Anyway, sorry about taking years to respond to this post. I knew as soon as I read it on the day that I would actually have some ideas to contribute.

1) I had a few cycles of Clomid which were a complete and utter waste of time. I was started off on 50mg, but then it was decided that my uterine lining thinned too much and hence my dosage was lowered to 25mg. I don’t think 25mg would be enough to stimulate anyone’s ovaries, but yet that’s what I was given month upon month. Oddly enough, I still got bastard hot flashes.

2) Egg quality–dunno. I should find out about this tomorrow. Shit.

3) I only had one IUI cycle with injectibles. I am on the same injectibles for my IVF cycle, just in larger dosages. I hate IUIs and have a hard time believing that they work for anyone, but I hear they do. I got all but one of my four free, and I’d be far less likely to have an IUI again if I had to pay for them. Assuming I get one kid out of this I would consider going straight to IVF when I wanted a second.

4) Lindy has taken care of this quite well. Not that I’d have any to offer up anyway.

Exeunt.

First, about the cooter maintenance. The thing I swear by – Bathina shave cream (made by Benefit cosmetics) and just a regular Gilette razor. Works like a charm. The more you shave, the less sensitive your skin will become, and you’ll be less prone to razor burn. Although you probably shave against the grain, if it’s your first few times shaving down there, shave with it. It won’t be as close as a shave, but it will help the irritation.

Two years ago I decided to get a braillian wax, and honestly was a little disappointed because it grew back in really fast. A tip I learned from an “adult entertainer” is to use roll on deoderant to shave down under. Apparently it’s less irritating and allows for a closer shave. Haven’t tried it so I can’t vouch for it, but still.

As to the drugs. I took three rounds of clomid. 50 mg, 100 mg. and 100 mg. None of them did anything for me except give me a brief taste of menopause. I had unbelievable nightsweats and in general was just a complete bitch. It was horrible, and I would never ever do them again.

As you know, I’m on a follistim/IUI cycle right now, and just found out about my PCOS status close to half way through. To be honest, the follistim wasn’t that bad. I’m petrified of shots, and the pen was very easy to use. Incredibly easy even. The only problem is, with PCOS you have (as I understand) a tendency to overstimulate, leading to OHSS. Gatorade, rest, and lots and lots of fluids made it better, but it did suck for a while. You also have an increased risk of multiples with PCOS and injectibles I understand.

Does it work? Uh, I have no clue. Would I do it again? Yes. I’m lucky and my insurance covered the great majority of the cost. If Michael’s sperm counts were smaller though or if the insurance didn’t cover it, I would have skipped it if possible and gone straight for the big guns – IVF.

And, I really like your idea about the flow chart, though I sure wouldn’t like to try and sketch it out! Talk about an infinite task!

For many PCOS women, Clomid is all they need to get pregnant – it’s like it adds just enough regulation to the mix to get things working. I’m not sure of the mechanics behind it and don’t have the energy to look it up right now, but I know that I did ovulate on Clomid, once we found the right dosage (150 in my case) and added estrogen supplementation (for the lining). I agree with Lindy about doing IUIs, since the Clomid really does a number on the cervical environment. Much as I hated being on the Clomid, I don’t regret trying it. What I regret is not doing J’s Kruger analysis sooner, because that’s what bumped us immediately to IVF. Otherwise, we would have done at least one and potentially a couple of injectable/IUIs first. So, unless the SA is really bad, it’s probably worth at least a try or two at some combination of meds/IUi. It’s not just the money aspect of it (though that is indeed a factor) but the insane emotional and physical drain of an IVF. As Lindy said.

That said, I think there may be other reasons for you to consider skipping Clomid. I don’t know if a history of anxiety or panic attacks or whatever else will exacerbate the effects of the Clomid, but given your psych history, that would be something to explore. The injectables, while more intense in their administration (the whole idea of giving yourself shots is a bit freaky), are far less crazy-making. In either case, you should be monitored – anyplace that would give you Clomid and leave you alone is a bad place. I don’t think Dr. Doctor would be that type, but it’s always worth a mention.

I think that’s it for now, though when my brain shifts I might come up with something else. Oh. So. Scattered.

That said, I haven’t looked at any of this stuff from a PCOS perspective, so don’t really have any better answers to your questions that others have already supplied. You’ve gotten some good info!

Can we split your LH surges? I’ll take one, you can have the other one, and maybe that would fix both of us! If only it worked that way.

At the RE clinic, my cost for the IUI, including the drugs (Follistim, HCG, prog supps), one month’s cycle cost ranged from $1400 to 1800. The range was due to our 1st IUI occuring on only day 11. The 2nd IUI was higher as we had to pay for one more day of blood/US. If we had known that DH’s sperm count was so poor, I never would have wasted the $3000 and would have went straight to IVF. I would recommend making sure that the count and motility is more than exceptional before I would ever recommend to anyone IUI. This does not take into account PCOS potential complications.

Thank you for your kind words about my double lines.

And now… for your questions. I love this stuff. I’ve done clomid alone, clomid/IUI, injectables/IUI and now IVF.

1. Clomid suuuuhhuuhuuuucks. But, it’s just so damn cheap and easy. And it does seem to work for some people. I’ve seen several Internet PCOSers (not with blogs though) on a metformin/clomid combo and I’ve certainly seen pregnancies come of it. I’ve also seen annovulatory PCOSers (Cass comes to mind) who get nothing but trouble from clomid. It’s a good starting option, simply because it’s so cheap and easy, if you aren’t in a big hurry due to age or other circumstances (which, in my book, include going insane thinking that you’ll never get pregnant) if you can find an RE who will actually monitor you to see if it works. You’d need to start at a dose of around 100 mg and see what happens. Some docs would then try a higher dose, others would move on if you don’t ovulate. The huge downside of clomid is that of all the wonky hormone maddening drugs I’ve taken over the last several years, clomid was the worst. The side effects can be truly horrible. It made me completely insane. H. said he barely recognized me. I screamed and cursed and cried and screamed some more. I had hot flashes and migraines and was generally miserable. Some women apparently handle it better than I did, though. Also, if you do take clomid, please just go ahead and do it with an IUI. Clomid dries up cervical mucous. An IUI doens’t actually cost that much more than the monitoring already will and it overcomes the hostile clomid CM. Also, clomid can thin your lining (one of the reasons it didn’t work for me). If your lining is thin the first cycle, I’d quit and move on to something else.

2. I can’t help with this one.

3. Femara/letrozole is a clomid alternative. Personally, I sort of suspect that too much is made of the benefit of femara over clomid. I talked to a couple of REs about this and they were also skeptical. It works the same way as clomid. Some say it thins your lining less, but the REs said they’re not sure they agree.

I’ve done three injectibles/IUI cycles altogether. The first one resulted in G.’s conception, so I do have a special place in my heart for FSH injections and the old IUI. I’ve researched IUI vs. IVF more than any one person who would like to sleep at night should. And here are the conclusions I’ve come to (I don’t know about PCOS though, so I can’t help you with that part): If the Nearly’s semen analysis is good, but you don’t ovulate on clomid, try injectibles with IUI. The stimulation drugs are the same as for IVF (minus the supression part, because they aren’t trying to get a lot of eggs the same size, just two or three dominant ones). If you’re going to be able to produce eggs for IVF, you’ll be able produce eggs for IUI (barring cycle weirdness, which is always a risk with both protocols). Injectibles with IUI gets you around a 15-25% chance of success for roughly 1/5th the cost of an IVF cycle. It’s also A LOT less involved and invasive. On the way home from my egg retrieval, I turned to H. and said “Even though those IUIs didn’t work, we were right to give them a try. Because this sucks.” If, however, the Nearly has poor SA results, move straight to IVF. Research suggests that with “total motile” sperm counts (not the same as total or per-mL counts) of 10 million or more, IUI is more cost effective than IVF. And chances of success with IUI increase between the 10 and 50 million range. Anything above 50 million doesn’t improve your chances. Between 5 and 10 million is a sort of grey zone. IUI might well work, but IVF is probably more cost effective. Below 5 million IUI can be a bad idea (but for some people it’s their only option and it certainly could still work). The other big downside of Inj/IUI compared to IVF is the risk of higher order multiples. With IVF, the risk of twins is higher than with IUI, but the risk of triplets or more is higher with IUI. You have less control with IUI because they can never be sure how many eggs will be released. A lot of this can be helped with good monitoring and a careful RE, but the risk will always be there.

4. Here’s my favorite IUI page: http://www.fertilityplus.org/faq/iui.html (remember that a lot of the statistics include clomid/IUI cycles, which have more like a 10% success rate).

And here’s my favorite IVF page:

http://www.cdc.gov/ART/ART02/section2_questions.htm for fresh, non-donor cycles

and this http://www.cdc.gov/ART/ART02/section3.htm
for frozen cycles.

Wow… sorry for the long message. You’re helping me stay distracted!

Lindy

Don’t know about PCOSer’s – sorry! Your RE should have IUI numbers. They were a waste of time for me, but then again, it took 6 ivf’s, so you’re talking to a hard case here.

Thanks to both you and Molly for the tips – I use this trimmer like thing. I think it’s getting unruly now, should really try to take a look at that.

Regarding cooter maintenance — I entirely quit using razors over a year ago. Even if it was a brand new razor with plenty of shave gel, I would end up with bumps and itching, and pretty soon one of the bumps (which I assume was an ingrown hair) would get infected or something horrible. It was a bad deal for all involved (namely, me). The best thing that has ever happened to me is the Veet Razorless Shaving kit.

It’s basically a depilatory like Nair that you spread where you want it to go, wait 7 minutes, and then use this like little scraper-like thing (like a car window scraper, but smaller (obviously) and softer) to remove the hair. Rinse and follow with a coat of Bikini Zone cream or gel, and there are no ingrown hairs and no pain. Fucking awesome.

Oh, and sorry, I was using your ovary as a pincushion the other day. Guess I forgot to remove that one.

See you in (eeeeep!) TWO AND A HALF WEEKS!