This is It.

My appointment didn't start off so well. I arrived at the infertility clinic and it was really, really busy. I guess it is because they are doing an IVF cycle right now. When I gave the receptionist my ID she asked, "Did they just book this appointment?" She didn't have me down! This is the appointment I had to fight for last week, remember? I was about to lose it on someone but luckily they straightened it out and I had a seat in the waiting area. It's always so lovely when I have to wait for an extended period of time considering the OB booking desk is just on the other side of the infertility clinic. Whoever planned the layout of the new clinic is a total idiot.

While I was waiting I saw a lady come in once, get sent away and then come in a second time absolutely furious. They hadn't put in her labs---sound familiar? At least I'm not the only one having such a hard time with them. 

Mike ended up being able to come with me since he finished at the range early so we both went back to the room and waited to see the doc. The nurse had me down taking Clomid, that I was 5' 6" and day 14 on my cycle. Double you tee eff. This clinic really needs to get it's shit together. My blood pressure was high and she asked, "Do you normally have high blood pressure or just when you come to see us?" Oh if she only knew.

Once again, my left ovary was taking the month off but I have several follies on my right. One 19.5 that is nice and ripe and several smaller ones that won't be doing anything. I got my trigger shot and we're going up to Seattle tomorrow for IUI #3.

Dr. C sat and talked with us for a long while, which was very much appreciated considering everything that is going on.  He talked to me about my low AMH and said that it does mean that we're working against a clock but that we shouldn't be too concerned just yet. If I don't get pregnant this cycle we will do CD3 labs at my request though he feels like they unnecessary because of my everything else in my cycle is normal.  Because I'm 27 he would expect the quality of my eggs to still be good but obviously this is only something we can figure out once we get to the IVF stage. For now he presented us with a few options:
#1 Continue to do ovulation induction and IUI. We could definitely continue doing this but the cumulative success rate for IUI decreases each month. He feels that there wouldn't be much point in continuing this protocol after IUI #3 since most women who achieve pregnancy do so in the first three months.  Plus, that's money that could go into our IVF fund.
#2 Diagnostic laparosocopy. This is highly recommended before pursuing IVF and there is the chance they could get in there and be able to "fix" whatever it is that is keeping me from conceiving on my own.

#3 IUI with stims. He doesn't normally like to do this because the risk of OHSS is so high coupled with increased risk of multiples. He said that IUI + stims shows no increased chance of conception when compared to clomid or femara cycles. It'd basically be a more aggressive protocol than what  we're doing now but without an increased chance of getting pregnant. 
#4 Move straight to IVF.  Well, not really. There's still the long ass waiting list of course. We did find out, however, that IVF without ICSI is closer to 6k and with ICSI is around 8k (I'm guessing the 7,500 that Dr. B. told us about last time.) The wait time may actually decrease because they are going to start doing cycles more regularly plus people PCS, get pregnant on their own or just decide to take themselves off the list entirely. Dr. C said we might be able to cycle as soon as 6-8 months. Until then, I guess we'll be trying the old fashioned way. It didn't work for us for the first 20 months so there's no reason to think it'd work now.

Overall it was a great appointment. I really appreciated the time he took to sit and talk with us about our concerns; I just wish he'd done it sooner.  Who knows? Maybe he doesn't talk to his patients about all the options because most of them get pregnant right away?  I really wish the logistics of the clinic would get worked out though. They seriously need to work on scheduling and following through with things. 

 It's so bizzare to be moving forward with IVF and feeling total okay with it. I remember how upset I was last summer when we thought Mike had low motility and that we'd have to do IUI to get pregnant. The idea of not being able to get pregnant on my own was heart wrenching and now I can talk about IUI and IVF in my sleep. Mike and I have talked about it and agreed that while the idea of surgery completely sucks, that is the option we need to go with for now.  Surgery will most likely be late August or September. At this point, we've also agreed for this to be our final IUI and to start saving for IVF. If I don't get pregnant I will be calling the clinic on day one and scheduling my lap. After that, we'll see where to go from there....