A Call For Advice

[Asked elsewhere. Obviously by now we've made up our minds. - R.B. 12/24/05]

It looks like metformin alone isn't going to be enough to get me to ovulate, though we're going to give it until December to work its magic. (This has the added benefit of putting off all infertility-related expenses until the next calendar year, so that they all count toward one year's deductible and my insurance company will actually pay for something.) The next logical step is a low dose of Clomid (or generic equivalent; I'm too lazy to respect trademarks this morning) in conjunction with the metformin. We have already confirmed (via medical history, charting, and day 3 blood tests) that I have PCOS.

My current doctor (a family practitioner) feels confident that she is the appropriate person to handle this level of fertility treatment. She will do blood-test monitoring for the first cycle (blood draws on day 3 and 17, I think, with Clomid days 5 through 9 or 10, to compare hormone levels) but not ultrasound monitoring. I am mildly concerned about developing severe ovarian hyperstimulation syndrome (which can be fatal, but then again so is breathing under certain circumstances), since my age (young) and having PCOS are both risk factors. On the other hand, don't FPs and GYNs hand out Clomid all the time nowadays?

Several months ago, I was a little more "set" on going to a reproductive endocrinologist before moving to anything stronger than Clomid. It seemed like the prudent and responsible thing to do. Now, though, I'm feeling antsy and a little foolish...Clomid's not that big of a deal, I could get pregnant on my first Clomid cycle, an RE is likely to make us both undergo a whole bunch of tests, I may not get started on meds until the spring, etc.

Ezra thinks my change of heart is due in part to the fact that we also socialize with my FP somewhat (she goes to our synagogue); he also worries that she is a bit overconfident and is eager to pursue fertility treatments for her patients because she has suffered from fertility issues herself.

Complicating factor: given my current job situation, I will probably be back on the market in February or March. If I'm not pregnant by then, obviously I will have to look for work, but if I get pregnant after I find a job, I'll be in the delicate situation of having to resign before I've even started (or less than a year after starting), since our plan is for me to stay home at least a year after giving birth. The professional community in my line of work is awfully small and I don't want to mess up my reputation like that, but on the other hand I am just not willing to put off fertility treatment for the next two to four years just to avoid the possibility of maybe having to leave my job "too soon" after starting it. On the other hand, there's no guarantee that a January or February Clomid cycle will result in pregnancy. On the other-other hand (I grea a whole bunch of arms when nobody was looking), maybe one or two cycles this winter would at least let us know whether we can expct success very soon, or not for many years.