Now here's a sentence I thought I'd never write: I miss Dr Abrupt. His secretary called on Friday afternoon: Dr Abrupt is away at a conference all this week, but he had asked her to telephone me to let me know that he had received the results of my Day 3 bloodwork, and that everything looked fine. He had passed my file over to his colleague Dr Knows Best, who would be seeing us for our Day 21 appointment.
This morning, we got up bright and early for our appointment at the Great Big Infertility Clinic. After waiting over half an hour, eventually we were called in to see Dr Knows Best. I renewed my acquaintance with the dildo cam, which revealed that I had ovulated from my right ovary this month (so still no confirmation that my left ovary is in fact functioning as it should). After some prompting on my behalf, Dr Knows Best volunteered the information that I had 9 follicles on my right ovary, and 5 on my left ovary. I said I thought that, given my anxieties about diminished ovarian reserve, this was a good sign. 'Not necessarily,' said Dr Knows Best. 'It doesn't matter how many follicles you have, if they don't respond to stimulation.'
After I'd put my knickers back on, we then sat down to discuss my protocol.
Dr Knows Best explained that I would start taking the nafarelin nasal spray on the first day of my next period. The dose would be 3 sniffs per day. At this point I interrupted. Did that mean I was doing a regular dose, rather than a micro dose, flare? 'You've obviously been spending too much time on the internet,' replied Dr Knows Best. 'Why don't you let me worry about what protocol we're doing? All you really need to know is what dose of drugs to take, and when to take it.'
He proceeded on with his explanation. I would start the Menopur injections on day 2 of my period, and would come in for a scan eight days later. I explained that, given my poor response last time round, I didn't feel terribly comfortable about being left to stim for eight days; I would prefer to be more closely monitored on this cycle. Dr Knows Best informed me that the Great Big Infertility Clinic no longer performed scans earlier in the stimulation phase; they did not feel that they were of any use in monitoring patients' response (they also don't appear to check E2 levels either). I was on the maximum dose of Menopur, and after eight days they would know whether I had responded or not. If I hadn't responded, then there really was very little more they could do for me. He then smiled, and asked us whether we had any further questions.
Why are you such a pompous and patronising ass? What the fuck are we doing here? Instead, I asked him about my day 3 bloodwork. What were my FSH levels this time round? 'I really don't think it would be helpful for you to know these,' he replied. I disagreed. I said I thought that knowing as much as I could about my treatment was very helpful. Grudgingly, he told me that my FSH was 6.
On the way home in the car, we decided that this is very probably the last cycle of treatment we will undergo at the Great Big Fertility Clinic. Neither of us can escape the feeling that we are paying vast amounts of money for what seems to be very cursory treatment. I have no sense that I have been given a protocol that has been tailored to my individual needs; instead Drs Abrupt & Knows Best appear to be trying a series of default options. Possibly my feelings about them both may change if I get a positive result from this cycle - it's just, at the moment, that feels a fairly remote possibility.