And the Verdict is...

IVF with ICSI.

If we want to have biological children - that's our only option.  Dr. R thinks that we're very good candidates.  Given my age, and my FSH values the last time they were tested, he thinks our chances are about 60% if we did one cycle and a better than 90% chance if we did 3.  ( doing the binomial probability thing bears this out).  Our chances without IVF:  "As close to 0 as you can get without actually being 0."

He looked at Jakobe's SA and said that the volume really didn't matter, because everything else sucked. He described the motility as "every so often - one of them twitches."  I guess we've got twitchy sperm.  So - Jakobe wants karyotyping because Dr. R brought up the possibility of mosaic Klinefelter's syndrome. He doesn't think that it's likely - but Jakobe wants to be sure.  Thankfully - it looks like most of the screening tests are covered under insurance.  They don't have an infertility code attached at all - including the karyotyping.  So - Insurance should cover it.

I did my CD3 blood work again today - so we'll see what it looks like this year.  While we were there - He did a basic exam - determined what size catheter to use on my cervix, and got some good shots of my ovaries and uterus with the ultrasound machine.  I don't have any idea what look was on Jakobe's face during the actual exam - but he thought that the ultrasound was pretty damn cool.  I really just felt uncomfortable.  Exams during my period are a lot more painful for me than usual - so it was even further on the "not fun" side of things than usual.

The plan: We don't have one.  The cost figures didn't even start to sink in for Jakobe until we were sitting there in the office.   It didn't really matter that I had told him how much I thought it would be - it wasn't real for him until he saw it in black and white on the piece of paper there.  It's making him very hesitant.

We talked a bit at lunch after the appointment, he feels like I've already made up my mind.  In a way I have - I know that I want to do.  I also Know that what we do has more to do with what we both want, and what we can both accept.  I don't get to make these decisions on my own.  We're a partnership, and we have to make them together.

It turns out that Dr. R does have a shared risk program.  It's a 3 cycle package (no refunds) where you pay for slightly less than 2 cycles upfront - and you can have 3 fresh cycles. It doesn't include the cost of anesthesia, medications or ICSI, which we would pay for at the time of each cycle - but I think that if we go ahead with IVF - the 3 cycle option is what we'll do.

I'm thinking that now may really be the time for us to take advantage of the EAP (Employee Assistance Program) and maybe a see a counselor.  Hopefully there is someone in our area who has some experience helping people to make decisions like this.

For now - we'll keep thinking, and trying to figure out what we're going to do.  And - maybe I'll have a good cry.