What do we want? CLOMID! When do we want it? NOW!

So, we had our first RE appointment today. We showed up half an hour before our 3:30 appointment time (they said to be there fifteen minutes ealy) and still were not called out of the waiting room until nearly ten to four. For the significance of this fact, you'll need to read to the end of the post.

I haven't yet come up with a good name for the nurse we dealt with today. Or maybe it was nurses...I was so nervous that I can't remember whether the woman who took my blood pressure and did an initial review of my medical history is the same person who joined us for the pelvic exam and gave us papers for bloodwork. Anyway, Nurse took my blood pressure (you've been paying attention, haven't you) and reviewed my medical history before summoning Dr. Q. And thus began our appointment.

Would it be mean of me to call him Dr. Quixotic? I wouldn't say he has no regard for practicality, but the man did say, upon seeing Ezra's family history of [medical condition unrelated to fertility], "...and you should be sure to tell your children's pediatrician about that, and the children themselves, when they get older." Um, hello? Fertility specialist? I know you like to think of yourself as fairly successful, and you are, but could you maybe tone down the high hopes thing a leeeetle bit?

Anyway, Dr. Quixotic went through my forms first. He asked for my impression of the situation, and agreed that I likely have "some form of PCO." Noting the history of ovarian cancer in my family, he gave us the name of a doctor at a local ovarian cancer prevention clinic, and suggested we talk to him about genetic screening, early warnings, and so forth. Duly noted and tucked away, but at this point it's not going to affect IF treatments so I'm not running to make yet another appointment with yet another specialist. Dr. Quixotic went through Ezra's form as well and commented that he looked generally healthy (on paper, I guess), but for the aforementioned family history issue. We chatted about my metformin tolerance (I haven't been handling a 1500 mg/day dose very well, and so scaled back to 1000 mg) and Clomid and its alternatives. He said that about 45% of women fitting my profile get pregnant with three (or fewer) cycles of Clomid...encouraging, I suppose. We skillfully mentioned halachic considerations; the doctor immediately suggested a collection condom and verified that we can start having sex again on day 12 (me: "usually"). Then, on to the exam room, where Dr. Quixotic poked at my thyroid, felt me up, and ascertained that I do, in fact, possess a uterus and a pair of ovaries (nonfunctioning though they may be). Oh, and I made Ezra join me in the exam room, where he spent several minutes meditating on the tip of my nose, which was about as far away as he could get from noticing what the doctor was doing to my reproductive organs. I love you too, honey!

We retired to Dr. Quixotic's office again (well, I got dressed first), where we settled on an initial treatment plan. At first he suggested 50 mg of Clomid, with temperature charting, an OPK at home starting on day 12, and no monitoring in the clinic unless I show no sigs of ovulation by day 17. I expressed concern about the lack of monitoring and the possibility of multiples, kind of hoping for him to just placate me, but instead he scaled back the dosage to 25 mg and agreed to ultrasound monitoring every few days around the time ovulation could be expected. Unfortunately, this clinic location is not open on the weekends, and the associated location that is open Saturdays and Sundays in out of town, so Dr. Quixotic pointed out that we wouldn't be able to do any monitoring on Shabbat. Oh well, not that big of a deal at this stage, and when it does become a big deal we can always find ways to work around it. We reviewed the plan one more time, and then his phone rang - Nurse was calling to say the lab downstairs closed in about ten minutes, and we'd better hustle if we wanted to get our blood drawn before leaving. Well, you know, maybe if our appointment started on time...!

On our way out the door, Nurse instructed us to call the financial coordinator tomorrow to go over insurance stuff. We signed a small stack of forms and then raced for the elevator, making it to the lab just minutes before they locked the door. Ezra got off easy with just three tubes of blood, but they drew eleven for me! Of course, that's because Dr. Quixotic ordered a full panel of Ashkenazi genetic screening. Better to know, I guess. Among the other tests for me were a pregnancy test and something that tells them whether I've ovulated yet...if both come back negative (expected), I am to start Provera over the weekend. And then, on day 5: Clomid.

We swung by the recommended pharmacy on our way out, where we were told that collection condoms are apparently no longer on the market. When I call Nurse tomorrow, I'll see if she can help us procure any, but if not then we'll just have to move a notch or two down the Seman Sample Heirarchy. This will be a fun phone call to make, though I definitely won't be doing it from my (not at all private) desk!

Reflections? I guess low and slow is the way to go, but I'm also kind of anxious that this is going to take a loooooooooooooooooong time. I mean, of course it is. There's no way I'd be lucky enough to get pregnant on my first cycle (and if I am, I'm sure the rest of y'all would hate me appropriately), but I feel like at 25 mg I don't even stand a chance. It will be interesting to have the monitoring, though, and see how my body reacts to the drugs. Maybe it'll be just enough to start up a picket line again.

Note to self - things to ask Nurse tomorrow: Is there any other way for us to get a collection condom? If not, can we use the pull-out method to get a semen sample? When can we pick up a specimen cup? During what hours/days can we drop it off? What time do you open for u/s monitoring in the monings? Should I continue taking my metformin? What dose?

(Morning update: You, my dear readers, should feel free to share with me your experiences on Clomid. I'm going to resist spending my entire day researching this myself, as after a week of obsessing about my RE appointment, it's time for me to actually do some work!)