Questions to Ask Your Fertility Doctor

I know when I first was told by my OB that I should see a Fertility Doctor, I felt like someone punched me in the gut. I thought I don't really have a fertility problem- I had a fibroid, had it out, and now I will be normal again. Regardless my mom and mother-in-law wear waiting with baited breath for me to see a specialist.


I am so happy I did, because I left with two things: hope and a plan.


There are generic questions that I think everyone should ask and then some more specific questions about your own situation.


When you meet, your doctor will take a very in depth history of your TTC struggle. Make sure to have you OB fax over or deliver a copy of all test results to date (everything from thyroid to blood clotting disorders).


Here are some things to discuss:

1. Hours of operation: Let's face it, once you go down the assisted reproduction route, you will have lots of appointments. If you have a full-time job, this can be difficult to run out everyday during lunch to see if you sprouted follicles overnight. Many clinics offer testing at 7am and after work hours. Weekend hours are also critical because your ovaries don't take Saturday and Sunday off just because your doctor does. My doctor has morning and evening hours as well as limited weekend hours.


2. Blood test results: My regular OB takes about 36 hours to get blood test results. As many of you know this is agonizing. At my Fertility Doctor, if you take a blood test by 9am, you get results by 3pm the same day. If you are like most TTCers, this is a huge benefit.


3. Success Rates: How successful has your doctor been with IUI, IVF, etc. Also, make sure they are citing live births, not just BFPs.


4. What tests will she run: My RE ran more thyroid tests than my OB had. She also did a genetic screening for diseases, she tested progesterone levels 6dpo and 12dpo, and a second HSG. This is particularly important if you have unexplained infertility.


5. Accessibility: My doctor prides herself on speaking to you the day of your call. In fact, she asks that you leave her a message when you go in for blood tests, so she can call you as soon as results are in. It is also fairly easy to get a hold of her nursing staff.


6. Costs: Like me, many people have no fertility insurance. Get an idea of what procedures cost. My doctor didn't let me get to far ahead of myself so we only talked about the costs of Clomid+trigger+IUI, which she thought with all the monitoring would be around $1000 with no insurance. Find out if you pay upfront if you get a discount or if they have payment plans.


7. What's her plan for you: My doctor had a clear plan, try for four months, if not pregnant, we will get my husband tested, start clomid (IUI if I wanted) and if that didn't work after a couple months, we would do IUI. After the discovery of my Luteal Phase Defect last month, the plan has revised. We will try for a total of two more months naturally + progesterone after ovulation, and if that doesn't work, clomid+IUI+progesterone. You want to leave knowing how many times you will try each step until moving on to your next options.


8. Does your doctor trust your gut: All along I felt I had a luteal phase problem and my OB attributed it to poor ovulation. My RE respectfully disagreed and I was proved right last month when I started off with a great progesterone number and it tanked. My OB would have forced me to take clomid while the RE said let's try supporting the Luteal Phase with progesterone before we put clomid in the mix.


9. What else can I do to help me get pregnant: she might suggest baby aspirin, b-6 vitamins, progesterone, lose or gain weight, more exercise, less exercise, a specific diet


10. At what point do I go back to my OB: For me, as soon as I get my blessed bfp, after calling the Chicago Tribune and my third grade social studies teacher, I will call my regular OB to let her know that I am pregnant and set up a 12 or 13 week appointment. My RE will keep me until 9 weeks when she can confirm my baby has a strong, healthy heartbeat.


11. How do you treat recurrent miscarriages: If this has been an issue for you, find out if you will get additional screenings and what she does to try and sustain pregnancy.


12. How does she feel about pregnancy reduction: This is a good question to ask yourself and discuss with your man. It is proven that carrying multiples increases the risk of health problems for mom and babies. Some doctors don't want a mom to carry more than twins while others will feel comfortable with you carrying many more. Discuss her stance. This is a reality you will have to discuss since many fertility drugs stimulate the creation of multiple follicles.

I will end with this bit of advice. A friend of mine who is about 12 years older than I am went through fertility hell to get her daughter. She told me to go to a fertility doctor about 4 months before I did. She said just do whatever it takes to get a baby and don't waste time. She said she wished someone would have told her that when she started. I didn't take her advice because I was hell-bent on doing it naturally. And now I am sitting her absolutely agreeing with her. I honestly don't know what I was trying to prove with my puritanical approached to trying to conceive.


This morning I was on the phone with my sister-in-law. She was two weeks behind me in pregnancy with her second. Obviously, mine didn't work out. I have a beautiful baby niece now. As we were talking, I could hear my niece making the cutest sounds enjoying cereal, her new found food. It is times like this where it just hits me. The baby I was pregnant with last year would have been 6 months old and in all this time, I am not even pregnant.


So if you are on the fence about going to the fertility doctor, I say what do you have to lose other than months of frustration. While it might be scary to hear there is something wrong with you or sometimes worse, we can't find anything wrong with you, it is important that you have this ally. A fertility doctor is dedicated to getting you and keeping you pregnant, simple as that.

Understanding Semen Anaylsis Results

Time to share the blame! Approximately a third of all fertility issues in a couple are attributed to semen problems. It is easy to assume that if you aren't getting pregnant, it is your fault, but it is definitely beneficial to get your man checked out before starting invasive procedures or taking fertility drugs. In fact, both my fertility doctor and OB insist on a semen analysis before prescribing clomid.

How it works:

• He collects a sample. Depending on distance from lab, you might be able to collect it at home and bring it in immediately (within one hour). They don't want it getting too cold or too hot. It is recommended you hold it against your body to keep it at the right temperature. The lab might insist he provide a sample in their office. They will give him a private room to "collect" himself.


• Your OB or Fertility Doctor can write the orders for the semen analysis. Otherwise, he can see a urologist.


• He might be asked to abstain for ejaculation for 2 to 5 days prior to the test. His doctor or lab will provide specific restrictions. However, they typically want you to have sex within two weeks of the test to insure the sperm are active.

What it shows:

• The results will show if he has a healthy quantity and quality of sperm.

Normal Results:

• Volume of ejaculate (how much semen is present in one ejaculation): 2.0 ml or more


• pH (the acidity or alkalinity of the semen): 7.2-8.0


• Sperm concentration: 20 million per ml spermatozoa or more


• Total sperm count (amount of sperm in 1ml of semen): 40 million per ml spermatozoa per ejaculate or more


• Motility (percentage of sperm that can move forward): 60% or more with forward progression


• Morphology (percentage of sperm that have a normal shape): 30% or more with normal forms


• Vitality: 7 5% or more live,i.e.,excluding dye


• White blood cells (white blood cells normally aren't present in semen): fewer than 1 million per ml

Terms used to discussed results:

• normozoospermia: results are normal


• oligozoospermia: low sperm count


• asthenozoospermia: poor sperm motility


• teratozoospermia: sperm have more morphological defects than usual


• oligoasthenoteratozoospermia: signifies disturbance of all three variables above


• azoospermia: no sperm is semen


• aspermia: absence of semen

Bad results, now what:

• The information from the semen analysis will help your fertility doctor determine the best way to treat. Some situations require surgery, however drug treatments or assisted fertility (IUI, IVF) might just do the trick.

Sources: www.med-direct.com, www.webmd.com, www.wikipedia.com

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Can Cough Medicine Lead to a BFP?

Anyone who is anyone in trying to conceive knows the importance of EWCM (egg white cervical mucus). It is the holy grail of CM because it means you are most fertile. What distinguishes EWCM for other CMs, besides it being well timed with ovulation, is its actual physical properties. It is thin and stretchy, allowing sperm to travel more freely in its journey to your egg.

Some people fret because they don't create enough EWCM. Those who take clomid might notice their cm dries up or becomes thick, making it difficult for sperm to reach the egg. TTCers have thought of any and everything to combat such problems. One of the more interesting approaches is cough medicine.

It makes sense to me. When you have chest congestion or a cough, you take cold medicine to break up the congestion, or mucus in your lungs. There is an ingredient in cough medicine that is responsible for this: Guaifenesin. This is an expectorant that thins mucus in the lungs, allowing you to cough it up. The medicine can't distinguish between lung or cervical mucus. It works systemically, so it will affect all mucus membranes, including cervical mucus. This ingredient causes CM to thin out and become more stretchy, allowing sperm better transport through the cervix.

Not all cough medicines are created equal. Per my research, you want the only active ingredient to be Guaifensesin. I can't stress this enough because other ingredients can actually dry up CM. I looked at a ton of Robitussin and Mucinex products and they are not interchangeable. Some cough medicines don't contain Guaifenesin at all. Some have too many active ingredients that can dry up CM. Others don't contain enough Guaifensin. According to the cough medicine wives tale, you need 600 mg of Guaifensin. I could only find Robitussin up to 200mg, while the Mucinex has 600mg per dose (take 2 a day). Also, Robitussin is a syrup and Mucinex is in pill form. I personally would be more inclined to try the Mucinex for this reason alone.


After researching this, the only product I would recommend is Mucinex Expectorant with 600mg of Guaifensesin. I included a link at the bottom of this entry.

From my reading the recommended dosage is to take Mucinex daily for the 5 days before your expected ovulation and stop the day after ovulation. Typical daily doses are 1200mg for the day.

If you have high blood pressure, thyroid issues, or take medicines you think might have a negative interaction, you might want to check with your doctor before trying this approach. In general, it is a good idea to check with your doctor before taking "unnecessary" medicines.

Preseed: What you Need to Know

If you spend your days learning from other TTCers how to best up your chances for conception, you have probably come across a product called Pre-Seed . Pre-Seed is a lubricant that mimics your natural cervical fluids. Unlike most lubricants, it is sperm friendly (some lubes actually kill sperm or decrease their motility even though they aren't labeled as spermicides). Pre-Seed makes the sperm's journey to the egg and easier ride. It was actually formulated to aid in conception.

People swear by it. My friend used it and got pregnant the first time. Personally, I have never tried it. It is particularly helpful for people on clomid. Clomid changes the chemistry of your CM, making it thicker and harder for the sperm to travel.

Customer comments on Amazon are very favorable but some people caution it isn't a magic baby pill. People like that it is easy to use (comes with applicator) and doesn't feel sticky. There are a good number of people that say they got pregnant their first shot using Pre-Seed . One person wrote she had been trying to conceive for 5 years, even tried clomid in vain. She used Pre-Seed and fell pregnant. Another person wrote on drugstore.com that she tried for a year, and then used Pre-Seed and got pregnant. The majority of posters said they got pregnant with Pre-Seed.

In terms of price, I have seen it cost as much as $19.99 however, I found this link for just $16.50. This comes with 6 applicators. So it seems like a month's supply.

Based on the testimonials I have read, if you have been frustrated and are contemplating more invasive steps (clomid, IUI) then this might be an easy, cheap thing to try first. Also, if you tend to not have a good amount of fertile CM, this might be exactly what you need. Based on the testimonials, I am more inclined to use it than before.

Let me know if you have used it and did or didn't have success.

The 411 on Clomid

With Clomid being dangled in front of me like a baby-making carrot, I set out to learn more about it. Here is some information about what it does, how you take to, side effects, risks, and success rates. I would love feedback from past users to hear if it was successful for you and any side effects you have had.

What is Clomid:

• The most commonly used fertility drug that stimulates ovulation about 80% of the time
• It works by stimulating hormones that cause ovulation

How do you Take Clomid:

• Pills are taken orally early in a woman's cycle (Typically CD 3-7 or 5-9)
• Typically, you start off with the lowest dose, 50 mg. If this proves unsuccessful in achieving ovulation or pregnancy, the doctor may increase the dosage all the way up to but not exceeding 150mg
• Often used in conjunction with IUI treatments (artificial insemination)
• Some doctors monitor your follicles to see if quality eggs are being produced, others do not
• Many doctors have patients do what is called the Clomid Challenge. This is used to evaluate a woman's ovulation and egg quality or ovarian reserve. Clomid increases FSH levels after 5 days of use. On the sixth day, the FSH blood level is drawn. It it drops back to normal levels, then ovarian reserve is normal. If it is high, it indicates a low ovarian reserve (your body is working harder to ovulate)

Who should take Clomid:

• Clomid is administered when there is a known problem with ovulation, but no physical problem, i.e. blocked fallopian tubes
• People with irregular cycles or anovulatory cycles (don't ovulate)
• Woman with PCOS have had good success with Clomid
• Used commonly for people with unexplained infertility
• People with Luteal Phase Defect may take to achieve a strong ovulation and produce more progesterone to lengthen the luteal phase

Side Effects from Clomid:

• Nausea
• Bloating
• Dizziness
• Blurry Vision
• Breast Tenderness
• Hot Flashes
• Moodiness
• Ovarian Hyperstimulation Syndrome

Risks of Taking Clomid:

• The risk of multiples is exponentially higher on Clomid than natural conception. The twins rate is 10%
• Triplets and multiples of higher order are much more rare, with a 1% chance
• Clomid can decrease the amount of cervical mucus present and makes transporting the sperm to your egg more difficult
• Potentially, Clomid can thin the uterine lining, making implantation harder to achieve
• It is not recommended to take Clomid for more than six cycles

Success Rates with Clomid Use:

• 80% of users will ovulate
• 30% of users get pregnant their cycle of use
• 40-45% of women using Clomid for 6 cycles will achieve pregnancy

Sources: infertility.about.com, webmd.com

B6 Vitamin and Your luteal phase

Big caveat- I am not a doctor and don't pretend to be one on a blog. I have, however, read an awful lot about how to get pregnant. One common problem (which I might still have, we will see after charting this cycle) is a Luteal Phase Defect.

Essentially, the time between Ovulation and Menstruation should be 14 days, but really needs to be a minimum of 11 days in order to sustain a pregnancy. If your Luteal Phase is short than 11 days, you might not be able to get pregnant or if you do, there is an increased chance you will miscarry. Basically, your uterine lining sheds to quickly, starting your next cycle.

Doctors tend to want to treat Luteal Phase Defect with Clomid. Clomid is highly effective, however, for those not willing to risk the chance of multiples or feel uncomfortable jumping to fertility drugs without trying less invasive approaches, you answer might be in the form of a super vitamin- B6.

B6 has been shown to lengthen the luteal phase. Reports vary about how much you need, 50mg - 200mg. Most pre-natals have some B6 in them, but not enough to lengthen your Luteal Phase. Stand alone B6 vitamins are available and are relatively inexpensive (less than $10 for 100 capsules). B6 is also found in foods like yeast, whole grains, eggs and meat.

If you suspect you have a Luteal Phase Defect, you should chart your cycles. Once ovulation is detected, make sure you have at least 11 days before your next cycle starts. If so you are probably in the clear. If you notice it is at least 11 days but have spotting prior to that, you might want to consider taking a B6 vitamin supplement.

I personally was taking 50mg a day in conjunction with my pre-natal. When I ran out of vitamins, I bought a new bottle with 100mg of B6 a pill. Since I haven't charted since my miscarriage in April, I don't know if it has been affected, but will be sure to report back to you. I did not take B6 prior to my second miscarriage.

Check this out- Comedian making fun of TTC

Someone referred me to this link of a comedian talking about his wife's efforts for trying to conceive.

www.in.com/videos/watchvideo-nick-d...

The Fertility Doctor- A Ray of Sunshine

I heart my fertility doctor. I even granted my mother an "I told you so". Let her have her moment of maternal glory, she was right, I should have been dealing with a fertility doctor.

I got to the office which was actually inside the hospital. I can't say it is the swankiest office but the staff was nice. I notice people of all ages in the room. While I was at the front desk, a woman walked in who looked 48 came in and the receptionist asked how her baby was. So seems like they are having lots of success.

The doctor met me and took me into a room to talk, not an exam room which I appreciated.

Reasons I heart the fertility doctor:

1) she was the first person that admitted she thinks the fibroid was my problem, she said we don't know for sure but it majorly distorted my uterus.

2) she wants me to started getting my progesterone levels tested 7 days post ovulation and if it is low she will give me supplements to help support a pregnancy if indeed I were pregnant. She said there is a small subset of people that do need progesterone supplements. No more arguing this point.

3) she made several comments that given my age (31) she didn't want to jump to drugs or more aggressive treatments- meaning I am young.

4) they have screenings and blood tests between 7 and 8 in the morning so you get same day results so they can take action right away, like progesterone and HCG levels, which works out perfectly since I am impatient. They are open 7 days a week. When I had the first pregnancy I had took a beta test on friday and didn't get results back until Monday and couldn't get the second round results until Tuesday. I was so anxious.

The Plan

1. She told me to start taking one baby aspirin a day. Some minor blood disorders aren't picked up on a panel test and the aspirin will help.
2. She had me give blood for genetic diseases, a screening I didn't have yet
3. I have to schedule another HSG, ugh, as soon as my cycle starts so that we can see if that tube is still blocked post surgery and if the surgery caused scar tissue. Not looking forward to this but at least I know what to expect this time.
4. I will track ovulation and come in to get my progesteron measure, I will also chart to track my luteal phase.
5. Assuming LP and HSG are normal, I will try on my own to get pregnant for three or four cycles.
6. If not pregnant on my own, I will take clomid and be monitored. You go in on CD3 and get an ultrasound, take pills days 3-7, and get monitored a week later, get a trigger shot, and then can either get IUI or given my exceedingly young age (I know I am pushing it) go home and have "timed intercourse" for three days in a row. Then they monitor you after.

I left feeling very hopeful that she thinks I am going to get pregnant on my own and even if I can't she will get me pregnant. She didn't say as much, but she did say most people they do clomid for three months before moving on but because of my history of getting pregnant and age, she would go to six if I didn't want to try more aggressive methods. Also, I don't have fertility coverage through insurance, so we would rather try natural/clomid before tons of money for IUI, IVF.

RE-garding my appointment

Tomorrow is the big day- my first official appointment with the RE. While I don't think it is going to be a typical first fertility doctor appointment (since I haven't been classified as infertile and we don't know if I will have issues getting and staying pregnant now that the fibroid is gone), I do have a bunch of questions.

From what I have read, the hours of a fertility office are critical, because if you are taking a drug that needs monitoring and you ovulate on Sunday, well you are screwed. Also, sometimes they need to monitor you several times a week to look for follicles which means then need long office hours so you can go before or after work.

I also want her take on progesterone to get and sustain pregnancy and how she approaches Clomid. How many times will she give you Clomid before they trying something more serious? Will she make me get another HSG and have my husband tested before giving me the pills? Is she willing to do progesterone draws post ovulation to evaluate my numbers?

Finally, I want to understand better how the relationship works between an RE and your OB. When do you stop seeing the RE and going to OB?

If you have any other suggestions for questions, let me know!