Our first appointment with Seattle Reproductive Medicine went great! I am very happy that they were open on a Saturday, that made if very convenient.
The nurse took my vitals and pictures of J and I, she was very friendly. Afterward, Dr. K brought us back to her office. It was the first time we'd discussed our game plan, and the state of my lady-bits, over a desk and not while I'm up on an exam table.
She asked about our history and what we'd be through with our other doctor (Doc Oc). She explained the typical protocol for a new patient, how PCOS works and how the different treatment options could affect me/our chances of conception, and what she typically recommends.
Dr. K says that there are two basic plans, IUI or IVF. Since I am young and assumably have a good ovarian reserve (plenty of eggs left) and J has excellent little swimmers, she thinks we'd have great success with IUI. Secondly she talked about the drugs that could help me ovulate more regularly since that is obviously our largest obstacle. Since I'd previously seen more success with Femara (vs my non-response to Clomid), we're going to start with that.
I will go in for a baseline ultrasound once my next period starts. Based on the looks of things (so long as there isn't any problems like a large cyst, etc) we are going to do the max dose of Femara (3 tablets) on days 3 through 7 (slightly more aggressive than days 5-9). Potentially even days 3-9 for a better response.
In addition to the Femara, I got a prescription for Metformin. I start taking that immediately so that when we get going next cycle I will be ramped up to the full dose (you gradually increase the dose to minimize side effects). This is my first time on Met and hopefully the combination of these two drugs will be what I need! Metformin works by helping to regulate my blood sugar. A fringe benefit may be that with that help, and my continued focus on eating right and exercising, it could help me with weight loss. Won't get any complaints from me!
She also talked to us a bit about injections: HCG & FSH. Dr. K did not recommend the FSH injections for someone with PCOS. Because PCOS causes a lot of follicles to develop (vs. a normal woman who has 2 or 3) the FSH could result in a lot of those follicles maturing and vastly increase the rate of a multiples pregnancy. The HCG trigger may be the direction we go. We'll see!
Afterward we established our game plan she collected some information about us (are we allergic to anything? taking meds? how often we have intercourse? Do we do drugs or drink? etc). The only medicine I am taking is a Vitamin D supplement, because like every single person in Western Washington - I lack the necessary environment (AKA the sun) to produce enough of that on my own. She asked J if he has had his tested and he hasn't. We learned something else new - according to a new study Dr. K has read, apparently a deficiency in Vitamin D can impact the strength of the sperm and their ability to fertilize an egg. Go figure! We'll see what J's results look like and go from there.
That's the plan! We really like our new doctor, we're very comfortable with the current game plan, and actually a little excited for my next cycle so that we can get started!
If you have experience with Metformin (and I know some of you do!) or even the Femara/Metformin combination, I would love to hear about it.