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.

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.