if I wait until after my deductible resets, we will pay for everything!!!


My main question is has anyone with PCOS taken time off to quiet their ovaries?  or have you not and gone ahead with treatments?  With a well-monitored cycle that watches out for hyperstim, are there risks of going ahead with treatment?  I can choose to do anything I'd like at this point, but here are the main options.  Please weigh in if you can!  I am in desperate need of advice!




Option 1:  Take time off TTC by quieting the ovaries for 3 months with Metformin and Birth Control pills                                                    


  • PROS - medically speaking, the chance of conception will be higher                                                                     
  • CONS - this is the best TTC time for me when dealing with infertility as I'm a teacher and off for the summer, makes appointments and stress more manageable     
  • adds 3 months to our already long wait
  • this is the best time to TTC being a teacher as due dat would be April, May, or June           
  • I have met my deductible and it would seem (surprisingly) that my insurance covered 100% of last month's ultrasounds and appointment.  Thus, taking time off might not make sense financially as I can get it covered, but only for the next 3 months until the new year kicks in September 1st                                                                                                                                                                                                 


Option 2:  Take one month off by quieting ovaries for 1 month with Metformin & birth control pills                                                                 


  • PROS - might help medically     
  • will be able to do one cycle with full insurance coverage before new plan year begins  Sept 1st                                        
  • CONS - adds one month to time table
  • best time to TTC with due date 
  •  will only be able to do one cycle with full insurance coverage before new plan year begins (chances of IUI working first cycle, not great)                                                                                                                                                                      




Option 3:  Just continue on this month with Clomid, injections, IUI                                                                                                                  


  • PROS - best timing for TTC  - emotionally, financially, due dates, etc.   
  • will get in two IUI cycles with insurance coverage before new plan year begins
  • mentally prepared to jump into this now 
  • CONS - chances aren't as great medically without quieted ovaries, ovaries more likely to respond well after more Metformin & birth control                                                                                                                                           




As always, thanks for your support!

18 comments:

H said...

I totally understand about the timing issue and deductible. I am a teacher too and the best time for infertility treatments are in the summer time.

I personally have not heard of taking time off to "quiet" the ovaries. I have heard of doctors recommending just taking Metformin for a couple months, but never with birth control pills too.

Good luck with your decision...I would probably go ahead and at least try treatments now because I am an impatient person and timing is important to me :-) But best of luck! Do what's best for you!

mommie-to-be said...

My Ob/gyn suspects pcos for me, but my treatment has been a bit different from yours. I have taken bcps and Met as well, but not at the same time. I recently completed a 3-month regimen of bcps to help regulate my cycle and "jump start" my ovaries, and I just started taking Met a few days ago. Doc prescribed me 3-months worth and said that if I am not pregnant by the time I go back in Sept., we will then be pairing Clomid with the Met. I am taking Met in the hopes of successfully conceiving. Doc said it should hopefully regulate my cycle and restore ovulation. I personally have never heard of Met being used to "quiet the ovaries". My doc never mentioned anything about that, as it is my understanding that Met is a med used to aid in conception.

As far as what to do, all I can say is follow your heart and do whatever you feel most comfortable with (I know that is easier said, especially when there are so many variables involved). If you would like to follow me back please do, It sounds like we are in a similar struggle. Best of luck with whatever you decide.

C said...

That's a big decision. I don't have PCOS, or insurance coverage, but given your situation, I think I'd take a break and quiet your ovaries. Personally I think I'd always wonder if I could have done something differently, if I did cycle right away, and it didn't work.

Good luck with whatever you decide to do.

Visiting from ICLW!

Sarah S said...

hmmm....tough choice.

When DH and I had to make hard decisions one of our biggest decision factors was always, if this doesn't work out are we going to blame and question ourselves??

Personally I think i would go for option number 2, it ends up being the best of both worlds.

Happy ICLW #96

Heather @ A Little Hope in My Pocket said...

I think I'd go for option #2. Good luck with whatever you decide!!!

Visiting from ICLW :)

My Infertile Confessions said...

Waiting REALLY sucks! But I know with pcos it might be good to "quiet" them so you don't produce too many follicles and end up the next sextuplet mom. I would ovulate like 5-6 eggs sometimes when we were doing IUI.

Good luck to you!

Lucy said...

Waiting sucks. I wasn't insulin resistant, so my RE didn't want me taking Metformin. She never mentioned it to help quiet my ovaries. In fact, I was canceled three times due to overstimulation in our inject/IUI cycles (never responded to Clomid), and I specifically asked if I needed to take a cycle off, if that would help--she said no. She had me on the low and slow protocol. In the end, we went on to IVF, but our insurance covers IVF, so that was an easy decision for us to make. It's not easy to wait when each cycle feels like a lifetime. Before we were TTC, I did try Metformin with a different RE for 6 months, but I never got AF, so he said he wasn't helping anyway. Sorry I can't be of more help. My detailed cycle history is on my blog, but fair warning, we're parenting now, so my blog is about our son just about all of the time.

Kristin said...

I didn't go through PCOS but I know a number of people who have been treated for that. Taking time off to quiet your ovaries (or more specifically, get rid of the cysts) is fairly common. I think that if I were in your shoes, I would proceed with this cycle and keep my fingers crossed. If this cycle doesn't work, I would then plan on the 3 months off to quiet the ovaries.

Wishing you the best of luck.

ICLW #10

Jackie said...

Ugh what a decision! You're the only one who knows what what is best for you - it sounds cliche, but go with your instincts.
I just had to cancel my 2nd iui cycle in a row for personal reasons, so I can relate to the emotional toil it takes and the pro/con weighing. Being on hold, even for a month, seems SO long. And especially when you're trying to work around another schedule (teaching, insurance plans, etc), it just seems like the pressure is on. Good luck, in whatever choice you make. There isn't a wrong choice.
Happy ICLW!

Ashlee G. said...

I'm also a teacher so I understand the timing issue. Now is just the best time.

I also have PCOS and havne't heard of quieting the ovaries.

But what if you continued TTC this summer and then took off a few months at the beginning of the school year if quieting them could really help?

Best of luck in whatever you choose- and enjoy your summer!

ICLW #45

embracingtherain said...

Hello from ICLW. I hope you are starting to feel a little better. The waiting in this journey is so hard. I am a teacher as well and can definitely relate to the timing issue. I don't have much advice other than to go with the option you feel most at peace with and think you will be the least likely to result in you looking back and wishing you had made a different choice. Good luck!

Pix said...

Hello from ICLW. Sorry, I have no answers for you. But the advice that always seems to work for me is to go with your gut. Sometimes it's hard to hear what your gut is saying, but spend some time listening. Don't let all the perfect timing and other issues that you can't control get in the way. Best wishes.

Pix--
Cheese Curds and Kimchi

zygotta said...

Stopping from ICLW

I have PCOS, but we went right ahead with Fe.mara. The first cycle they were having trouble distinguishing all the garbage in my ovaries from the growing follies, and we didn't get pregnant.

By CD 2 on cycle 2, there were no cysts left. And we got our BFP.

Good luck, whatever you end up doing!

waiting and wishing said...

I was diagnosed with PCOS in September when we started seeing our RE. I started metformin and began treatment cycles as soon as we could. The metformin will take a little time to show results, but my doctor never suggested resting my ovaries prior to treatment until be decided to move on to IVF. Good luck with your decision!

bean dreams said...

Thanks to everyone for all your advice! It is so nice to have a supportive network here. I'll be catching up with all your blogs soon! Thanks again!

katery said...

i totally understand how you feel, before i had my daughter we had to take time off so i could have a laparoscopy to clean up enod and afer that i had to be on medication for three months to get it under control with no ttc, i thought i would die i was so devastated. in the end, it paid off, i got pregnant on my second iui post-surgery. i hope you are able to find some peace, whatever decision you make, good luck to you :)

mag said...

Hi there - just chiming in with my two cents here. I think I would just go for it with TTC this summer because the timing is good and you feel so positive and encouraged for that right now. I've never heard of going back on BCP to calm your ovaries. Medically I guess it makes sense, but I'm just so convinced that BCP can calm your ovaries TOO much. With PCOS, I was always told that BCP could put your ovaries in a dormant stage, and I would be too nervous that it would stay too calm much longer than you'd want.

Who knows! I'm no doctor :) But my vote is probably #3.

Visiting from ICLW, #80. Looking forward to following you along in your journey.

modernmedicinemiracle said...

Chiming in with my two cents here(from ICLW).
I'm a PCOSer that was completely anovulatory before metformin. Every month that I was on met, I had a better response to the clomid. The first cycle, I still had swiss cheese ovaries. Second cycles, the swiss cheese was not so much. By the time I'd been on the met for 3.5 months, my ovaries had settled down a lot. I was actually able to come off the metformin and my ovaries are doing pretty good. I'd be wary of doing clomid + injects this cycle with your ovaries not quieted, you could end up with some massive cysts. What about trying just clomid? I'd probably keep trying, simply because at this point I'm really bad at voluntarily waiting, and if you don't get a BFP by september try a few months of BCP or lupron to suppress your ovaries and then try again.
Good luck with your decision!

Monday, June 20, 2011

Whatta to do???

So many decisions in an infertile's life!


I just got back from the doctor and am pretty disappointed... hmmm... make that bawling uncontrollably while feeling like I have no idea what to do or where to turn.  My CD2 baseline ultrasound revealed my very PCOS ovaries remain after only 2 weeks of Metformin.  I know this is to be expected as it takes time for Metformin to work its magic, but it is still a blow.  The main blow is the advice I got after this was found:  To take three months off TTC in order to quiet my ovaries with Metformin & birth control pills.


This is such a blow to me as I was so mentally prepared to go all out this month - Clomid, injections, IUI.  And now, I have to wait again?  My fertility nurse is very supportive and stressed the entire time that she is giving me options and that I am in the driver's seat.  She was wording things so carefully as to not influence me, but basically, it seems that I would have a better shot at successful IUI after my ovaries were quieted for a few months.


Still, then I begin thinking of the fact that this is prime time for TTC as a teacher as it results in perfect due dates and a better window in which to manage the stress and appointments.  In the same way, I now find out that it is prime time per our insurance as I have met my deductible and they will cover everything 100%.  Well, everything may be an overstatement as I am always unsure of what exactly they cover as their policy is to cover diagnostics, but not treatment.  I assumed that once I was diagnosed as PCOS, the coverage would stop, but they covered all three ultrasounds last month, all blood tests, and all meds except for Clomid.  I know that we will have to fork over some money and am completely realistic about this, but if I wait until after my deductible resets, we will pay for everything!!!


My main question is has anyone with PCOS taken time off to quiet their ovaries?  or have you not and gone ahead with treatments?  With a well-monitored cycle that watches out for hyperstim, are there risks of going ahead with treatment?  I can choose to do anything I'd like at this point, but here are the main options.  Please weigh in if you can!  I am in desperate need of advice!




Option 1:  Take time off TTC by quieting the ovaries for 3 months with Metformin and Birth Control pills                                                    


  • PROS - medically speaking, the chance of conception will be higher                                                                     
  • CONS - this is the best TTC time for me when dealing with infertility as I'm a teacher and off for the summer, makes appointments and stress more manageable     
  • adds 3 months to our already long wait
  • this is the best time to TTC being a teacher as due dat would be April, May, or June           
  • I have met my deductible and it would seem (surprisingly) that my insurance covered 100% of last month's ultrasounds and appointment.  Thus, taking time off might not make sense financially as I can get it covered, but only for the next 3 months until the new year kicks in September 1st                                                                                                                                                                                                 


Option 2:  Take one month off by quieting ovaries for 1 month with Metformin & birth control pills                                                                 


  • PROS - might help medically     
  • will be able to do one cycle with full insurance coverage before new plan year begins  Sept 1st                                        
  • CONS - adds one month to time table
  • best time to TTC with due date 
  •  will only be able to do one cycle with full insurance coverage before new plan year begins (chances of IUI working first cycle, not great)                                                                                                                                                                      




Option 3:  Just continue on this month with Clomid, injections, IUI                                                                                                                  


  • PROS - best timing for TTC  - emotionally, financially, due dates, etc.   
  • will get in two IUI cycles with insurance coverage before new plan year begins
  • mentally prepared to jump into this now 
  • CONS - chances aren't as great medically without quieted ovaries, ovaries more likely to respond well after more Metformin & birth control                                                                                                                                           




As always, thanks for your support!

18 comments:

H said...

I totally understand about the timing issue and deductible. I am a teacher too and the best time for infertility treatments are in the summer time.

I personally have not heard of taking time off to "quiet" the ovaries. I have heard of doctors recommending just taking Metformin for a couple months, but never with birth control pills too.

Good luck with your decision...I would probably go ahead and at least try treatments now because I am an impatient person and timing is important to me :-) But best of luck! Do what's best for you!

mommie-to-be said...

My Ob/gyn suspects pcos for me, but my treatment has been a bit different from yours. I have taken bcps and Met as well, but not at the same time. I recently completed a 3-month regimen of bcps to help regulate my cycle and "jump start" my ovaries, and I just started taking Met a few days ago. Doc prescribed me 3-months worth and said that if I am not pregnant by the time I go back in Sept., we will then be pairing Clomid with the Met. I am taking Met in the hopes of successfully conceiving. Doc said it should hopefully regulate my cycle and restore ovulation. I personally have never heard of Met being used to "quiet the ovaries". My doc never mentioned anything about that, as it is my understanding that Met is a med used to aid in conception.

As far as what to do, all I can say is follow your heart and do whatever you feel most comfortable with (I know that is easier said, especially when there are so many variables involved). If you would like to follow me back please do, It sounds like we are in a similar struggle. Best of luck with whatever you decide.

C said...

That's a big decision. I don't have PCOS, or insurance coverage, but given your situation, I think I'd take a break and quiet your ovaries. Personally I think I'd always wonder if I could have done something differently, if I did cycle right away, and it didn't work.

Good luck with whatever you decide to do.

Visiting from ICLW!

Sarah S said...

hmmm....tough choice.

When DH and I had to make hard decisions one of our biggest decision factors was always, if this doesn't work out are we going to blame and question ourselves??

Personally I think i would go for option number 2, it ends up being the best of both worlds.

Happy ICLW #96

Heather @ A Little Hope in My Pocket said...

I think I'd go for option #2. Good luck with whatever you decide!!!

Visiting from ICLW :)

My Infertile Confessions said...

Waiting REALLY sucks! But I know with pcos it might be good to "quiet" them so you don't produce too many follicles and end up the next sextuplet mom. I would ovulate like 5-6 eggs sometimes when we were doing IUI.

Good luck to you!

Lucy said...

Waiting sucks. I wasn't insulin resistant, so my RE didn't want me taking Metformin. She never mentioned it to help quiet my ovaries. In fact, I was canceled three times due to overstimulation in our inject/IUI cycles (never responded to Clomid), and I specifically asked if I needed to take a cycle off, if that would help--she said no. She had me on the low and slow protocol. In the end, we went on to IVF, but our insurance covers IVF, so that was an easy decision for us to make. It's not easy to wait when each cycle feels like a lifetime. Before we were TTC, I did try Metformin with a different RE for 6 months, but I never got AF, so he said he wasn't helping anyway. Sorry I can't be of more help. My detailed cycle history is on my blog, but fair warning, we're parenting now, so my blog is about our son just about all of the time.

Kristin said...

I didn't go through PCOS but I know a number of people who have been treated for that. Taking time off to quiet your ovaries (or more specifically, get rid of the cysts) is fairly common. I think that if I were in your shoes, I would proceed with this cycle and keep my fingers crossed. If this cycle doesn't work, I would then plan on the 3 months off to quiet the ovaries.

Wishing you the best of luck.

ICLW #10

Jackie said...

Ugh what a decision! You're the only one who knows what what is best for you - it sounds cliche, but go with your instincts.
I just had to cancel my 2nd iui cycle in a row for personal reasons, so I can relate to the emotional toil it takes and the pro/con weighing. Being on hold, even for a month, seems SO long. And especially when you're trying to work around another schedule (teaching, insurance plans, etc), it just seems like the pressure is on. Good luck, in whatever choice you make. There isn't a wrong choice.
Happy ICLW!

Ashlee G. said...

I'm also a teacher so I understand the timing issue. Now is just the best time.

I also have PCOS and havne't heard of quieting the ovaries.

But what if you continued TTC this summer and then took off a few months at the beginning of the school year if quieting them could really help?

Best of luck in whatever you choose- and enjoy your summer!

ICLW #45

embracingtherain said...

Hello from ICLW. I hope you are starting to feel a little better. The waiting in this journey is so hard. I am a teacher as well and can definitely relate to the timing issue. I don't have much advice other than to go with the option you feel most at peace with and think you will be the least likely to result in you looking back and wishing you had made a different choice. Good luck!

Pix said...

Hello from ICLW. Sorry, I have no answers for you. But the advice that always seems to work for me is to go with your gut. Sometimes it's hard to hear what your gut is saying, but spend some time listening. Don't let all the perfect timing and other issues that you can't control get in the way. Best wishes.

Pix--
Cheese Curds and Kimchi

zygotta said...

Stopping from ICLW

I have PCOS, but we went right ahead with Fe.mara. The first cycle they were having trouble distinguishing all the garbage in my ovaries from the growing follies, and we didn't get pregnant.

By CD 2 on cycle 2, there were no cysts left. And we got our BFP.

Good luck, whatever you end up doing!

waiting and wishing said...

I was diagnosed with PCOS in September when we started seeing our RE. I started metformin and began treatment cycles as soon as we could. The metformin will take a little time to show results, but my doctor never suggested resting my ovaries prior to treatment until be decided to move on to IVF. Good luck with your decision!

bean dreams said...

Thanks to everyone for all your advice! It is so nice to have a supportive network here. I'll be catching up with all your blogs soon! Thanks again!

katery said...

i totally understand how you feel, before i had my daughter we had to take time off so i could have a laparoscopy to clean up enod and afer that i had to be on medication for three months to get it under control with no ttc, i thought i would die i was so devastated. in the end, it paid off, i got pregnant on my second iui post-surgery. i hope you are able to find some peace, whatever decision you make, good luck to you :)

mag said...

Hi there - just chiming in with my two cents here. I think I would just go for it with TTC this summer because the timing is good and you feel so positive and encouraged for that right now. I've never heard of going back on BCP to calm your ovaries. Medically I guess it makes sense, but I'm just so convinced that BCP can calm your ovaries TOO much. With PCOS, I was always told that BCP could put your ovaries in a dormant stage, and I would be too nervous that it would stay too calm much longer than you'd want.

Who knows! I'm no doctor :) But my vote is probably #3.

Visiting from ICLW, #80. Looking forward to following you along in your journey.

modernmedicinemiracle said...

Chiming in with my two cents here(from ICLW).
I'm a PCOSer that was completely anovulatory before metformin. Every month that I was on met, I had a better response to the clomid. The first cycle, I still had swiss cheese ovaries. Second cycles, the swiss cheese was not so much. By the time I'd been on the met for 3.5 months, my ovaries had settled down a lot. I was actually able to come off the metformin and my ovaries are doing pretty good. I'd be wary of doing clomid + injects this cycle with your ovaries not quieted, you could end up with some massive cysts. What about trying just clomid? I'd probably keep trying, simply because at this point I'm really bad at voluntarily waiting, and if you don't get a BFP by september try a few months of BCP or lupron to suppress your ovaries and then try again.
Good luck with your decision!