The short version:
I feel good. It went better than I expected. We're on track for an IVF cycle sooner rather than later. I'm feeling optimistic and ready to go.
The long version:
We're definitely going forward with IVF. The RE talked to us about our options (IVF or laparoscopy/injectibles) and made it clear she felt IVF was the best choice for us at this point. Her reasoning for not recommending injectibles is that it is a significantly larger expense that is not accompanied by significantly larger odds, and she frequently sees patients go through 3+ injectibles cycles (same cost as IVF or more) with no success. We asked a lot of questions about my medical history and the likelihood that there could be something wrong with me that we haven't found that could interfere with IVF working. She reassured us that people with ttc histories just like ours ("unexplained infertility") have success with IVF every day. She was baffled as to why we weren't already pregnant, but had genuine high hopes that IVF could be our answer. I asked specifically about endo and she said the worst case on record wouldn't interfere with the success of IVF.
They will only transfer two embryos per cycle because of my age and medical history, which is fine by me. The clinic's pregnancy rates for my age group are 52% with 46% resulting in live births. Of those live births, 32% were multiples (133 sets of twins and 7 sets of triplets). Their FET success rates are much lower, but I guess that is typical? She did recommend ICSI (ker-ching!) for half of the retrieved embryos because of us having tried 12 times with KD with no luck. I wasn't expecting that, but whatever she thinks will give us the best shot sounds good to me. I would so love to be able to do this once, if at all possible. She said she hasn't seen enough research on acupuncture to say for sure that it helps, but she knows it can't hurt so she supports me in continuing with that.
I had a much better experience with the RE this time. She was warm and friendly and informational. I think she was probably that way last time too, but I was too overwhelmed to absorb or appreciate it. She was remarkably sympathetic about our lack of insurance coverage and said that we'd be first in her mind for assistance if they get any samples or donated drugs. She said we shouldn't count on getting a full cycle's worth, but she'd surely be able to help us a little.
Because we've already had so much fertility testing done, and because we're not heterosexual and won't have any accidental pregnancies messing things up, she said we could get started right away without having to take BCPs or wait for a new cycle to start. Our checklist includes: Attending their official IVF orientation, getting an updated STD screen, deciding if we want to do cystic fibrosis screening (and doing it if we decide yes), and having a trial embryo transfer. I'll call tomorrow to schedule these things, and then we'll be off and running.
Aaaand, the fun part: We also have to figure out how we're going to pay. They don't offer any financing or shared-risk plans of their own, but they contract with Advanced Reproductive Care to offer payment plans and 1-, 2-, and 3-cycle plans with refund guarantees. So that will be our next question - do we want to pay a cycle at a time or invest in one of their multi-plan programs? Definitely have some thinking and talking to do there. The single cycle cost directly through the clinic is a little more $$$ than we were expecting, especially since we have to add the ICSI, but not totally out of the ballpark. It's crazy to have reached a point where the difference of a couple thousand dollars seems reasonable.
The bottom line is that I'm feeling cautiously optimistic about this move. We both are, actually. Thank you to anyone out there that may have shared a little birthday goodness with us - we definitely felt it. ;-) It's crazy expensive, yes, but it is the appropriate next step - simple as that. If the RE did one thing today it was put my mind at ease about that. It was obvious that she genuinely feels this is a good decision and that it can work for us. On we go!