Another Reason to see a Fertility Doctor

I thought there was a big stigma attached to going to a fertility doctor. When my OB strongly suggested it over our disagreement over progesterone, I was upset. I kept thinking, I don't need a fertility doctor, I can do this on my own.

From previous posts you might have read that once I met with my RE I felt so much better, like we had a plan if the natural route didn't work or if I did in fact have a luteal phase defect.

Now that I am pregnant there are a couple things that truly made me appreciative of having a fertility doctor.

1) Her whole job is to get you and keep you pregnant. She has more tools at her disposal and knowledge than a regular OB/GYN whose primary function is keep you healthy and help you deliver a healthy child. OBs pretty much can offer you clomid. But many REs feel that clomid should be used with IUI because of the affects of the drug on CM. An OB can't perform IUIs.

2) The level of responsiveness is unparalleled by any doctor I have ever dealt with. You can get your doctor on the phone and in my experience she remembered me, or at least was courteous enough to review my file before calling me. You can get in the same day for blood work (betas, progesterone) or an ultrasound need be and results usually came a couple hours later for me.

3) My first month trying after surgery, my progesterone was tested 6dpo and it was high but at 10dpo I started spotting. I called her 11dpo. She personally took my call and said it was an unusual way to present but wanted me to get checked out before she put me on progesterone moving forward. I went in the next day and it showed I did have a problem. She wrote me a prescription that day to start using the next month after ovulation. It wasn't a fight about the use of progesterone. I wasn't forced to go on Clomid either.

4) Here is the biggie. Even though I conceived naturally, I was still in the care of the RE. As her patient, she insists (and I happily obliged) to do an ultrasound every week until the 9th week. At that time a healthy heartbeat has been sustained and you get released to your regular OB. Again this comes back to my theory that an RE is all about getting you and keeping you pregnant and an OB is all about your health. When you go in, there isn't a weight check, urine test, blood pressure screening. It is just an ultrasound. She would always ask me how I was feeling, but it wasn't like I came in with a big list of questions. She also did the ultrasounds herself, not a tech, which made me feel better. She was very understanding of my anxiety and my spontaneous explosion of emotion the first time I saw the baby's heart beating. Once you go to your OB, it is more about you. You get tested and checked but it isn't fun because you aren't seeing your baby. One more point, it is truly an unbelievable experience to have 4 ultrasounds in successive weeks because the sixth week it is a little blob where you can see the heartbeat. The seventh week you can see tremendous growth and hear the heartbeat. The eight week I saw legs. And at the nine week appointment, which my DH joined me for, we saw our little baby kicking. A normal OB won't allow you to have so many ultrasounds.

All in all, for me and many, it was a big psychological hurdle to go to a fertility doctor. I think it was one of the best decisions I ever made. What is the point of putting it off because of pride? Just because you go doesn't mean they are going to push you into fertility treatments. They first will check if you have an underlying problem (or you man) and then gauge how aggressive you want to be.

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.

Well I'll Be...

I guess my doctor didn't like being on a break either. While yesterday I made peace with going to the fertility doctor, she was reconsidering. Turned out she called the Fertility doctor (the main guy not the one my appointment is with) and asked his take on my progesterone request.

He told her that he agrees that LPD (luteal phase defect) should be treated with clomid, but if I am insistent on progesterone supplements than "it isn't worth arguing about". He said it wouldn't do any harm and if it brought me peace than go for it.

So that means we aren't on a break! She said if I get a BFP I should come to her not the fertility doctor and I should cancel my fertility appointment.

But here is the catch, if I cancel that appointment my mother in law will personally drag me out of the house by my hair (making note not to hurt my healing uterus) and then my mom will roll over me in a semi truck. They are both thrilled that I am "finallllly" (to be read exasperatingly) seeing an expert.

What I realized is I don't know if I have LPD because I haven't tracked my cycle since my miscarriage in April and now I don't have the mutant fibroid. So all I want is to try the first cycle on my own, if I do get a BFP, bring on the progesterone need be, and if I don't I will take the clomid.

I am going to keep my appointment and at least get a game plan in case I do have LPD. And this way my mom won't live with the guilt of maiming her daughter.

Well that didn't go as planned.

Back from the doctor's office. She came in and looked at the incision and said it looks good.

I mustered up the nerve to confront her on the progesterone issue. She said, studies show that it doesn't do anything. And I said well I have friends that have had 3 miscarriages and then they take it and have healthy babies. She said, and they would have been fine without it. I said my friend was spotting for days and took it and now she is fine and she said and your friend would have been fine and the spotting would have gone away on its own.

I asked can't you budge on this, it makes me so nervous. She didn't budge. So then I mentioned the fertility doctor said people with luteal issues might need it and my LP has been bad since last year. She said I think it is good idea if you set up an appointment with her. She can look into the luteal phase issues.

A minute later she something about clomid. So I should, well should I just forgo trying on my own and go straight to clomid? She smiled and said, I think you need to speak to the fertility doctor. I asked who would be doing my next HSG and she said either one of us can.

I've been dumped. She wasn't pissy. She said if I had trouble getting an appointment call her and she would make a call to get me in right away. She told me what to do to get my file copied. And she was like, "alright my dear, I will see you in 4 weeks." Oh also I said who would be my doctor if I got pregnant (since I was being dumped) and she said the fertility doctor would monitor me for a while.

I set up the fertility appointment for next Thursday morning. I asked the doctor if I would be starting back at square one and she said now they will have your file.

I feel a bit defeated by this. It makes me think I can't do this on my own, that nobody thinks the fibroid was an issue at all and I have even more fertility problems than the mutant fibroid.

I feel like crying (which is out of character for me) and the Noah Wylie commercial with the endangered polar bear didn't help at all.

I'm Down with HSG- Yeah You Know Me

Yesterday was the big day I have been building to for 1.5 months - the HSG.

I worked from home in the morning and then when I went to leave to pick my husband up, I couldn't find my keys. I looked around like a crazy person, called my husband accusing him of taking my keys, and then looked through the garbage. Turns out they were under a magazine on the kitchen counter. Point being, I was so nervous after what I had heard and read.

I might have mentioned it in a previous post but my friend at work told me to "bring a towel or stuffed animal to bite into (for the pain)" and that she screamed "get it out" during the procedure. And she is not a girly girl. She likes hiking and things don't seem to phase her much.

Okay, so we get to the hospital and my husband seems more concerned with getting something to eat than my apprehension. I told him to grab food and meet be back in the waiting room.

So the test is in the radiology department, not the OB department. They give you a pager, like you are at the Cheesecake Factory. Greg came back carrying a tray with tortellini and was lamenting that they advertised a taco salad but they ran out (his biggest concern of the day) and before I could get pissy, my pager went off.

Next I am escorted into a dingy locker room. They gave me a hospital gown to put on and sock booties. It was weird, because you put this stuff on and instantly feel like there is something wrong with you. After changing, you are ushered into the ladies locker room waiting area. I was there for about twenty minutes and they called me. BTW, at no point did I have the option of bringing in my husband- maybe because of the radiation.

As the escorting nurse led me through the hall, I looked like a scared sheep. She said, "you look nervous". I said, "I heard this is excruciating". She said, "I am not going to lie, it hurts, but you'll be okay." Unconvinced, I shuffled on in my hospital booties.

Once inside the room, my regular Ob was there, clad in a radiation vest you wear at the dentist.

You climb up on a stool and onto an x-ray table. They essentially put your butt on what looks like a puppy pad. The doctor told me the results would need to be discussed with a radiologist.

Getting back to the pain, the doctor said this will give me a glimpse into childbirth without an epidural and the nurse said if I have to practice my opera singing (meaning screaming), go ahead.

I asked the doctor if it would hurt the whole time or just when the fluid went in and she said the whole time but different types of pain.

That was then I started practicing the Lamaze breathing you see on TV. I had flashbacks to the Cosby Show episode when Alvin, Theo and Cliff were pregnant. You might recall one gave birth to a boat and one a sub-sandwich.

I have to say, given how this was built up, it wasn't that bad. It hurt but I kept breathing deeply. And before I knew it, it was over. I think it took 8 minutes.

Results: My fibroid is huge and covering a tube and part of my uterus. Since it is impinging on my uterus it has to come out via surgery.

Next steps: My doctor is going to consult with a fertility doctor (I haven't met with a fertility doctor yet, but my doctor will make the contact)this week and get back to me by end of week to tell me what their consensus is (type of surgery).

Afterwards, I felt crampy. But not horrible at all.

Bottom line was, it really isn't that bad. Take 2 Advil before you go in and try to relax during the procedure. I wouldn't rush to do it again, but if a friend had to have it, I would say, it isn't so bad, it will hurt for a couple minutes, but nothing you can't handle.

If you have questions I didn't address, drop a comment and I will get back to you.