Well, as expected, the appointment with Dr. K went well. It's nice to have a doctor I really love.
She asked about Robbie and was stunned to learn I'd delivered at 26 weeks. Then proceeded to say "wow" and "okay, then" approximately 47 times. At point she even said "I keep saying wow!" She said that we definitely made her nervous, but was glad we'd seen the peri (Dr. Bitchy) and passed all our tests. She did mention that she could help us with a surrogate and that she's had people who delivered even at 33 or 34 weeks go that route. Maybe she thinks we have a money tree, too?
Otherwise, the appointment was as expected and good. Standard workup. They drew a number of labs to check my various hormones and levels. I need to have a 7dpo progesterone drawn. David needs a repeat semen analysis. She wants me to have an HSG next cycle because apparently having a c-section early is a great risk for scarring. Apparently if the uterus gets very large, the scarring is minimal, but if it's still somewhat smaller, it's worse. Thank you again, prematurity.
We talked about how to reduce the risk of multiples. This was a big one because Dr. Bitchy was absolutely adamant we can not have more than 1 baby. She was extra bitchy on this topic, if you will. Dr. K agreed. Though she managed to do so without being bitchy. The biggest hope is that my labs (particularly my progesterone) are normal. If so, we're going to try a med-free IUI. That would be lovely on a lot of levels. I certainly wouldn't be sad if my ovaries didn't have to swell up like softballs again.
Of course, the likelihood is that it'll be low like it always was and I'll need Clomid. I've had three singleton 50 mg Clomid pregnancies, which is good. But Dr. K says she's had patients with triplets on 50 mg. We can not have that. Dr. Bitchy's head would explode. (Along with my liver, I'm afraid, or that might almost be fun.) Fortunately she completely agreed with my suggestion to half it. So if I need it, 25mg it is.
If that doesn't work, or if David's swimmers have gotten even worse, we'll go straight to IVF with a single embryo transfer. We are very, very fortunate to live in a state which mandates infertility coverage, so if we go that route, the money part is there. Of course, IVF has a limit, and comes with its own issues. But it also allows for a lot of control when it comes to multiples, so it's a good option.
In a bit of serendipity, it turns out that the clinic is conducting a study on pregnancy outcomes. They are looking for information on pregnancies which result in miscarriage, preeclampsia, preturn delivery, ectopic pregnancy etc. They just want spare fluids for testing. So they will take extra blood when I have blood drawn, if I were to have an amnio, they'd take extra fluid, a piece of the placenta if I deliver there (which I won't, but if I did, they could have it.)
I was more than happy to agree to anything they wanted. Obviously it won't help me, but hopefully someday the research they do will help Robbie and other children. I honestly choked up with tears when I heard what the study was about. She walked me out to the coordinator in charge of the study and presented me to her, "You want her."
The only real disappointment in the appointment was that she also didn't agree to put me on Lovenex. Dr. Bitchy said she didn't think it would help but I could ask Dr. K. Dr. K said she doesn't keep up with pre-e research, since she doesn't see patients who get it ("but you came close! Twenty six weeks, sheesh!") so she would defer to Dr. Bitchy. Which means no. I realize that the long term studies don't show it helps, but some of the short term studies do and I am all for anything that would help. But since this made doctor #3 who said no, I can't really argue any further.
So The Plan is set. Now we just see how things go.