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.

Chemical Pregnancies- Nature's Cruel Joke

My friend's doctor recently told her that she may be experiencing a chemical pregnancy. Given her specific sent of circumstances (beta numbers going up at a very fast rate) I am not sure I agree. That said, I wanted to find out more about chemical pregnancies.

Up until my foray into the world of obsessively TTC, I had never even heard of a chemical pregnancy. Essentially, it is a very early miscarriage. Typically it occurs right around when your period is due. Back in the dark ages, when our parents were trying to have us, they had no clue they were even pregnant. But with early home pregnancy tests, we can find out we are pregnant almost a week before our period is due.

This is one reason some women are against testing early, because you get a positive test, do the happy dance, tell your parents and best friend, and then a couple days later your period arrives.

The most common cause of a chemical pregnancy is a chromosomal abnormality, meaning the baby couldn't have survived. Other reasons are hormonal problems (luteal phase defect), uterine lining abnormalities (such as fibroids), or inadequate uterine lining.

I haven't been able to find in my search what the beta levels are in a chemical pregnancy. One site said a chemical pregnancy occurs when a baby isn't able to be seen on an ultrasound (nothing in the sac). I know from my experiences that my doctor likes to wait until your beta reaches 3000 to do an ultrasound. So by the transitive property I learned in geometry, perhaps a pregnancy that doesn't experience levels of 3000 is considered a chemical pregnancy. This is just my middle-school conjecture, though. It does seem for the ancedotal posts I have read online that numbers tend to be much lower than 3000.

Regardless of how, why, or when it happens, a miscarriage is a miscarriage. The upside for those who have experienced a chemical pregnancy is the knowledge that they can get pregnant. But let's be honest, it still sucks.

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.

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.

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.