much, much later

It’s been a long time. So many of you have moved on and have a baby (or even two!) now. I’m very happy for you, I truly am. But also feel stuck in the same place as almost two years ago.

Between moving to the other end of the world an the butt pain becoming too annoying to bear, we stopped trying for a while (as in, back on BCPs). And for a while I was fine with that. But eventually I asked for a referral to Big Teaching Hospital — the wait for talking to one of their endometriosis specialists was 2+ months, but worth it, I think. My doctor seems very experienced (or maybe it’s just that I accidentally found out that she has over 200 papers on the issue, that always helps in impressing a scientist ;) and I feel like she gives me a realistic understanding of what might work and what is less likely to.

The odd part is that, apart from my history, things look okay on my side. Follicles, check, lining, check, ovulation, check, clean uterine cavity, check. So the main data point we’re waiting for is the next SA — if it has significantly improved over the previous ones, we’ll try IUI, otherwise it’ll be IVF. Which is not only much more expensive, but also not covered by insurance in the slightest. We’re lucky in that we have insurance that would cover part of the IUI costs — but if that won’t work for us, it seems a bit like all-you-can-eat: sounds good at first, but perhaps not what you really need. I have no idea how we’d finance IVF, but that has time for later posts. I’ll try to slowly find my way back into this, and, admittedly, I’m not keen on trying to open that particular can of worms.

HSG vs. lap

As nothing has happened in a year, although I seem to be ovulating and the LPD is successfully corrected, my doctor suggested to

  • re-do the SA, as the period of rest before the last one was too short (they did it immediately at the appointment, which we hadn’t expected), and we don’t know if/how this affects the results — maybe my poor husband is worrying about his sperm quality for no good reason. And the guy doesn’t need more stress than he already has.
  • check whether my tubes are clear. And there are two ways to do that, HSG or laparoscopy. The advantages of HSG are that it’s less invasive, no stay in the clinic or general anesthetics needed. However, while it can show that the tubes are clear, it cannot show whether they work correctly, i.e., whether the cilia properly transport the egg towards the uterus* (and, I think, the sperm towards the egg, though that seems contradictory). To evaluate that one needs a lap. And, apparently, clear tubes without the proper movement are about as unhelpful in conceiving naturally or via IUI as blocked tubes. Therefore the doctor I saw in winter recommends a lap. My doc here was less convinced, and said that it depended on what we’d do with the results. A worst-case scenario for me could be that they find the tubes full of endo**, which would make passage almost impossible, or if an egg and sperm meet, it would likely lead to an ectopic, so that we’d need to do IVF for a reasonable chance at (a sustainable) pregnancy.

However, we’ll move next year. Out of the country if not the continent. So we weren’t planning to start any major treatments before that, but keep trying naturally and do tests to make sure conditions are good, we’re not overlooking something “obvious” such as blocked tubes. Based on this, I said we probably wouldn’t do IVF immediately, and then an HSG might be the better choice.

Until I (almost accidentally) read what IVF costs in my home country. About 4k. Insurances even pay 50% for the first 3 rounds, but alas, I don’t have insurance there. I still have to find a good source, but I think costs are similar here… and on the other hand, where we’re likely moving it’s around 10k+. So we could have 2.5 chances at home or here for the price of one chance there…

So, I’m back to considering the lap. Yet somehow, and despite desperately wanting a baby, I don’t feel ready to move to IVF. I’m not even sure why. I think in part I’m afraid of the investment, emotional and financial, with a rather high risk of having nothing to show for it. And if the first round doesn’t work, I’d likely have to stop for the move, although the doctors would just be getting to know me and my body’s reaction to the meds and thus maybe have better protocols for the 2nd round. Maybe I also want to give us a little more time to work this out naturally, but I do want to make sure that everything is in order, so the tubes and the sperm will certainly be checked after the summer. Unless I get pregnant before that… although to be honest, right now I don’t believe I will.

Does anyone have advice on HSG vs. lap, perhaps especially with a history of endo?

* Here’s a video showing lots of information you probably know anyway, but also some cilia movement. I saw someone show videos of functional (coordinated) and non-functional (random) cilia movement in a talk recently, but cannot find it online.
** I have no symptoms though. Yay for that!