Met with RE! I have two options: Lap and THEN injectables, or straight to injectables? I need your advice!

So I was really happy with my appointment today with my doctor.  He was a lot more informative this time.  I think I understand why he put me straight on the clomid and trigger without checking more than the HSG.  Basically it was a very inexpensive way to see if I would get pregnant with just that and if not, onto more tests and more meds, etc.  

My first question for my RE was if I was acutally ovulating.  He said he absolutely thinks I am ovulating because I have a period every 28 days.  I also produced good sized follicles for three months in a row and then had a period after those were there and they were gone following month.  He is not concerned with that at all.  He said there is no way to tell if I am releasing an egg, or a good quality egg....there is no way to tell that.  All we can do is hope the medication is doing the job of producing better quality eggs and they are releasing when they are of good quality.  Sooooo....this is where we stand.  He gave me the option to do a lap with injectables after we make sure all is well with the lap.....or straight to injectables.  He knows we do not have any insurance coverage on fertility treatments, so he said he prefer I go for the lap so we can be sure all is well,  but once I told him our Rx plan covers the meds, he said he wouldn't mind me going straight for the injectables without the lap.  So I am just trying to decide what I should do.  I am leaning towards the lap...just so I can make sure all is well.  I think I would feel better about going into the expensive meds and another IUI KNOWING for sure that I am ok on the inside.

Can someone give me their personal opinion?  I know this is 100% my decision, but you all have had experience and I just want to get your opinions.  

Thank you in advance....

Heather

[dnikki0928]

I recommend going for the lap first - that way you know then all is well and it can put your mind at ease.... If it were me, and I didn't have the lap and was still getting BFN's, then I would be kicking myself wondering if there was something else wrong.... ya know? Good luck to you and I hope all goes well for you :)

Hugs :)

[mommyof3andhopefully4]

dnikki- Thanks....

For all of you that have had one.....how is it?

[scienceteacher79]

Do you have endo or any reason why you would need a lap? If you have a history i would say go with the lap first. If you don't have a history of endo, I would try 1-3 months of injectibles first. I got preggo the first month I used clomid (did that for 5 months with no luck by itself), menopur shots, and trigger - I also had 2 u/s's before O to see the eggs  progress. I was followed pretty well. 7 dpo progesterone, estradoil levels before O ( with each u/s). So, I would recommend the injectibles first, try it for a few cycles and then lap if nothign happens, that is - if you have no history of blocked tubes or endo. Good luck!

Jen

[mommyof3andhopefully4]

No history of endo.  My sister (half sister) had a partial hysterectomy at age 21 and then four years ago had the rest taken due to endo.  I have four 1/2 sisters and she is the only one with issues in my family.  Like I said, I have none.

He is going to put me on follitism.  He said it was the easiest to use because you dial it.  I have heard that before from you all also.

Thoughts?

[Helen72]

I would do the lap first. It's better to eliminate all possible causes of infertility before you move to more invasive treatments such as injectables.
Good luck!

[ALT76]

Heather, I'm glad you're happy with his response.  Obviously I have no idea what's going on inside of you, but I can tell you what happened to me.  As I alluded to earlier today in your other post, I was originally dx'd with NOTHING, even though I had a test with very high testosterone and insisted I thought I had PCOS.  Then I moved on to another doc and he Dx'd the PCOS and started me on the clomid.  He was terrible.  If it weren't for the ladies of this forum I never would've been monitored at all and I never would've known what they were SUPPOSED to be doing!  They sent me packing with 3 Rx's (clomid, provera to induce my period and metformin for the pcos) and said "come back in 3 months if you're not pregnant" Now I wasn't doing triggers, so they NEEDED to be checking if the clomid was actually working - and they weren't.  I begged them to run a 7dpo progesterone level the second month I was on it.  Sure enough, it showed I didn't ovulate.  Then I begged them for u/s monitoring since I have PCOS and it can cause cysts.  They said (I quote with a snooty attitude) "We don't DO ultrasound monitoring" then I ended up in the ER w/a cyst rupture, and again another cyst rupture and they finally started to monitor me.  I was on clomid 7 months (five cycles - mine are long) and gave up after the third cyst rupture.  I met another doc in the ER that time and she was astounded I had not yet been checked for endometriosis.  My mother and sister both have it, and even though I insisted it was a possibility, the current doc said no, and just gave me an Rx for FORTY-EIGHT oxycodone to help with my menstrual cramps.  Even THOSE were NOT taking my pain away - a sure sign something was up inside.  I asked this doc I met in the ER if I could switch to her, and within a couple of months she did a lap on me.  Turns out I HAVE endometriosis as well!  I asked her if the tissue that was connecting my uterus to my ovaries and tubes could've been pulling down on the tubes and disrupting the path of the egg, and if that was why 7 months of clomid never worked, and she said "absolutely!"  I was so angry that I wasted that time in misery on clomid.  But now I get to my overall point, which is that my very first try after I recovered from having the endo and the adhesions removed, which was also my first try on injectables, I got my BFP - sure, it didn't stick, but it was also my first pregnancy and 50-60% of all first pregnancies, regardless of the woman's fertility status, end the way mine did.  So if you are suspicious that there may be scarring or something interfering inside, I say it's worth it.  Also if you have abnormally painful periods (not sure you do?) - it has certainly helped tame some of my pain.  

Sorry for the long response!

[mommyof3andhopefully4]

Thank you so much for your response!

I don't have painful periods or any reason to think I might have endo.  BUT, like my doctor says, you don't necessarily have to have any symptoms to have endo.

I am so sorry you have had such a difficult time with it all.  It sucks.  They did monitor me really well when I was doing the clomid and trigger.  I had u/s on day 12 to make sure I had follies.  They didn't check after to see if they were ruptured/gone, but they did make sure I had them.


Helen 72- Thank you for your advice.  

[Helen72]

I am not sure I told you my story but my lap showed I had no endo.  Also, I had no symptoms of endo either (unlike ALT76) so that was not a big surprise.  But a lap can reveal all kinds of problems.  I was diagnosed with scar tissue due to an old surgery.  With my scar tissue my doc found that no clomid or injectables could ever produce a baby.  So, we wasted lots of time doing clomid cycles.  I really wishes I picked the lap first when my doc offered me clomid or lap.  Based on my experience, I think that a lap is a good decision.
I hope this helps!!!

[mommyof3andhopefully4]

Thank you!

So have you been able to conceive since you had that scar tissue removed?

[Helen72]

Scar tissue was removed but it comes back within weeks (unlike endo which may or may not come back and typically does not come back for a year at least).  So, ivf was the only way for us.  It was a bit shocking to know that we had to do ivf but I was glad the lap finally revealed what the problem was since after 2 years of trying unexplained infertility was driving me up the wall.  We were incredibly-incredibly blessed to get our first bfp on our first ivf try last week.  

[mommyof3andhopefully4]

Well congratulations to you!

Thank you for all your help!

[SHP]

I did the lap first but I was older - age 39.  I am glad because we found that one tube was blocked and they could not flush it out.  I would not have realized that I only had the one side and 1/2 the chance of getting BFP.  That made me go on to IVF after all of the IUI failures.  I am glad that I know what is right and wrong with me.  You are younger and may not want to - but I wanted to know.

[mommyof3andhopefully4]

Grrrrrr, part of me is saying to go for it and get it, but I just don't know!

I do know one thing though, I am 11 dpo and I had EWCM for the first time in a really long time today!  My OPK (CVS Brand) says negative, but it is a darker negative like it could be starting to turn positive.  This is my third day testing.  Temp is still low...it went up yesterday and more a little today, but not a huge fluctuation...and FF didn't say I have ovulated.  Hmmmm, interesting.  But I haven't seen EWCM in a long time.  I have been on Clomid for the past three months and am taking this month off.  Definitly didn't have any then, but I don't remember seeing this much before that!  

Any thoughts?