Sunday, June 12, 2011

Dr. K and the new game plan

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.


  1. Hey there! So glad you feel good about your new doc and the new plan. I started taking metformin about a year ago and was very worried about the side effects we all hear so much about. I ended up not getting any of them! I did lose about 15 pounds and I think it has helped me ovulate more frequently... Overall no comcomplaints. Hope it does the trick for you! Best of luck!!

  2. If you're taking regular Metform and it gives you an upset stomach, ask to be switched to Metformin XR. It's the extended release version and I find I'm able to take 3 pills a day with the XR version without getting the runs :)

  3. It sounds like you guys have a good, solid plan! So glad you like your new doctor, that makes such a big difference. I am on Metformin, now, and I definitely suggest avoiding super sugary things when you first start taking it (including alcohol) because it will TEAR UP your stomach! Gradually increasing the dosage definitely helps. I take mine all at once before bed, which helps, too, since I sleep through a lot of those icky feelings. It's mainly just stomach upset, and you do get used to it over the first several weeks. Good luck!

  4. Having a plan that you are comfortable with is key :) Hoping this is it!

  5. Some women have no side effects and lose weight while others have nasty diarrea and do not lose an ounce. I am in the second category. Femara seemed fine to me except for headaches and an occasional hot flash. Just increase slowly and see how you feel.

    Good luck with your game plan!


  6. The best advice I received about Met was to take it inbetween your meals. Like literally eat half your dinner, take it and then finish. If you can't eat when you take it, a big glass of milk always seems to help. Unfortunately my stomach never fully adjusted to regular Met and I asked to be switched to the Extended release, which is a god-send. I've lost about 6 pounds in the 2 months I've been on it. We're currently just doing Met/Clomid combo - fingers crossed that the Met works for you!!!

  7. So exciting! This is too funny--our RE is with NWCRS, which just merged with Seattle Reproductive Medicine!!! Good luck to you! We are doing our frist IVF cycle in August and are anxious and excited.

  8. So glad to have found your blog! I also go to SRM! I live in eastern washington so I have to commute but it's worth it! I look forward to following your progress! Best of luck!