"Fertility Specialist" Appt (OR Why You Should Go Straight to an RE)

AnonymousNurse

I have been super busy working overtime lately and haven't had much of a chance to be active here... I hope everyone's doing well and enjoying summer so far : )

As some of you may know, I have been having super short LPs; 5-6 days to be exact.  I do occasionally have longer LPs (9 days, like last cycle) but the majority have been short.  For this issue in combination with low post-O temps/spotting/inability to turn an OPK anywhere near positive, I decided to seek medical advice.  My OB's office wanted me to see their "fertility specialist" prior to a referral to an RE.  

My appointment was this afternoon.  I brought my charts, and provided all of the information on the issues I've been having - assuming that my charting would be taken seriously (SPOILER ALERT!: it wasn't).  So even though I had my charts from FF, they made me fill out their paper chart which just tracks spotting/menstrual flow.  And then she went on to explain to me when I'm "probably" ovulating based on those dates.  I reminded her that I have 6 months of charts that disagree with the numbers she gave me.  She then told me that temping is "not an exact science' and that the temperature rise is seen 2-3 days after ovulation and sometimes more, so therefore all of my ovulation dates are probably off.  

After completely brushing off my concerns about low temperatures, etc, I got a long talk about how I need to reduce my stress and stop worrying and get some fucking acupuncture.   She told me that I have no problems whatsoever and if we still haven't conceived by December I should make another appointment with her before the RE referral.  

I absolutely do not want to borrow trouble, but I do feel like I have a potential issue here.  I'm not trying to be impatient, we really aren't in a huge rush to get pregnant, but I also don't want to waste time if there is something going on.  So what do you ladies think?  Should I push for a referral? See a new OB?  Chill out for 5 months?  I'm pretty frustrated, I didn't expect this appointment to really go anywhere but I thought I would at least have my concerns understood.  

themrsJRD

I think with your history of confirmed very short LPs you should try to see an RE, if you're ready for that. I'm really sorry about the crappy appointment today.

AnonymousNurse

wickedsugar said:

How many months of short LPs ? More than 3-4 ?  

ETA : how long have you been off BC ?

I've been charting for 8 cycles (since January)... 6 of them have had 5-6 day LPs.  I've been off BC for a year now.

Trampslikeus

A "fertility specialist" recommending reducing stress makes me a little... hurhhhnnnpphhhh???

In that position, I'd have said look, lady, with all due respect, I've seen 50 women living in literaly SHIT conditions in a refuge camp in the middle of the Congo get pregnant. You want to tell me that's because they relaxed and got acupuncture? 

In all seriousness, I feel like any time a doctor makes you feel brushed off or dismissed when you go to him/her with concerns, its time to either have a very blunt conversation with them about how you felt and see if they apologize and readdress your concerns, or look for someone new.

AnonymousNurse

MeatandBandP said:

How many months of short LPs? There is no way I would do fertility treatments or testing with an OB. They are just not set up to be able to handle the type of monitoring that you need and most doctors really don't have the knowledge needed.

Yeah, I knew this going in -the only reason I agreed to the appointment is that they basically told me that I had to in order to get an RE referral and I need the referral in order for my insurance to cover it, unfortunately.  Not that I really want to jump into testing, but I feel like this issue isn't going to resolve itself.  Maybe I'm wrong though!

lebradford

I would push to see a RE. Do you even need a referral? Not all insurance companies require a referral. If possible, just schedule a RE appointment on your own. If you can't, I'd see a different OB/GYN to get the referral.

I'm sorry your doctor blew you off. Mine did too, to a lesser extent, and I've been so glad that I left him for a specialist. In hindsight it sucks enough that when I need another OB/GYN appointment, I'll probably find a new one. Who wants someone delivering their baby (or screening them for cancer) if they won't listen to you, you know?

I know I'm kind of rambling, but my point is, you are right to advocate for yourself, and you're not out of line to want to see someone else.

Ladymouse

Apologies if this is a stupid question, but are you taking a B complex supplement?  They lengthened my LP by several days.

PinkRoses53

I would push for the RE.  I'm sorry they brushed you off.  I'd be pissed.

chaysefaith

Can you call your insurance and get the referral yourself? With my last pregnancy my doctor referred me to an MFM but apparently getting the referral was like rocket science to her office staff. I ended up calling my insurance company and rep I spoke with just put the referral in for me: "Dr. So and So referring to Dr. So and so to consult and treat, 50 visits." I hung up and immediately called back to confirm the referral was there and it was.

AnonymousNurse

Ladymouse said:

Apologies if this is a stupid question, but are you taking a B complex supplement?  They lengthened my LP by several days.

I am actually!  I started a while ago and I had a 9-day LP the first cycle I was on it so I got all excited, but it must have just been a fluke.  

DHester said:

I'm sorry your appointment sucked. I don't think I would continue to use that OB honestly. That kind of experience would cause some serious mistrust. I hope you find a good RE who can help you sort this all out.

Yeah - i'm not a fan of this doctor at all, but I do love my NP I see there.  I have a good relationship with her and I have an appointment with her for my annual in a couple weeks so I plan on discussing this with her.  I was told by someone else that she would not be able to just refer me but I really don't see why not.  Fortunately, this doctor only handles their infertility treatment (ugh) so I don't think I will ever have to interact with her again.  

SNLT1012 said:

Can you call your insurance and get the referral yourself? With my last pregnancy my doctor referred me to an MFM but apparently getting the referral was like rocket science to her office staff. I ended up calling my insurance company and rep I spoke with just put the referral in for me: "Dr. So and So referring to Dr. So and so to consult and treat, 50 visits." I hung up and immediately called back to confirm the referral was there and it was.

IMaybe I'll try this - I didn't even know they could do that.  I also just found out that the RE office by me will do a phone consult with no referral or anything, so as long as they agree that I should be seen then I think it will be easier for me to get the referral from my OB office.  

AnonymousNurse

lebradford said:

I would push to see a RE. Do you even need a referral? Not all insurance companies require a referral. If possible, just schedule a RE appointment on your own. If you can't, I'd see a different OB/GYN to get the referral. I'm sorry your doctor blew you off. Mine did too, to a lesser extent, and I've been so glad that I left him for a specialist. In hindsight it sucks enough that when I need another OB/GYN appointment, I'll probably find a new one. Who wants someone delivering their baby (or screening them for cancer) if they won't listen to you, you know? I know I'm kind of rambling, but my point is, you are right to advocate for yourself, and you're not out of line to want to see someone else.

Unfortunately I do need the referral - I think I will do the phone consult with the RE office.  If I tell my OB's office that I spoke with them and they want to see me, I don't see how they could refuse to refer me.  If they do, then I will know for sure that it's time to find another doctor.  

AnonymousNurse

I seriously love all of you... thanks for the support, I feel like 100x better right now.  They made me feel like I was some silly, impatient, baby-crazed idiot.  Not cool.  Like I said, I was not expecting a lot from this appointment, I just wanted the referral, but I didn't expect to feel like such crap because of it.  I probably should have been a little more assertive, but either way I don't think I would have gotten anything else out of this appointment.  

I will be calling the RE office tomorrow : )

Trampslikeus

Let the RE office request the authorization/referral - I do it all the time - its harder for doctors to argue with me than with a patient, especially if they've kind of come to a decision already (and don't want to admit they're possibly wrong).  Also, a lot of times they'll just fax over an auth form and the doctor will just glance at it and sign it.  You might luck out.   But regardless, if you don't have a good feeling about this doc, listen to yourself and find a new one

KatzKiss

@WhoCanItBeNow‌ Can I ask what you do? I've always wondered because you seem to know so much about fertility.

KatzKiss

WhoCanItBeNow said:

KatzKiss said:

@WhoCanItBeNow‌ Can I ask what you do? I've always wondered because you seem to know so much about fertility.

I'm an accountant.

I'm shocked! I always pictured you as doing something in the medical field. Knowledge from experience I guess then.

cdubs85

We have very similar stories.  I had been charting/temping long before TTC and notice I was having on average a 9 day LP.  I actually got pregnant the month we started TTC and had a chemical pregnancy.  My progesterone during that pregnancy never went over a 5!  So I brought up my LP issues with my OB who brushed me off.  I thought "well if he says everything is ok, then it is".  So we kept trying and I got pregnant a second time with a progesterone level of 2.4!  That pregnancy ended in miscarriage as well.  My point is, if you feel you have a problem and are consistently having short LPs, yes I would seek an RE.  I've read people here say "don't borrow trouble", but like you said if theres an issue that might prolong having a successful pregnancy than go ahead an ask for a referral.  

 I was told at some point that I was jumping the gun by visiting an RE but you bet I'm glad I did.  I want the comfort of knowing I am doing everything possible to keep another miscarriage from happening.  Just for the record, yes my feelings about a short LP and progesterone issues were confirmed by my RE and we will be addressing those issues when we decide we're ready to TTC again.

Trampslikeus

FINEdoubleLINE said:

So, now I am really curious. Before I went to see the RE, I looked at different OB/GYNs to see if any would actually do the proper testing. I would find offices that would list a "Fertility Specialist" on staff. The Bio of the Doctor would only list a "special interest" in fertility and no additional, formal education beyond being an OB/GYN. Do OB/GYNs that call themselves "Fertility Specialists" actually have any more training? I can't find anything.

An OB/GYN can be board certified as a Fertility Specialist, but that's additional YEARS of either fellowship or residency.   And like most things, its probably easy for someone to refer to themselves informally as a "fertility specialist" without actually being a board certified fertility specialist.  Unless a patient files a complaint, I bet no one is really looking in to that kind of thing.  Just like "nutrition specialists" and "family therapy specialists", so on and so forth.

AnonymousNurse

Trampslikeus said:

Let the RE office request the authorization/referral - I do it all the time - its harder for doctors to argue with me than with a patient, especially if they've kind of come to a decision already (and don't want to admit they're possibly wrong).  Also, a lot of times they'll just fax over an auth form and the doctor will just glance at it and sign it.  You might luck out.   But regardless, if you don't have a good feeling about this doc, listen to yourself and find a new one

I'll try this!  I never even thought of doing it that way.  Thank you!

FINEdoubleLINE said:

From my understanding, a "Fertility Specialist" typically has an "interest" in fertility and I really don't know if they have any additional education (besides being and OB/GYN.) I was talking to my sister this past weekend about fertility testing and treatments. My sister told me that when she was trying to conceive her first, she went to her OB/GYN after a year of trying. They referred her to the "Fertility Specialist" in their group. He told her she was "fat" and that is why she hadn't conceived. He also said she probably wasn't ovulating. He did no testing and prescribed her Clomid. She had been charting and had clear temp shifts. As well as postive OPKs, ect.. She never took the Clomid. She conceived my nephew 3-4 cycles later. I had no idea. She had been too embarrassed to tell anyone. She said that the "Fertility Specialist" in the group decided he didn't want to deliver babies, and took on that role. I found out that he did and said, the same thing to my neighbor. Fantastic. Maybe there are "Fertility Specialist" that know what they are doing. But I have yet to hear of one. My RE really looked at my charts and found them valuable. The very first thing he said after reviewing my charts, "Well, you are ovulating." Then "I am happy to see your luteal phase is of a normal length, we don't need to worry about a luteal phase defect." We confirmed everything with bloodwork. So, I am pretty sure my RE would disagree with that "Fertility Specialist." My point is, there are Doctors out there that will listen to you and care. You have valid concerns. It makes me stabby that the doctor treated you that way. TL;DR - Push for the RE.

That's exactly how her bio on the office's website reads... "special interest' in fertility.  She did explain her background to me a little bit and she has done a lot of lab work with semen analysis and is part owner of an "advanced semen analysis' company?  So that's great and all but in no way does it qualify her to help with my issues.  I think that my cycle issues are just over their heads, I guess.  

cdubs85 said:

We have very similar stories.  I had been charting/temping long before TTC and notice I was having on average a 9 day LP.  I actually got pregnant the month we started TTC and had a chemical pregnancy.  My progesterone during that pregnancy never went over a 5!  So I brought up my LP issues with my OB who brushed me off.  I thought "well if he says everything is ok, then it is".  So we kept trying and I got pregnant a second time with a progesterone level of 2.4!  That pregnancy ended in miscarriage as well.  My point is, if you feel you have a problem and are consistently having short LPs, yes I would seek an RE.  I've read people here say "don't borrow trouble", but like you said if theres an issue that might prolong having a successful pregnancy than go ahead an ask for a referral.  

 I was told at some point that I was jumping the gun by visiting an RE but you bet I'm glad I did.  I want the comfort of knowing I am doing everything possible to keep another miscarriage from happening.  Just for the record, yes my feelings about a short LP and progesterone issues were confirmed by my RE and we will be addressing those issues when we decide we're ready to TTC again.

See now, I brought this up at my appointment as well:  I have had a previous MC and was told that my progesterone was "extremely" low.  I was not TTC at the time and didn't really care what my progesterone was, but since it is known that low progesterone was an issue in the past and I'm having the problems I am now, you would think that alone would be a concern. Even if I were able to conceive right now I worry that I would miscarry.  She said that she wasn't concerned by this, but I certainly am.  

Cythe

NariaDreaming said:

WhoCanItBeNow said:

FINEdoubleLINE said:

From my understanding, a "Fertility Specialist" typically has an "interest" in fertility and I really don't know if they have any additional education (besides being and OB/GYN.)

I was talking to my sister this past weekend about fertility testing and treatments. My sister told me that when she was trying to conceive her first, she went to her OB/GYN after a year of trying. They referred her to the "Fertility Specialist" in their group.

He told her she was "fat" and that is why she hadn't conceived. He also said she probably wasn't ovulating. He did no testing and prescribed her Clomid. She had been charting and had clear temp shifts. As well as postive OPKs, ect..

She never took the Clomid. She conceived my nephew 3-4 cycles later.

I had no idea. She had been too embarrassed to tell anyone. She said that the "Fertility Specialist" in the group decided he didn't want to deliver babies, and took on that role. I found out that he did and said, the same thing to my neighbor. Fantastic.

Maybe there are "Fertility Specialist" that know what they are doing. But I have yet to hear of one.

My RE really looked at my charts and found them valuable. The very first thing he said after reviewing my charts, "Well, you are ovulating." Then "I am happy to see your luteal phase is of a normal length, we don't need to worry about a luteal phase defect." We confirmed everything with bloodwork. So, I am pretty sure my RE would disagree with that "Fertility Specialist."

My point is, there are Doctors out there that will listen to you and care. You have valid concerns. It makes me stabby that the doctor treated you that way.

TL;DR - Push for the RE.

Shit, by that logic I'm a Fertility Specialist. Sweet.

And since I'm pretty sure that most of the ladies on TTGP would agree to that statement, would that make you....

.... Board Certified? 

~~~quote box~~~

Someone get this woman a Heratio Caine "Yeeaaaahhh!" meme.

getnauti

Another vote for the RE.  I'm sorry your appointment didn't go well.

cdubs85

cdubs85 said:

We have very similar stories.  I had been charting/temping long before TTC and notice I was having on average a 9 day LP.  I actually got pregnant the month we started TTC and had a chemical pregnancy.  My progesterone during that pregnancy never went over a 5!  So I brought up my LP issues with my OB who brushed me off.  I thought "well if he says everything is ok, then it is".  So we kept trying and I got pregnant a second time with a progesterone level of 2.4!  That pregnancy ended in miscarriage as well.  My point is, if you feel you have a problem and are consistently having short LPs, yes I would seek an RE.  I've read people here say "don't borrow trouble", but like you said if theres an issue that might prolong having a successful pregnancy than go ahead an ask for a referral.  

 I was told at some point that I was jumping the gun by visiting an RE but you bet I'm glad I did.  I want the comfort of knowing I am doing everything possible to keep another miscarriage from happening.  Just for the record, yes my feelings about a short LP and progesterone issues were confirmed by my RE and we will be addressing those issues when we decide we're ready to TTC again.

See now, I brought this up at my appointment as well:  I have had a previous MC and was told that my progesterone was "extremely" low.  I was not TTC at the time and didn't really care what my progesterone was, but since it is known that low progesterone was an issue in the past and I'm having the problems I am now, you would think that alone would be a concern. Even if I were able to conceive right now I worry that I would miscarry.  She said that she wasn't concerned by this, but I certainly am.  

The fact that my progesterone after my second BFP was so low it was indicative of no ovulation was what really concerned me.  That, the CP, and the short luteal phase convinced me I was not jumping the gun on seeing an RE.   Before I actually visited the RE I also called and spoke to the nurse and explained my medical history and based on that, they did advice I consult.  Good luck!

hydrangea1019

Not too much to add. All PPs offered great advice and first hand experience.

I just wanted to say in sorry your appt didn't go very well and you didn't feel heard. Hopefully you can get the referral you need, one way or another.

Good luck!!

AuroraP725

BBnut said:

I have this mental image of going to a consult with WCIBN.   In my head WCIBN has a buzzer to press any time anyone says or asks something stupid.

If this buzzer is connected to a shock collar then I think you are spot on. 

AnonymousNurse

Update:  I called the local RE office and spoke with a nurse this morning.  She was super helpful and also concerned by my short LPs and I went ahead and made an appointment.  I see the NP at my OBGYN office in July for my annual and I will work on getting the referral then.  I couldn't get in until September which is not really a bad thing - I've felt a little hesitant about starting testing and such so I'm glad to have a couple more months before that starts.  Thank you everyone for the encouragement!