By the way, if you're looking for a doctor, I recommend cross checking their credentials with Vitals.com. This is a 100% FREE site... unlike some of the sites out there that want to charge you for similar information. Don't fall for it - it's all free here. I love this site because it's easy to find someone in your local area, according to specialty. You can see where they went to school and how long they have been practicing for, as well if they are board certified or not. The site is still fairly new, so there aren't tons of reviews, but I would guess that in the future more and more people will rate their docs on here. I recommend everyone do that, so that as a community we can share our experiences and help others make an informed choice. And no, I am in no way affiliated with this website or company, I just really dig their site.
Anyway, back to my appt...Luckily, I had a 9am, so there wasn't much waiting at all. One of the nurses, Marilyn, called me in from the waiting room, introduced herself, took my weight and showed me to the room. I should also mention that my husband went to this appointment with me as well. We decided that it would be good to get on the same page as far as what our options are and it would be good to hear it from the Dr. herself.
Once in the room, Marilyn, took my pulse and blood pressure and proceded to run down a list of questions regarding things like when my last period was, serious family medical conditions, etc. She and my husband left and the Dr. came in. Overall, she was very pleasant and very to the point. She had a question and I had and answer and usually a follow-up question. The first thing she asked was if I have a history of regular periods. When I said no, she took a look at the bloodwork I had done and the BBT charting I had been doing for the past three cycles and said that we need to get me to ovulate - that is priority #1.
She recommended I take prometrium to induce bleeding and call her on the first day of heavy flow to schedule and ultrasound for day3. She said if the ultrasound reveals a cysts over 2mm, then I will go back on birth control for a month and she will up my metformin slightly - both of which would be used to get rid of the cyst and to prevent new ones from forming (I assume that's the role of the metformin at that point). If my ovary looks good and this isn't the case, she will start me on Clomid on days 3-7. Then we BD and wait to see if I've ovulated. She didn't say how she would determine IF I did in fact ovulate (I'm assuming via bloodwork... possibly by looking at my progesterone levels?), but she did say that she is looking for ovulation specifically. If I did ovulate and I don't get pregnant, she wants my husband to get a sperm analysis. If everything checks out with him, I believe she said we will do one more month of Clomid - either that or she wants me to consider doing a laprascopy or an HSG (I don't remember which one because she mention both at one point.)
If I didn't ovulate, I'm assuming she will up the dosage to see if that works... she didn't really say much about that at this point.
I asked her if we should be concerned about hyperstimulation with the one ovary when we use Clomid. She said yes, it can happen, but in her 15 years of practicing, she has never seen it - only once in residency, and she's not sure of that persons treatment leading up to it. I asked her about Femera and if that is maybe a better option - she seemed to very strongly feel that no, Clomid is the better option, that there is more data to support it and a lot of women have success with it. I'm still not sure if I agree with this 100%, but as long as she is planning on monitoring me with an ultrasound, I figure it is worth starting out with her recommendation.
I should also mention that Dr. Keisler herself had the same experience with a one of her ovaries filling up with blood and ruining an ovary and fallopian tube. How weird is that... that I would pick one doctor out of the blue who is in a similar boat as me?!! She said she was able to get pregnant twice after this happening, so it IS possible. She didn't say whether or not she has PCOS.
Speaking of, she didn't really seem super focused on my PCOS like my last doc. The last doc wanted to start with metformin and see what that could do, and this doc, even though she new I have been on it for about 60 days now, she didn't really talk about it much. She did say that she will sometimes start women out with it, but not always. In the case where they are on it and doing ok, she will leave them on it, but that's it. She mentioned in passing that docs thought at one point "oh metfomin, it's the new cure", but that it isn't really. Sometimes it's helpful, sometimes it's not. In the end, I'm not sure how to perceive her take on metformin. From my perspective, I know I am not ovulating yet and I figure it can't be that bad to give Clomid a try and keep going with the metformin in some capacity, so I won't push too much on this issue. It seems that if it works for women, it takes quite a few months and, even then, it's still pretty iffy.
The one big thing I forgot to focus on was the whole hormone issue and miscarriages. I wanted to ask about maybe having a larger hormone check done (particuraly progesterone, estrogen, and testosterone) to make sure my body isn't totally out of whack in this area - if it is I'm afraid that if I don't address it now, and I DO get pregnant, that I could be at a higher risk for miscarrying. After stressing a little about this post-appt, I've decided that it's probably ok to the prometrium and get the ultrasound done and maybe address this at that time, if I go forward with Clomid. Ultimately, I assume I'm ok to wait until I actually get pregnant to really be concerned about this, but I'm not totally sure.
Dang, I also forgot to ask about Vitex! I hate to take it without talking with her first... I have a feeling like she'll say don't bother, but I still might bring it up. I mean, it's got to be better for me to get my body regulated, regardless of whether or not I am TTC or not.
So, tonight I go to pick up my prescription for prometrium. Let the fun begin!