Balancing Act

I had lunch with my mom last week. She is the awesomest mom a girl could ask for.

She brought me some info about all of the recommended pre-natals that I need to start taking. She encouraged me to get up to date on my flu and whooping couch vaccinations. She offered to research chewable pre-natals for me, since the swallow pre-natals are gross. (I was hoping that my dinosaur chewables would suffice, but mama knows best.) *** if you can recommend any good chewable pre-natals, please let me know!!!

My brave mama also asked me about how the IUI process works thinking that maybe we could take back some control of the process, de-medicalize it, and do it at home. Wouldn't that be awesome? If all other factors were equal at this point, I would really love to conceive in love with ML in the privacy and comfort of our own home.

I am really glad that I could go thru all that with my mom, so that she can understand what options we have and the factors that we are using to make decisions. 

The thing is that all other factors are not equal at this point. The way I see it we are balancing three big factors - physical, emotional, and financial - and will be choosing from essentially three different treatment options - non-medicated IUI, aggressive medicated IUI, or IVF.

Physically
From what we know, I can get pregnant. I have regular cycles and ovulate regularly. I've never taken hormonal birth control and would rather not mess with things unless necessary.
treatment choice = non-medicated iui

Emotionally
I am a mess. I want to be pregnant now. I am done waiting. The sooner I am pregnant the sooner I can move beyond the despair of this journey. The thought of prolonging treatment cycles any longer than absolutely necessary sounds completely unacceptable to me.
treatment choice = IVF

Financially
We've already spent about 20% of our income on fertility testing & treatment this past year. We have some savings, but it is limited and it makes me sick to think about spending it all. But I know we will if we have to. We'd like to be cost effective in our decisions. At quick blush were looking at a cost of $1,200 per cycle for un-medicted iui (with a 10% chance at success), $3,000 for medicated iui (with a 20% chance of success), or $15,000 for IVF (with a 50% chance of success).
treatment choice = I don't know how to do that kind of statistics, but I think it would be medicated iui.

So that leaves us... I'm not sure where exactly, but I think in the middle with an aggressive medicated iui as our starting place.

We meet the new RE on Wednesday, so we'll get better info then. (and my cycle starts on Thursday, so cross your fingers that we can jump right in! ohhhh am I hoping.)

IUI questions

I am thinking a lot about what comes next. Regardless of what it is, having a plan that I can follow makes the whole process so much smoother. There is of course the risk that the plans I make will get changed at the last minute, which seems to occur at nearly every junction. Yet, in the meantime, my anxiety is much more manageable when I can see our potential options laid out ahead of us.

Barring a miracle with this FNA MAP (which we scheduled for September 29th) we will be proceeding with donor sperm. I want to start working through some of the choices that I'll be faced with. Ultimately, I am trying to balance the emotional, physical, and financial components.  I am hoping that some of you who have been here/done that can offer your advice.

How do I choose a RE for dIUI?
There is one local RE who has a very small boutique practice. He is fairly new and only had one year worth of IVF results reported. (He'd only had 4 IVF patients and only one was successful.) It would be so much easier to have a local Dr, but I have a general distrust of our rural medical practitioners and worry about a 'one man shop' being the right fit for me. I would not do IVF with this Dr for those reasons. PROS: local, personal, less time off work, ML could be with me at all appts,  CONS: one man shop, I'd only do IUI with him

There is the big university hospital RE program in the City. I had an initial consult and ultrasound with the head of their program, they did my saline sonogram, and their geneticist reviewed our records too. It is a 3 hour drive each way to get to the City, which requires a day off of work. I trust their medical judgement and like the fact that although I'll have a primary RE, there is a team approach to every case. PROS: reputation, trust, team, consistent care if we move to ivf, CONS: travel, time off work, ML couldn't be there at every appt.

The other option would be to find a different RE in a nearby city. I might be able to cut an hour off the drive while still benefiting from the larger practice.

What questions should I ask the RE?
How much experience do you have with IUI? dIUI?
What can we expect as a IUI success rate with your office?
Do you have a preference for medicated vs unmedicated cycles?
What hours are you available? Evenings? Weekends? Holidays? Emergencies?
What lab do you use?
Where did you train/residency? Where did you work before?
What are the costs associated with dIUI? (actual procedure, monitoring, sperm prep, other?)
At what point would you recommend we switch to IVF?
What records / tests will you need from me? Do I need to repeat anything?
How quickly could we start a cycle?

How to choose sperm?
Oh My, this is a loaded question that deserves its own post.... but here goes.
Which sperm bank to use?
How do we narrow our choices and make a selection?
Are there cost differences between the banks and donors?
Which bank will give us the most information about the donor?
How do ML and I do this together? Will ML do this on his own?
Things that are important to me:
Open donor, not a CF carrier (full screening?),

What do we tell people?
Who do we tell?
What exactly do we say?
How much privacy do we maintain for the child to choose to disclose?
What kinds of reactions should we expect and how to best respond?

I think that this is a good start at organizing my questions. I am going to keep this post active and add to it as I think of other questions or topic areas. I really would love your wisdom and experience about all of this - comments, links to other posts that explore these questions, any resources that you know about!

Three cheers for the ALI community. Thank you for being here.