Be Careful What You Wish For

For the past few weeks, I had been feeling frustrated by having no real diagnosis. I had a few seemingly unrelated abnormalities like mild ovulatory dysfunction and fibroids and also the glaring fact that I cannot seem to be pregnant. The treatment plan outlined by my RE (3x clomid/IUI cycles, 3x injectibles/IUI cycles, then IVF if no success) was basically the generic plan for unexplained IF. I found it frustrating that without knowing what was going wrong, we were sort of taking a shot at the dark and hoping for the best and yeah, for a minute or two, I might have just wished I had an official diagnosis with a specific plan targeted to the problem.

Fast forward to this week when I went in for my final monitoring ultrasound before IUI. I had 8 medium to mature follicles. This was on the lowest dose of Clomid (50mg). "Sweet!!!" I thought to myself, "I responded swimmingly!" Um, the RE had quite a different take on my response to Clomid and my previously noted odd follicle maturation patterns.

In fact, what he said totally surprised me. He told me that he felt fairly confident that I have an atypical case of "lean" PCOS. He also told me that because I am low weight and likely not insulin-resistant (the most common form of the disease is insulin-resistant and affects primarily overweight women since excess fat tissue is what fuels the hormone imbalance), I would be more difficult to treat and more difficult to get pregnant than most PCOS patients.

Since only 2 of the 8 follicles were fully mature, he told me to trigger right away and do the IUI the next day (which was yesterday) in the hope that no other follicles would have the chance to mature further. I still have a risk of higher order multiples this cycle that I am honestly not totally comfortable with. My impression is that 8 follicles on an injectibles cycle is not crazy at all, but 8 follicles on the lowest dose of Clomid is quite unusual and bodes poorly for my ability to handle more aggressive hyperstimulation.

I suppose the larger underlying issue is this: I can't get pregnant on my own but yet with even the lowest dose of ovarian hyperstimulation I over-respond which places me at high risk for OHSS and HOM. No picnic here. If this cycle doesn't work, he said we need to re-think the old plan and go back to the drawing board.

Yesterday we did IUI #2. Unfortunately, our numbers were half of what they were last cycle (12.8 million/50% motility). I hope that I will get lucky this cycle, but not too lucky. Again, I have to be be careful what I wish for! I would love so much to be just 'medium lucky' with one healthy singleton. I am still trying to process all of this new information about my situation and to learn more.