So I went to my appointment yesterday. I was good and introduced myself to the practice administrator guy before I went in. That was fine. I brought copies of my charts since my last appointment (May), carefully marked with my all-new premenstrual spotting, as well as the intermittent ovarian pain. (I discovered when marking it that it generally appears somewhere around CD7-10, generally lasts about three days, and remains through the first day of fertile CM, then leaves.)
Dr. L/C was focused on getting me a new prescription to stimulate ovulation, but I managed to drag the focus back to doing something about the ovarian pain, which I believe to be cysts. She did an exam and said that there was no indication of cysts, and also noted that the pain doesn't appear in my cycle where an endometrioma would cause pain. (I already knew that, but darn it, it feels like cysts to me.) She didn't have any specific ideas - possibly scar tissue around the ovaries that tightens leading up to ovulation, she said, but she wasn't sure.
So, the plan is that I will get an ultrasound right before ovulation and see whether the culprit can be spotted. If it is something cyst-related, we can make a treatment decision then. She didn't think depo would be all that helpful (lupron and the like shrink adhesions, but endometriomas are more serious and she would not expect them to comply). If there's nothing wrong with me (you know, other than me being in pain), then I have various treatment options...she proposed tamoxifen, clomid, or femara (oh joy! Apparently, femara is now an option without a fight).
I also asked about HCG shots, and she said this supports good hormone levels post-ovulation, rather than a strong ovulation. She seems more concerned with the latter (I mean, fair enough, since I'm not pregnant). Because of the premenstrual spotting, it seems to me that the only thing obviously in need of remedy is my post-peak progesterone level. So maybe I will lobby for femara and HCG, or something. But only after seeking out the cysts (I still believe they're cysts) and doing post-peak bloodwork to check on the hormone levels.
My husband is very relieved to hear that the doctor does not think I have cysts. While I cannot argue with the reasonableness of this response, I disagree completely. I have had lots of cysts. If the prognosis is that surgery could (temporarily) fix the problem and something else might perhaps help in the meantime, and the problem is a serious impediment to fertility (but hardly the only one), that doesn't seem so bad to me. If the prognosis is that surgery probably will not help the problem and would not in any case be advisable, and that no medication (including analgesics) will do anything whatsoever to limit it, and I will be in pain for years (but there's no impairment to my reproductive health) - then I'm not happy. At all.
I guess this means I'm not just kidding myself when I say that I no longer hold out hope for a child, and just don't want to live the rest of my life in pain. I know there are people with much worse problems, but that seems like so little to ask.
Oh, and I didn't actually discuss my historic problems with Dr. Lorna. She appeared in a massive rush from her last appointment (mine was late because some pre-op patient decided to show up three hours late and the nurses had committed to seeing her "whenever she could make it," which I don't hold against the doctor). And she didn't seem hostile. And she offered the femara,* which is what I had originally wanted. Some people like to hash things out, some don't...some (like my crazy family) prefer to make nice by making up for problems rather than talking about them.
For now, I am going to accept that that's where we are and proceed with the next round of diagnostics. And, at the same time, I need to be looking into other options. At some point, I will gather my courage to make the requisite phone calls.
*For some peculiar reason, I initially wrote "tamoxifen" here. As I have documented thoroughly elsewhere, I DO NOT LIKE TAMOXIFEN.