What would you do?

GoaliesWife123

I know I already explained things in my check-in, but I could use everyone's advice in my situation if you all have any. I went in for my first clomid ultrasound last Friday and there were 3 follicles. They weren't huge (but I was never given the size), but this wasn't alarming to me because I don't ovulate until CD 21. I've been charting for over a year and that is the pattern I have. I went in for a second clomid ultrasound on Tuesday and had a different tech. This tech was rough and had a terrible bedside manner, but alas, I had no choice but to have her. She did a quick scan and said she didn't see any follicles and proceeded to say "Well, maybe the clomid isn't strong enough for you" and then in her very next breath, "Or maybe you already ovulated." Clearly this did not give us much confidence in her opinion.

I don't know if I trust her scan and today I am seeing multiple positive opks. I'm not surprised because today is the day I almost always see the first positive tests. The RE is just not available and I had to leave a message for the nurse, but I am at a loss of what to do. Should I call and ask for an additional scan tomorrow to see if something was missed OR to see if I am getting all of the hormonal changes without the follicle growth? Should we do an insemination? 

I really, truly though that being with an RE would help to feel more in control and at this point, I feel more helpless than I have throughout our entire journey. We don't have any other choice as far as what RE to use because our insurance is paying for almost everything. We are fortunate because I know there are many, many people who don't have coverage. We know we are fortunate in that respect, but are at a loss otherwise. 

What would you do? Would you call and ask for another scan to make sure that nothing was missed on the last ultrasound? @trisholio and anyone else doing at-home inseminations, would you inseminate or would you wait? Despite the fact that I know my body better than I ever have, I have no idea what to do next. 

StacyLH24

I would ask for the extra u/s. During that u/s I would ask for the size of each follie. You should be entitled to that information. If you aren't happy with the tech you get, I would ask to speak with a nurse, supervisor, etc. Be your own best advocate!

GoaliesWife123

Thanks, @StacyLH24, I will do just that. I am waiting for the nurse to call me back and I will be requesting the ultrasound. 

JGY

If the RE is not available, I would call back and ask for the Clinic Manager.  There should be someone in that sort of a roll who you can explain your situation to, and ask for help.  And you can always be totally honest and say something like "I was so stunned by the lack of clarity in the information I was given by the tech., that I couldn't think of what questions to ask at the time."  Definitely let the Mgr. know that the info. you received is insufficient to guide you in making choices for this cycle.  I mean, the reason you're getting the ultrasounds is to help you make informed decisions about if and when to inseminate, right?  And you are paying for that (or your insurance company is, but treat it like your own money)!

I often find myself unhappy with having not advocated for what I need.  Don't do that!  You are paying for a service here, and at the very least you should receive what you are paying for!

Full disclosure - I work in healthcare (on the administrative side) and the visit you described is unacceptable by our standards.

Good luck!  I'm sending some extra strength your way today.

GoaliesWife123

@JGY thank you. So much. I will do just that!!!

healz413

I agree. Given that the ultrasound tech found "no follicles" you are entitled to either a meeting with your RE to find out WTF or another ultrasound to "confirm" those findings. Since it sounds like the RE is too busy, they'd better give you an ultrasound!
I'm sorry you're having a bad experience with this RE! Our ultrasound techs are not supposed to discuss the ultrasounds with us but that is because we also meet with the RE every time we get an ultrasound so she gives us the results and tells us what they mean. If you're not getting to see your RE, you should be getting better info from the ultrasound techs or nurses!

KH826

I am so sorry that you are having to deal with this. I would definitely request another ultrasound ASAP. If you got the positive OPK today, I would see if they can squeeze you in today for an ultrasound. Also, even if your RE is not available, are there other docs in the practice you could consult with? Or at least a nurse when you are there in the office. A doctor or nurse always did my ultrasounds and there are about 10 doctors at my practice so there was always someone I could talk to in the office if needed. It isn't unacceptable that the tech didn't know how to explain what she saw at your last ultrasound (it isn't the tech's job to interpret results that way) but it is not OK if several days later a dr or nurse hadn't contacted you to further discuss the results and next steps. Did they do any blood work? If not, and if your next ultrasound shows no follies, you can ask for blood work to confirm if you ovulated. Also, there should never be "no follicles" -- either the mature follicles will be collapsed if you already ovulated, or your antral follicles will have never matured or perhaps shrank, but not disappeared entirely over the span of a few days. I would hold off on doing a home insemination and push your RE's office for more answers. Good luck and keep us posted!

GoaliesWife123

healz413 said:

I agree. Given that the ultrasound tech found "no follicles" you are entitled to either a meeting with your RE to find out WTF or another ultrasound to "confirm" those findings. Since it sounds like the RE is too busy, they'd better give you an ultrasound! I'm sorry you're having a bad experience with this RE! Our ultrasound techs are not supposed to discuss the ultrasounds with us but that is because we also meet with the RE every time we get an ultrasound so she gives us the results and tells us what they mean. If you're not getting to see your RE, you should be getting better info from the ultrasound techs or nurses!

I am continually surprised to find out that communication with the RE is so common. I haven't seen the RE since the SIS. I feel like I am already more informed at this point and this feels very good. I feel like I can advocate based on standard protocols in most RE offices. Thank you! 

ATXmommas

I don't have much to add - the PPs covered it.  Just wanted to confirm that your experience is completely unacceptable.  My RE always did the u/s.  While that may not be the norm, someone should give you a detailed explanation.  Especially with a clomid cycle, you should be closely monitored by the RE, including direct communication with the RE!  I hope you are able to work in another u/s and can illicit a better response from the clinic.  So sorry you had this experience.

GoaliesWife123

KH826 said:

I am so sorry that you are having to deal with this. I would definitely request another ultrasound ASAP. If you got the positive OPK today, I would see if they can squeeze you in today for an ultrasound. Also, even if your RE is not available, are there other docs in the practice you could consult with? Or at least a nurse when you are there in the office. A doctor or nurse always did my ultrasounds and there are about 10 doctors at my practice so there was always someone I could talk to in the office if needed. It isn't unacceptable that the tech didn't know how to explain what she saw at your last ultrasound (it isn't the tech's job to interpret results that way) but it is not OK if several days later a dr or nurse hadn't contacted you to further discuss the results and next steps. Did they do any blood work? If not, and if your next ultrasound shows no follies, you can ask for blood work to confirm if you ovulated. Also, there should never be "no follicles" -- either the mature follicles will be collapsed if you already ovulated, or your antral follicles will have never matured or perhaps shrank, but not disappeared entirely over the span of a few days. I would hold off on doing a home insemination and push your RE's office for more answers. Good luck and keep us posted!

There are only two doctors in this office. My doctor is out of the office until Friday. The other doctor goes between three offices, which is, I assume, why I haven't seen her since my very first appointment. I set up an appointment with my RE, but couldn't get in to see her until February 3rd. Ridiculous. 

On the advice of @JGY, I called the office and spoke with the clinic manager. She was very sweet and listened to everything that I had to say. I explained that I felt as though I was given conflicting responses and also was made to feel like I was an idiot for not "understanding" the suggestions. I told her that I thought this process was supposed to make me feel like I was more informed, not just that I am some annoying patient.  Finally, I explained that I was never told the size of the follicles and was also never given additional blood work or a plan in general. 

She explained that I should never be made to feel the way I feel now. She also said she was concerned that I was told I have follicles because the follicles I had on the Friday ultrasound were antral follicles, that were less than 8 in size. She also explained that Tuesday showed the same. 

She is personally reviewing my chart and going to sit down with the doctor to get things cleared up. I should be getting a phone call back soon. I told her I wasn't sure what I was supposed to be doing at this point. I also told her that IF my follicles didn't grow, what are they going to do to find out WHY this happened? 

Overall, I think that the answers, advice and suggestions I have received from the bump have informed me greatly, and I already feel like I am a better self advocate. 

Thank you. 

KH826

I am glad you spoke with someone who had some knowledge to share with you at your clinic! What you learned makes more sense. I would ask in the future if you only had 3 antral follicles in total, or if that is all they counted based on size. 3 follicles at that point in your cycle is not a lot. So there might be more to explore there also. Have you had a baseline (CD3) ultrasound in previous cycles? In addition to exploring why you didn't seem to respond to the clomid (and perhaps had an opposite response) I would suggest looking into your antral follicle count/ovarian reserve. Also, given that you have PCOS as you previously mentioned, perhaps you have been surging in your LH but not ovulating. It sounds like your RE's office needs to be more aggressive with your monitoring and start doing blood work regularly to monitor if/when you are ovulating. OPKs may not really be reliable for you. Anyway... Sorry if I sound pushy, that is not how I mean this to come across. I just know that I wish I had more people telling me some of these things when I was starting off with my RE and doing IUIs. Being your own best advocate is truly the most important part of TTC with a doctor. You know the saying "it takes a village to raise a child"... Well in some instances, especially within our community, I think it also takes a village to make a child. Good luck!

healz413

It sounds like your call to the clinic manager was very productive and was exactly what you needed. I hope the call back provides you with helpful information about what to expected and what to do next. I'm sorry to hear that your follicles are not growing on clomid.

GoaliesWife123

Mamosey said:

Hi...I have 2 thoughts. Clomid REALLY messed with my OPKs.  There was one time where it turned positive on CD 8. My RE told me to wait a few days and come in for blood work. I went in a few days later to see my Estradiol and progesterone levels.  My progesterone was still low but showed that I had either just ovulated or was about to.  I would ask for blood work!

Good to know. At this point, I'm not sure it matters because unless I have super follicles, it seems like we might be out. I am waiting on the call back from the office to determine when my next ultrasound will be and we will go from there. Thank you for the information! I am so thankful for the experiences that people are willing to share. I would have no idea to request blood work in your situation! 

GoaliesWife123

KH826 said:

I am glad you spoke with someone who had some knowledge to share with you at your clinic! What you learned makes more sense. I would ask in the future if you only had 3 antral follicles in total, or if that is all they counted based on size. 3 follicles at that point in your cycle is not a lot. So there might be more to explore there also. Have you had a baseline (CD3) ultrasound in previous cycles? In addition to exploring why you didn't seem to respond to the clomid (and perhaps had an opposite response) I would suggest looking into your antral follicle count/ovarian reserve. Also, given that you have PCOS as you previously mentioned, perhaps you have been surging in your LH but not ovulating. It sounds like your RE's office needs to be more aggressive with your monitoring and start doing blood work regularly to monitor if/when you are ovulating. OPKs may not really be reliable for you. Anyway... Sorry if I sound pushy, that is not how I mean this to come across. I just know that I wish I had more people telling me some of these things when I was starting off with my RE and doing IUIs. Being your own best advocate is truly the most important part of TTC with a doctor. You know the saying "it takes a village to raise a child"... Well in some instances, especially within our community, I think it also takes a village to make a child. Good luck!

You don't sound pushy at all. This is all new for me, so all of your knowledge is very much appreciated. I did not have a baseline ultrasound on CD 3. My first ultrasound was the SIS. According to my blood work, my fsh is 5.9, which is excellent. I do have PCOS, so chances are high that I don't ovulate regularly and that would be why my reserve is so high. I would like to know why I didn't respond to clomid and if I need to change to Femara, I will. 

I am hoping to get more information when I hear back from the clinic manager. I will be writing down all of your advice and information and bringing it to my RE when I have an appointment with her. This has all been so informative and necessary and I sincerely appreciate it!

GoaliesWife123

healz413 said:

It sounds like your call to the clinic manager was very productive and was exactly what you needed. I hope the call back provides you with helpful information about what to expected and what to do next. I'm sorry to hear that your follicles are not growing on clomid.

Thank you!

GoaliesWife123

ATXmommas said:

I don't have much to add - the PPs covered it.  Just wanted to confirm that your experience is completely unacceptable.  My RE always did the u/s.  While that may not be the norm, someone should give you a detailed explanation.  Especially with a clomid cycle, you should be closely monitored by the RE, including direct communication with the RE!  I hope you are able to work in another u/s and can illicit a better response from the clinic.  So sorry you had this experience.

Thank you. It is so insane to me to find out just how many different clinics have the RE or a nurse do the ultrasound and give the detailed information. I should know soon if they can get me in for another ultrasound.

2MamazInSeattle

I just read the whole thread and I'm glad you called and got some clarity on things! Well done. I'm sorry it sounds like your response to the dose of clomid you were on didn't have the impact you hoped for. I hope the call from the clinic gives you clarity on the best next steps - I hope you're not 'out' but if you are, next month you'll have a ton more info and a more aggressive monitoring plan I'm sure. I'm sure this is super frustrating...hang in there.

StacyLH24

That is surprising to me that you didn't have a CD 3 baseline u/s. I had one done before I started on Femara. I have one done every cycle now with switching to Gonal-F.

I'm glad you spoke with the manager and that you were listened to and are receiving better care/attention now.

GoaliesWife123

Thank you @2mamazinseattle ! You are absolutely correct in that if I am out for this cycle, I will now have a lot more information for next cycle. That's exactly what DW and I talked about. 

I had a wonderful session with my acupuncturist yesterday and she had me in tears when she explained that she was trying to help me find peace and she could tell I needed it. I explained that it was so frustrating that I am doing everything I am being asked to do and yet it doesn't seem to be working. I am eating better, exercising, taking medication, taking vitamins and herbs...doing everything. Every doctor tells me I am a dream patient because I follow through on everything I am asked to do. Yet it is not working. 

My acupuncturist's response? "That is right. You ARE doing everything you can and should be doing, so now it is time to let go and find a sense of peace and a better you. If there is nothing more you can be doing, then it is time to take a deep breath and find and enjoy YOU."

That is my goal. I AM doing everything that I should and can be doing. At this point it is out of my hands. I am finally coming to terms with that and slowly (very slowly) letting go of control of this situation. 

@StacyLH24 Thank you. I had no idea that a baseline CD 3 ultrasound was common. Great advice! 

2MamazInSeattle

That is awesome what your acupuncturist said! I think it's true too - sometimes we do everything right and try so so so hard, that we end up trying to kill a mosquito with a fire hose! There is something to be said for finding a way to chillax. But it is hard.

I know this cycle for me was the most relaxed I'd ever been - part of it was a level of exhaustion/ambivalence - I just could only care/worry so much. So I made my to-do list, and did everything on it, but more as a matter of course vs. some grand effort. I think it helped. Even J said "you are so much different this cycle..."and it felt so much better. Stress is a fertility killer, and I think that when we (myself 100% included) try too hard, we end up tipping the scale in the wrong direction.

I know @ball.and.chain found the Circle & Bloom meditations super helpful! I went to actual meditation classes and did yoga throughout this last cycle. Maybe one of those daily meditations would be helpful? I think they are around $60 but I know people who used them helped a lot.

You are doing it right! Just hang in there, and try to trust the process (hard, I know   ). Hugs!

GoaliesWife123

Thank you @2mamazinseattle. I noticed the mention of the circle and bloom mediation and was going to look into that. DW and I changed our house around a few months ago so that it was more "zen" like and we just haven't brought the zen into it yet. I know that this is what needs to happen. 

FWIW, I am so thrilled about your success this cycle and have had thoughts and positive energy flowing your way  

JGY

Not to sound parental or anything, but I'm really proud of you!  Great job advocating for yourself and I'm so glad that the Clinic Manager listened to you and is personally reviewing your records.

I also hope you're not "Out" this cycle, but if you are at least you will have a much fuller understanding of why, and (hopefully) a solid plan for next month. 

Keep us updated!

Shout out to @KH826 for all the awesome info. and advice too.

GoaliesWife123

UPDATE: I just heard back from the clinic. According to my scans and my chart, the follicles seen on Friday were antra follicles and there was no growth on Tuesday. This does not yet mean I am out, it simply warrants an earlier ultrasound along with blood work. It is possible that the opk positive I am getting today is a false positive and in order to determine this, I will be getting an ultrasound tomorrow as well as progesterone and LH blood work completed. Once I have these tests done, I should have more information and will be able to decide whether or not I am out for this cycle. If we aren't out, we will come up with a plan. If I am out, it will help me determine what the steps will be for next cycle: Change to femara; increase clomid dose; change to injectables. We shall see. 

Thank you all again for your advice and personal stories. You have no idea how much it helped. 

trisholio

I am sorry that I am late to the party.  I haven't had a chance to be on here until now.  As the previous posts said it is common to have a baseline ultrasound around CD 2-5, then again around ovulation which for me was around CD12-CD14 to check on the follies.  I hope your appointment goes well tomorrow.  I hope you have a better experience with the staff.  We are lucky in that our RE did every appointment, it was never a tech, so I saw him or another RE each and every time.

Good luck chica!!!

shelly2314

I would ask for the extra us. I am sorry that you experienced that with the tech. You should never have that kind of experience!

GoaliesWife123

I had another ultrasound today and it looks like the follicles are bigger, but still small. My lining is 13, so that is good. We are still waiting on blood work results for my progesterone and LH levels. We are hoping for some clarity as to why I am getting a positive opk and all other signs of ovulation if I am not going to ovulate. I am waiting on a call back from the doctor today, so I'll update when I hear more. 

Manada

Good Luck.   FWIW -- from what I've read, people who don't respond to clomid will often respond to femara and vice-versa....

I also had great luck on a combined clomid (I didn't respond to femara) + menopur cycle --- my RE wasn't even going to try it until I asked about it, and ended up getting 2 good follicles from it.  

GoaliesWife123

@mananda thank you. That is something I was hoping to hear, actually. I'll explain in a moment...

So this appointment was with the same tech that I had issue with on Tuesday, but she had obviously been talked to because she was completely different. To start, she actually told me when she was putting in the wand. On Tuesday, I wasn't even at the end of the bed before she was jamming it in. Additionally, she gave me the measurements of the follicles and lining, which had never been offered before. Finally, we noticed she did not give her opinion at all as to what might be happening. It was a nice change. 

She did mention that the RE "usually" goes straight to injectable meds if clomid doesn't work. I'm not okay with that, at all. I was started on the lowest dose of clomid, so why on earth would you go straight to something that drastic? I asked her to please ask the doctor about adding an additional dose of clomid this cycle. If she is not okay with that, then I will be discussing femara with the RE at the next appointment, for the next cycle. 

I know that so many people are successful with injectable meds, but that is not where I expect to be after a single cycle on the lowest dose of clomid.

I'll know more later today and will update. Thank you again, everyone!!

trisholio

You are on a pretty low dose of Clomid, my Dr started me on 100 and then increased to 150 the last two months of us ttc.  Obviously month 4 of 150mg and our first IUI did the trick.  I would follow what the RE says but maybe also try an at home insemination since you know your body.  I would ask the Dr to increase your dosage next month though.

Best of luck chica, keep us updated!

GoaliesWife123

Thank you @trisholio for the advice! 

Here is my update from 7pm today. Clearly, urgency is not something practiced by my RE. 

My blood work confirmed that my LH is indeed rising and I should surge tomorrow or Saturday. My RE believes that we should do our inseminations this month, despite the ultrasound results. I will go in next Thursday for a test of my progesterone to verify ovulation and a week after that I will go in for a beta test. 

If this cycle doesn't work out, my RE would like to monitor me much closer next cycle. She would like to start ultrasounds and blood work on CD 10 and would like to have me come in for monitoring every other day. We aren't sure yet what we will do with the medication. We have a meeting with our RE (there are two in the practice and ours has been on vacation all week) and we will be bringing ALL of our concerns to her attention and discussing our plan should this cycle not work out. I'm going to request changing to Femara instead of clomid. 

I'm not sure how I feel about this cycle, to be honest. Through all of my testing and ultrasounds we have been told that I have small ovaries and a small uterus, so is it possible my follicles will also be small? I don't know. We will see. 

Thank you all for your support! 

Jazibel

I'm glad your RE is willing to be more hands on in terms of your monitoring this cycle and next (if its needed).  I wish you lots of luck going forward and kudos for being proactive and asking for what you want/need upfront.  :-)

GoaliesWife123

@herbabymama, thank you so much. Asking the bumpies their opinion has been the single best decision I made! The knowledge you all have is incredible and so helpful! 

Thank you for the compliment on the lining At least my body is doing something right!