New Doctors. Lots of Appts. Full Steam Ahead!

Boy do I have a lot to talk about this time around!

Meeting the new OBGYN
So, as you may remember, my last OB left the St. Louis area and left me high and dry. I had only been going to her for a little over a month. At first I was really bummed because I thought she was "the one" - she too only had one ovary and one fallopian tube, and she was able to get pregnant without too much trouble. However, at my last appointment with her, I realized she might not really know all of what she's talking about. She said she doesn't do mid-cycle monitoring while on clomid, so we had no way of knowing if my follicules were maturing properly the on the first round. She would also talk down to me a bit... more like giving me the look of "you silly girl"... which got old quick.

This idea of going to a new OB wasn't the worst thing ever as a result. I was hopefully she would know more about infertility - she was older so one would think that would mean more knowledgeable. I was wrong - again.

Maybe it's too much for me to be judging her too much too early, but in this type of situation it's half gut feeling and half what plan or advice she recommends. I didn't get a warm fuzzy on either of those. My gut told me "this isn't the one"... it was pretty obvious too because my husband said afterwards "I thought that if she told you to calm down one more time you were going to scream". I guess my body language is pretty outspoken.

I DID like the fact that she asked more about my female history than any other doctor ever has. It's amazing how reassuring that alone can feel. When she took a look at my chart and saw that this second round of clomid was, at the time, 52 days long, she said "that is unacceptable". She was baffeled as to why the clomid didn't work and asked why the last OB upped my dosage. (Remember that was done with the intention of it upping my ovulation date). I honestly think she thought I might have hyperstimulated and asked that we do an internal ultrasound that day. In the ultrasound room she took the time to show my husband what we were seeing - again my uterus looked good and I think she said my lining was at 5mm (not sure what this means for CD52 and she didn't really say much either).

Then she asked what ovary I still had intact. I am embarassed to say I can NEVER remember the answer to this question. I mean really - it's not like I dress it every day! For the record, if you must know, I have my left ovary (and apparently a little of my right still). I believe that she said I had around 5 or so follicules, but I don't remember for certain. I do know that she said there were several follicules that were not ovulatory follicules (were too small I think) and that there was one larger one, but it was oddly shaped. She said she thought this was because it was on the verge of being absorbed and there was nothing to worry about. She did confirm that there was no PCOS "string of pearl" style cysts present and thought that meant that the clomid was doing something, just not enough. She didn't know why this cycle was so wacky.

I asked about doing an HSG because I was concerned about my only tube being blocked (have read scar tissue from past surgery causing this). She said we shouldn't be looking into this right now because I'm not even ovulating or having a normal cycle. That we should first solve the ovulation issue and go from there. I didn't wholy agree with her - what if it IS blocked and all these months and clomid cycles are for nothing?

I also asked about whether we should have a post-coidal test done, since my cervical mucus was slim to none this time around (wasn't super great the first time either). She again stressed that we shouldn't do this now - it would be too premature because we don't even know if I'll actually ovulate and we would need to time the test around when we think I'm ovulating. I also didn't completely agree with her on this one either. My question is, isn't there another way to still do the test... like have me do the OPK testing and when I get a positive, schedule the post-coidal? Or, since OPKs detect an LH surge, wouldn't it make sense that if I get a positive OPK, I could come in to have bloodwork done to see if my LH is actually high and, if so, do the post-coidal then??

Of course that's assuming that we have Day3 bloodwork to measure from. Which we don't. In all fairness to her, I never mentioned this when she asked if I have had any bloodwork done. I just whipped out the results from the one test I had ((FSH 4.8, LH 18.3, TSH 1.58) which was actually done on CD13 by my OBGYN (3 OBs ago... can you believe I've been to some many different ones in the past 8 months!). That OB said "you can get it done any day", so I did. Honestly, at the time, I think she was simply looking for the FSH to LH ratio to determine if I had PCOS. As you can see it my LH levels are clearly more than 3x what my FSH is. I still think I should have these done again on the correct day - CD3.

She did, however, want to check my prolactin (which could help tell us if I have a pituitary abnormality) and estrodial levels (produced by the ovaries and the brain and will help tell us the baseline of estrogen in my body). The estrodial level is important in part because I have amenorrhea (lack of menses). Apparently estrogen monitoring during fertility therapy is also helpful to assess follicular growth. Seeing as how right now we have no way of knowing if the clomid is actually doing anything, that might be something to check out, though she certainly didn't suggest that. While I'm greatful she mentioned wanting these levels checked, she said I could get the blood work done anytime in the cycle - however, that simply isn't the case. Pretty much any infertility clinic website you read states clearly that estradiol (and others like FSH and LH) must be drawn on CD3. Prolactin can be any day of the cycle. The fact that she said any day makes me really doubt her expertise.

Oh, and I didn't mention that since my cycles are so unpredictable, and therefore my ovulation date is as well, she doesn't want to monitor follicule growth mid-cycle like she normally does. She said it would be "too difficult" and said to just wait it out to see what happens and to call her if it's day 40 and my period hadn't shown. I also don't agree with this decision. I don't really want to keep going with clomid if I have no measurable data with which to make a decision on what to do next cycle. Given the fact that doctors don't like to do clomid for more than 6 cycles (she also practices with this rule), this would mean I am getting ready to embark on my 3rd cycle and come out of it with very little new valuable data. That just doesn't sit right with me.

After talking it over with my very patient, and I do mean patient because I over-talk things, husband, he too agrees it would be silly to continue on the same path with no new info. We came up with few scenerios about what to do (since I'm now on my 4th progesterone pill and will start my period soon, which means that IF we want to immediately do another round of clomid, we'd be starting that on Dec 23, CD3). In the end, we decided I would call around this week to try and find another OBGYN who is more compassionate (I don't think me and this last lady would get along, let alone the fact that I don't think she's very knowledgable in infertility) and has more expertise in infertility. We also wanted to begin calling around to see how long it would take to get in to see a reproductive endocrinologist (RE) and how much an initial consultation would cost.

I had some extra time on my lunch today and was able to get a lot accomplished... drum roll please.... :)

New, new :) OBGYN Appointment Made - He does IUI's!
Dec 30 at 2:30 pm - I came across a local St. Louis baby forum with some OB recommendations and saw the name of a doctor located in O'Fallon, Missouri near Progress West Health Center. The poster said "he does IUI's". I was floored and thought there was no way! So I called and, yes, all three doctors in their practice do them. Not that that's what we will end up doing, but it does make me think that if they do a more advanced procedure like that, surely they know more than your average OBGYN. I have to admit - the only thing that bugs me is that he's a dude. I've never gone to an OB of the opposite sex, but, if he knows his stuff, then I guess it will be worth it. At least my husband will be there with me on the first appointment!

For your reference, the name of the doctor I'm referring to is:

Allied Associates OBGYN
830 Waterbury Fall Dr. O’Fallon, MO 63368 (near Progress West Hospital) (314) 569-2751
Dr. Craig Boyd - 21 yrs experience; board certified OBGYN; can do IUIs!


Appoinment Made with a Reproductive Endocrinologist!
Get this - Dec 23 at 9 am. I am so amazed that he could fit me in so soon! And, hold on to your pants, the consultation cost is: F-R-E-E!!!! Whoo hooo!!!!!!!!! I actually had to ask her to repeat herself and then, when I called back to make the appt, I asked the other girl who answered to confirm that. I just couldn't believe it. Especially since I had just got off the phone with another Infertility Clinic in the area who couldn't get me in until the end of January and who's initial appt cost would have been $300-400. Believe me, I'm still asking myself what the catch is with this other one I found. What's even cooler is that this is the same doctor that I listen to quite frequently on Haveababy.com Life's Online Infertility Talk Radio show. I always make note of who the guest was on the show when I take my own personal notes, in case you're curious what he has to say. It has been a great way to sort of get to know how he probably talks with his patients at the clinic and makes me feel much more at ease. Thus far, he seems to be very kind and knowledgeable.

Here is his information:

SHER Institute, St. Louis
456 N. New Ballas, Suite 101, Creve Coeur, MO 63141

Dr. Peter Ahlering
Obstetrics & Gynecology - 16 yrs experience

Sub-specialty: Reproductive Endocrinology

So... where does that leave us? Well, our tenative plan is to play some massive doctor toss-up. Meaning, on Dec 23 at 9 am I will go see the RE. We will probably talk about my history and he will recommend a battery of tests he'd want done before laying out a game plan. I am going to mention where we're at with our OB currently (getting ready to start a new round of clomid) and see if he has any opposition to that. If not, I will go the appointment that afternoon at 1pm with my current OB to have my CD3 ultrasound done prior to starting clomid that night. Then, on Dec 30 at 2:30 pm, CD10, I will go to the new OBGYN. We wanted to get in to see him before the time when I should hypothetically be ovulating so that if he wanted to do mid-cycle monitoring, we would still have time to do that. Though it just dawned on me that we'll be in Chicago at that time!! I can't believe I didn't think of that until now. Looks like we have something new to talk and think about. Oh well, not going to let it ruin my day. I am on cloud nine with the free consultation and the new OB am just going to trust that it will all work out. If we don't immediately do another round of clomid, then that might be ok, depending on what the new doctors think.

Ok, off to do some last minute Christmas shopping and grocery shopping for holiday parties. Should be fun :P

I started my second cycle of clomid this week!!

Well, I saw my OB on Wednesday. We did actually - that's right, me and my husband! I was so happy about that... it made me feel so much more collected mentally when I was there and it was just nice to have him move involved.

She agreed that I did ovulate last month and I had a perfect temperature rise, which is great news. The not so great part is that I ovulated late on clomid (50mg), which isn't ideal, however I have read mixed reviews on this...

This RE thinks that only short cycles are a cause for concern, and that long cycles usually indicate excess ovarian reserve, which is a good thing.

Whereas, this ART company's site states that "too late" could be anything after CD20 which simply means that there are fewer cycles in a given time period to try for a baby, and that you may be releasing eggs that haven't properly matured, or that the other parts of the reproductive system aren't in sync with the egg. You can conceive late, but your chances are just reduced.

With that in mind, she wasn't sure what to do next really. We asked her if I ovulated late because of PCOS and excess cysts, and she said it's really hard to say why. She said we DO know that the Clomid did "something" because I ovulated and my temps looked good. That's when she started debating on whether or not to do another round of clomid or do supression with birth control. She ended up doing another transvaginal ultrasound to see what my ovaries looked like, and I still had cysts - no more or less than last cycle really, which she said was fine - and the good thing is there were no big cysts. She ended up polling the other OBs in her office to see if I should stay at 50mg or up the dosage to 100mg (the vote was split), and she ended up deciding to up it and move my start date to CD3 - both in hopes that I will ovulate sooner. From what I've read it's hit and miss. I am concerned that the larger dosage might do two things - cause large cysts to develop (which I want to look into more, and to see if metformin actually descreases this chance) and that it might dry up my cervical mucus, which you need so that the sperm can travel through your vagina and into your cervix to wait until the egg pops.


Taking Robitussin to Increase Cervical Mucus
To address the last problem, I am going to give Robitussin a shot. I didn't have but one day with egg white cm last month on the lower dosage of clomid and don't want to chance it being worse.

I did a little research and BabyHopes.com states that you should take two teaspoons (200mg), three times per day. When taking it during a clomid cycle, you should begin the day after your last clomid pill is taken. The site also suggests to take each dosage with a full glass of water. An alternative to liquid that I might explore (if I can't stand to swallow that stuff) is Mucinex, as it comes in a pill form. IMPORTANT: No matter which one you choose to take, the key is that the one and only ingredient it can have in it is Guaifenesin. If it has anything else in addition to this, it could have an adverse affect on your cm. And, yes, you can get the generic form of these drugs - you just have make sure it only has the one key ingredient.

You can tell by the sign on my coffee cup.

At least that's how I feel anyway. Nothing like a big cup of caffeinated brew on my desk to announce that AF is here and that screams "I'm not pregnant" like nobody's business. Fantastic. My temp plumeted on Sunday and again today... so it's official that cycle one of clomid was bust. I'm really trying to focus on the fact that I did ovulate and had a great 12 day luteal phase, but it's a little hard to swallow on the first day of AF. Little did I know that would only scratch the surface on what my Monday would hold.

When I got to work, I started my day at work by logging into facebook to wish my baby brother a happy birthday (20 if you can believe that!!) and learned that a long-lost, long-distance, but very dear friend and her husband are pregnant. Don't get me wrong, I am so very happy for them. They have been through so much in TTC and she is just about one of the nicest, most God-loving women that I'll ever meet. It's just - did I have to learn about it today, of all days! Ugh. And I hate myself for not feeling anything by extreme happiness for them. I am praying that God lifts her up in my mind and shows me hope!

Ok, so my day... as always, it gets better. I put a call into my doctor's office this morning... we wanted to set up a face to face to discuss next steps for the new cycle. There are just too many unanswered questions at this point to feel good about making a rash decision to take a month off and do birth control (to get rid of cysts) or give the green light on the second round of clomid (without having another transvaginal ultrasound to know if there are too many cysts to move forward). Ok, so pretty standard, right? Wrong. The nurse is like "ok, so who's the appointment with - Dr. Kiesler?... you do know that she's leaving right?" ummm... no. Leaving how - like leaving SSM or what? No, like leaving the St. Louis area.

This isn't happening to me. Really, I mean come on! The good thing is that they were able to get us in on Wednesday - which is also good because she'll only be here through next week. Hopefully I can at least get a good referral from her. Who knows!

If ALL of that wasn't quite enough... I officially have a creepy stalker at work. Like legit. I was hoping I was overthinking it last week, but today put the nail in the coffin. People - and I can't stress this enough - today is not the day to screw with me. I will tell you like it is and it WON'T be pretty. Leave me the freak alone!!!

Knowing that, picture me returning to work from lunch to see a big vase of flowers. I immediately am like "shut up" there is no freakin way! But to my pleasant suprise, it was from my super adorable loving husband who knew what a crapola day I am having. Big sigh of relief!

Man, it's gotta get better, right?!?! I don't know how much more I can handle.

When enough is enough with your doctor

I was really looking forward to my yearly exam this past Monday... not something that I normally look forward to, but with us TTC, I was excited about the opportunity to talk to my doctor again about next steps.

For about three weeks now I've had a plan - I wanted to get her thoughts on if the metformin should be upped to 1500mg, if I should have a full set of bloodwork done (to check key hormones like progesterone and estrogen), and possibly to have another ultrasound done to find out what cysts I might be dealing with at the present time (in case she wanted to start me on clomid soon).

And what did I get out of the appt? Nothing. Zero. Nadda. Actually, I didn't even get to see my OB in person, rather I'm guessing it was her nurse practicioner (NP). Which, would normally be ok - maybe not the best scenerio, but I know OBGYNs are busy professionals and that happens from time to time. What I DO have a problem with is the lack of professonalism I received from the NP. Not once did she introduce herself. I still have no clue who actually stuck those things in me, which is a bit frightening. The other thing I found a bit alarming is that I'm guessing she didn't bother to open my file up before she came into the room b/c when she was doing the breast exam she pointed to my stomach and asked "what do we going on here?", referring to my vertical scar beneath my belly button. Well... you see... I ONLY HAVE ONE OVARY AND FALLOPIAN TUBE for crying out loud. Shouldn't a OBGYN of all people know that when they're talking to you?! I'm thinking I should get a black marker and put it on the top of my folder for them. As much as I like my primary OBGYN, it was pretty common for me to have to remind her about that as well. She did, however, appoligize for not remembering that right off the bat, which is nice, but still - not really very acceptable.

The best part about that appointment is that I actually tried to briefly explain my story and ask questions to which I was given what seemed like text-book replies and suggestions, at best. I could respect if she didn't feel comfortable giving me a hard-fast answer b/c she's not my primary OB, but the I would have appreciated if she would have been straigtfoward and told me to reschedule or phone the doctor. Instead, she gave me blanket replies or answers that didn't seem very accurate. Among these were "you know, it really does help to just relax and not stress about the whole situation" (thanks, I haven't heard that a million times) and "you don't need an ultrasound b/c cysts on your ovary really arn't that bad" (which I don't believe is totally correct).

There was lots more, but truthfully, I'd rather not think about it any more. Monday just wan't a good day and this whole week has been way too long as a result. What really didn't make things better is that I don't have many people who I can truely talk to about this and it just gets too much to bare on my own at times.

I DO know that I need to find a new OBGYN. Not because I don't like my doctor, I do, but only when I have her undivided attention, which is VERY hard to come by b/c she's just so busy. Other than that - her staff is not the friendliest and the NP thing just really rubbed me the wrong way. I would hate it if I actually WAS pregnant and had to work with her, so maybe this all worked out in the long run. I mean, I guess now is probably the best time to find someone who I'm totally comfortable with so that when I do get pregnant I feel comfortable and am as stress free as possible!

I LOVE IT when doctors listen!

I haven't written lately, but a lot has happened. The last week was primarily filled with a lot of late nights and uneasy, unproductive research for my first appointment with my OBGYN. Well, not "first" appointment ever with her... I have had the same doctor for about 3 1/2 years now, but have never been TTC and have never really went into an appointment with a true agenda.

I was so nervous because I feared that I wouldn't know what to say or what to try and demand. It's tough getting appointments with her sometimes and I just didn't want to waste any more time. After a long night of reading and studying (it felt like preparing for a college final all over again), I headed into the doctor's office that day with a binder full of key information and an outline of what I wanted to ask and insist on.

In the end, it didn't really come down to insisting. My doctor was actually very in tune and seemed aggressive about wanting to get me on track. The conversation went a bit like this: So, you've been trying to get pregnant since April. Yes. And when was your last period? 2 weeks ago - I have been charting, if that's helpful to see. Oh, you're on the ball. Yes, let's have a look at that. Ah, so you're last cycle was 67 days long - that's too long. And... let's see... you've definitely not been ovulating. If you were, you'd see an obvious shift... your temps aren't showing any sign of matching this shift. Let's get you started on metformin. This will help to regulate your cycles and encourage ovulation. If we need to go with clomid at some point, we might do so, but let's see how this does. Sound good? Sure does. Do you think we should do bloodwork again? Well, it has been almost two years since we did it last... let's go ahead and have it done. You can schedule it today in our office, if you'd like.

Long story short, they took my blood and checked for FSH, LSH, and something else... can't remember right now. The two tell-tell levels were very out of balance. I think my LSH was 3 x the FSH level, but I'll have to double check that.

I started metformin and so far so good I guess. I'm hoping my temps level out and I start seeing something normal. Wish me luck!