I like a good plan

I am not a very spontaneous person by nature. I like the occasional pleasant surprise (flowers from my sweetie! work is letting us go home early!), but generally I like to have a plan.

So walking out of my RE appointment today with some sort of plan was such a relief.

First we talked about J. He wasn't at the appointment but we discussed his first SA results and next steps:
1) Repeat SA, but at a different lab that measures morphology by Kruger's rather than WHO method.
2) If results are similar, follow up with bloodwork to test FSH, LH, testosterone, prolactin, TSH. May also want to do the following genetic tests: chromosomes, y-microdeletion, cystic fibrosis screen.
3) See a urologist who specializes in male infertility. She gave me two references in our area.

Then we talked about me. My periods have become increasingly more and more painful since going off the birth control pill last December. I've had lots of mid-cycle spotting, but otherwise regular periods, and am confident that I'm ovulating. She did an ultrasound. My right ovary and tube look ok. I have an endometrioma (about 2cm) on my left ovary. This seems to be recurrent as one was removed during my lap in 2007, which returned within six months. As of last December, it wasn't visible, but here it is again. The worst news is that my left tube, which is twisted around my ovary, is hydrosalpinx (filled with fluid). According to the RE, this could cause problems with implantation when we do IVF.

So the plan for me is:
1) Have CD3 bloodwork done. If the 2nd SA results are similar to the first, go back on continuous birth control to try and keep the endometriosis from getting worse and avoid having painful periods.
2) Go back for a follow-up visit in September to see how the cyst and left tube look.
3) Possibly have a second laparoscopy to a) drain the tube, b) pinch off the tube, or c) remove the tube about 2-3 months before IVF. Also remove as much of the endo as possible.
4) Start on Lupron about 2 months before IVF to get the endo as quiet as possible and because it has been shown to improve IVF results .

Then we would do IVF after the first of the year, when we hopefully have some insurance coverage for it.

If the 2nd SA results are significantly improved, we will reassess, but I'm not counting on that.

I feel like a huge weight is off my shoulders. If we follow this plan, we will have about 5 months of not TTC, which will mean:
1) No stress about trying to have sex on particular days.
2) No temping/charting (not a big deal but nice to not have to worry about waking up around the same time every day and stressing if I have to get up to use the bathroom in the early morning)
3) No avoiding the bathroom for hours in order to use the ovulation predictor kits.
4) No ups and downs hoping for a pregnancy and being disappointed.
5) Regular coffee! I had given this up at the beginning of the year.
6) A break from acupuncture (most people find it relaxing, I do not).
7) No herbs from my acupuncturist (blech!).

It wasn't great news today, but I'm feeling more positive about everything than I have in months. It's a good feeling.