I met with my RE today to go over our next move. I was wary of this conversation, since the fact she wanted to meet with me at all suggested she was hesitant about the course we've been taking, but I wanted to hear her out.
First, she mentioned her concern that I'm really sensitive to the Follistim--giving me 75 IU gives a big response, and dropping just to 50 IU really slows down the progress of the follicles (and subsequently my estrogen levels).
Next she brought up the increased risk of multiples, and how I might be particularly prone to this, since I had so many follicles last cycle. My RE seems very concerned that with that many follicles, I could conceive triplets or quadruplets, and then face the dilemma over whether to do selective reduction. In the last cycle, I had one follicle that was around 18 mm, and three that were 13-14 mm. From what I've read, this really isn't that many. It sounds like it's pretty common to do IUI with 3-4 mature follicles, to increase the chances of success. Am I wrong about that? Is she just being really conservative?
She once again brought up the option of going straight to IVF. I explained my reasons why I'm not ready to try that yet: that I don't have any IVF coverage, so we would pay for all of it out of pocket, and that I'm not ready to play my last cards yet. She seemed to understand that, and gave me the go-ahead to start another Follistim cycle tonight. We agreed that we would try as many as six Follistim/IUI cycles before moving on to IVF.
We're going to do the same dosage that we did for the last cycle: 75 IU for three days, then dropping to 50 IU. I'll go in for an ultrasound and bloodwork on Friday morning, after four days of dosing.