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.

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.

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.

Getting Back to Good

I still contend that it takes the precision of a rocket scientist to get pregnant (unless, of course, you are a teenager and scared to death of having a baby). Despite the work involved (temping, charting,OPKs, fertility monitoring, and let's be honest, doing the deed as a command performance) I kind of missed it.

The last time I new everything anyone would ever want to know about their own cycle was March-the month I got pregnant. After the miscarriage and my doctor's edict "do not get pregnant", I found it liberating not to set my alarm to 5:30am seven days a week to temp, not to pee on a stick 20 mornings a month, and not to date rape my husband after an uneventful and not particularly romantic dinner.

But now that it has been 5 months, I kind of miss it. I want to know if all my efforts have paid off. And let's call a spade a spade, I didn't take my fertility efforts in moderation. To recap I am seeing a reflexologist about 2x a month (though we will up once I can start TTC again), I am taking B-6 vitamins in an effort to lengthen my luteal phase, I started Atkins to help regulate hormones and hopefully help my long cycle, I started exercising 5 times a week without fail, I lost a bunch of weight and I had the mutant fibroid extricated from my body. Now, with the exception of fibroid, these other efforts have been consistent for 4 months and no longer a shock to my system.

I am seriously looking forward to setting the alarm early for my temp (though I got a 20 minute grace period from my DH, he agreed to never set his alarm before 5:50am), using my overpriced but well-worth it monitor, tracking my luteal phase, and of course inviting daydreams of my BFP back into my every day life.

I guess you don't appreciate what you have till it's gone.

How to Chart Temperatures

Just yesterday I was talking with a friend who is about to start trying to conceive. She had heard about temping but didn't know how it works or why it works.


Here is what you need to get started:

• a Basal Digital Thermometer (which is different than a normal thermometer because it goes to a tenth of a degree, so instead of 98.6 it would show 98.67, which believe it or not, makes a difference)
  
• a note pad and pen by your bedside to record temperatures or I keep my iPhone by my bed and record it directly on www.fertiltyfriend.com


• I highly recommend a membership to http://www.fertilityfriend.com/ and if you send me an email, and I refer you, we both get 30 free days. They offer a free service and a premium service. I did the premium service from the get go because you get more features plus charting can get confusing and the premium members can post their charts and experts answer your questions. I have used their help about 3 times, so it has come in handy.

What does temping show?

Your body's temperature changes throughout your cycle. When you first start your period it might be higher and a little more erratic. A couple days in you will see it is pretty low (my is typically between 96.8 - 97.3 degrees). All of these temps for the most part should be in the same ballpark. Once you ovulate, a hormone, progesterone is released. This is a heat-inducing hormone, meaning it causes your body temperature to rise. You will start to notice that your temperatures go up sharply and stay up, which is called a sustained thermal shift.

There are some signs that might indicate you are pregnant based on the temperature shift such as an implantation dip. Sometimes between 7-12 days past ovulation (dpo), you have a sharp drop and then the next day it goes back up, it might mean the egg implanted and your temp briefly dropped. There is also a triphasic chart where around day 9-11 you have a second thermal shift upwards (you are getting even warmer) which might indicate that even more progesterone is coursing through you and you are pregnant. Big warning, I once had a triphasic chart and I was late by 5 days, and not pregnant. But someone with a triphasic chart is more often than not pregnant.

The other important thing to gain from temping is understand how your specific body works. I quickly learned that the day before I ovulate my temperature drops quite noticeably. This is great because it let me know I am super fertile that day. Additionally, on http://www.fertilityfriend.com/ you need to track other secondary signs, such as cervical mucus. Sounds disgusting but you get used to it. There are a bunch of different types but when the consistency is that of egg whites, stretchy and clear, ovulation is approaching. Some people feel ovulation pain or get headaches. You chart all this and over time you might identify patterns.

How Do You Chart

• Set a consistent wake time: you need to take your temp at the exact same time every morning. You have to do it first thing without moving around and don't stand up. Even 20 minutes might make a difference for you, it did for me. I made mine 5:30am because I needed to insure my husband wasn't up earlier, snoozing and waking me up. Keep in mind you need to do this on the weekends too. I would set my iPhone for 5:30 to do my temp and then my alarm clock for 6:20am to get up for work.


• Take your temp using a Basal Digital Thermometer with as little movement as possible. I have read only take one reading, because you will confuse yourself, but I did three because I found them to be inconsistent. At one point I bought a second thermometer and it was completely different from the other. So use just one thermometer but try multiple readings. I have included a link on the lower right hand side of this page for a basal thermometer at Amazon.com.


• Jot down your temperature or load directly into fertilityfriend.com on your phone or laptop.


• After you go the bathroom, check for cervical mucus (cm) and classify it. Then load it in www.fertilityfriend.com, along with your temp if you haven't done so already


• 3 days after ovulation (showing you have a sustained thermal shift) you will get crosshairs on www.fertilityfriend.com. Basically a red X and Y axis are draw and your ovulation date is pinpointed. I included an image of a chart for you to see what I mean. The vertical, Y axis is the date of ovulation. The horizontal, or X axis is the coverline. Seemingly, all temps (except maybe a few at the start of your cycle) should be below the coverline and temps after ovulation should be above the coverline.



• At this point, if you have the premium membership, you will get a pregnancy signs tracker that rates your symptoms.


• If the end of your cycle comes (typically 14dpo) one of two things happen, you will see a precipitous drop in temperature, this means your period is on its way and you should get it that day or the next OR your temps stay elevated which is a good indication you might be pregnant. But keep in mind so people have longer luteal phases and some have fluke cycles. By 14dpo, if you have held out this long, take a pregnancy test.

Some other points Fertiltyfriend.com

• you can track exercise. I love this feature now that I exercise a lot, but wasn't a fan when I wasn't exercising that much and saw other people who seemed to live for marking it on their chart. It does look good to look back and see how much you did


• You can take notes about anything like, "did 60 minutes on the elliptical" to "felt dizzy and had no appetite."


• You can mark a million ailments, like tender breasts, tired, increased appetite, all the little symptoms your might obsess over and convince yourself mean your are pregnant


• You can track doctor appointments


• You can look at other peoples charts in a chart gallery and search for people with similar patterns (which is helpful for the neurotic conceiver like myself). This might be a premium only feature, I am not sure.


• You can input test data, such as ovulation tests, pregnancy tests, and there is even a box for the Clearblue Easy Fertility Monitor which you can select low, high, or peak. This helps your correlate all the data, such as knowing you get a peak generally 1 day before you ovulate, not the exact day of ovulation.

Charting helps you learn your body and to be more aware of primary and secondary fertility signs. If you are having trouble getting pregnant, I would definitely try this for a couple months before putting yourself through expensive and sometimes painful testing.