Medically, I have a real dilemma at the moment. The only thing that is certain is that I must get off prednisone. 3mg this morning, lets see how that goes... I really don't know why I'm posting this here as I doubt anyone can answer the questions I have, but I need to get it off my chest - it's all starting to keep me awake at night.

For longer term arthritis relief I have the choice of methotrexate or arava. I'm finding it hard to sift through the information relating to the two, but my rheumy says the side effects of arava are pretty much the same as MTX, and that concerns me. I get fatigue, brain fog, nausea and diarrhea with MTX, but I only take it weekly so I'm like that for one day of the week and the rest of the week I'm fine. Arava is taken daily... I suspect he's mainly talking about the completely trashing my liver and other organs side effects, but I'm not sure. My brain seems to shut down every time I try to look up the side effects.

Then there's what I've got to do if I want to go back to IVF. MTX, I stop and keep taking my 5mg folate tablets for 3-6 months and at some indeterminate time I can go back. I don't know if they can actually test to see if my folate stores are fine or not, but that scares me. Not only because of what the folate depletion may mean to any future baby, but because nobody can really tell me exactly what the safe period of time to wait actually is. Up to half a year unmedicated... petrifying. With arava, I stop and have to take a course of another drug for two weeks and then they test to see if it's out of my system. Without the other drug, it can take up to two years to clear. It sounds simpler, but I also figure that there's a reason it wasn't on the table until it started to look like I wasn't getting enough symptom control with a tolerable amount of MTX. And how does all of this change if I'm putting back a frozen embryo? Does it change at all?

Then there's the metformin and my PCOS question. Knowing how absolutely shocking my insulin levels were pre-Sam even while on metformin, I suspect I should be back on it now... but the doctors can't seem to agree and I don't even know if there's any problems combining metformin with my arthritis meds... Currently all they want to do to control my PCOS is put me on the pill, but I know that's just masking the symptoms rather than doing anything to actually correct the imbalance.

I just want someone to tell me what to do! I suspect I should go back and see my IVF doctor and get his opinion on all of this, but I can't locate him after his old clinic booted him out. And he changed his email address... And he didn't really care about how we treated the arthritis before, but surely he would have an opinion on whether I should be taking metformin or not and whether MTX or arava is the safer option? But it's impossible to see a doctor you can't find. My rheumy just keeps telling me that he'll give me the information and it's my decision to make, and it all revolves around when we want to try for #2. I can't convince him that #2 isn't up for discussion until my arthritis is controlled and I have been back at work for a suitable period of time!



BW