My Appt. Tomorrow

williegsocks

Tomorrow is the day I have been anxiously waiting for.  It's my fertility appointment with my obgyn...I have an appointment with a RE next week, but I'm debating putting that off depending on how this appointment goes tomorrow.  I know that many of you highly recommend a RE, but I'm trying to see if maybe my obgyn can help me first.  Wish me luck!  I will let you know how the appointment goes tomorrow  I'm cautiously hopeful about this.  If you have any experiences to share, advice, things I need to know, or questions that you think I should ask tomorrow please let me know!

lebradford

Good luck!

Of course you already know we'll recommend keeping your RE appointment. :-)


If you wanted to try to make it work with your OB/GYN, I'd ask what testing they do before treatment, what type of monitoring they offer for medicated TI or IUI cycles, and at what point they would recommend you go to an RE. I think the answers about testing and monitoring will help you decide if you can stay with them or not.

Good luck!

Eta- I guess I said good luck twice! I'm either really friendly or really enjoying my pain medication, I'll let you decide for yourself. ;-) Good luck!

LindseyM2012

I'm glad you're getting the process started.  I just re-read your introductory post to remind myself of what's going on.  That said, with TTC for such a while with a history of long/erratic cycles, please do not skip the RE unless there is an insurance requirement that you get the referral (but it sounds like that is a non-issue or already taken care of since you have the RE appointment). 

The RE is going to do a MUCH more thorough job testing and ruling out/in all different kinds of hormone, structural, etc. issues.  They are going to know exactly what test results mean as it relates to ovulation and implantation.  For example, my ob/gyn did a lot of tests and one specific test (Thyroid Stimulating Hormone) was within a normal range at around 4 (I think .5 - 4.5)  so she said that is fine.  When my RE re-ran that test, the same number came back but explained that for fertility issues, she wants it at or just under 2 because it can interfere with implantation.  I just wonder if I kept with my ob/gyn and that was never treated, would I have had difficulty implanting an embryo without knowing why?

With as weird as your cycles seem to have been, you may have a hormone imbalance of some sort (I'm not trying to diagnose you, just pointing out a hypothetical possibility) where you might have to induce ovulation.  For your health and safety, you need to be monitored which an ob/gyn won't do. 

I know I'm probably coming across as a preachy lecturer here, but your best chances are with an RE.  I'd hate to have your ob/gyn take a ton of blood and do tests just to refer you on anyways because the RE will need to run their own tests.  However, if you do decide to stick with the ob/gyn for testing, you can get an idea of what may be your diagnosis and then check out your area for REs that you're comfortable can work with whatever the issue may be.

BethKate2

In the last two years of TTC, I've completely lost faith in OBs. Mine was an idiot (told me to have sex after I ovulate, said that urine can't be too diluted to turn a hpt positive), and I've read too many stories on here about ladies who were put on meds without having any kind of testing or monitoring. I honestly wouldn't waste my time with an OB for fertility. It seems like some of them seem to act like they know what they're doing when it comes to IF, but most don't. They're trained to care for you during pregnancy, not to get you pregnant.

If you decide to go with the obgyn, I echo what @lebradford said about asking specific questions about the type of testing that will be done prior to treatment, and what monitoring will be done once you start treatment.

shirleymaeby

Super mega agree with PP...do not skip the RE.  I feel very, very lucky that I didn't get any cysts with the (unmonitored) Clomid my OBGYN prescribed me but I still feel a little bitter that she waited SO long to refer me to an RE.  By the time I went to see her I'd already had an HSG and had been trying for 2 years.  She putzed around and wasted another entire year of my life.

If I had just joined this board (or any board for that matter) a few years ago I could have had more/better advice about the next steps.  As much as I had read about conception and fertility and ovulation I had no idea what the difference between the two kinds of doctors is and my doc didn't tell me there WAS another step until after she'd wasted a lot of my time.  Thus endeth the rant.  

catlover790

I would just like to agree with the other ladies about seeing a RE. I know we must sound like broken records but it really is going to help you get the best care. REs go through an additional 3YEARS of med school/ fellowships to be a RE. That is a lot of time to learn about IF and how to treat it.

If you are going to the OB tomorrow I would ask them MANY questions and I would read up on testing and IF in general so that I knew when they say something that is wrong. My OB ran blood work when I went in for an anovulatory cycle on CD 90 and said "looks good"! what?! The blood work needs to be on CD 3!

Anyway, good luck at your appointment. I hope you at least go to your appointment next week also and compare the level of knowledge between the two before deciding. Good luck!

williegsocks

Thank all of you for your advice and support with this.  I am taking your advice and keeping my RE appointment.  My main concern for the RE was cost, but we were referred by my previous doctor so maybe insurance will help a little.  We have been trying for a year and a half now and after reading your comments I realize that I do NOT want to waste any more time.  I am so tired of waiting and I can't imagine waiting another year...it's difficult enough to wait another week.  

Thank you again for your advice and I will be taking it!  I am keeping the RE appointment and I will report back to all of you on how it goes and what they decide next week.  

LindseyM2012

Keep us updated!  Good luck!!

williegsocks

Oh my goodness!!!  That is awesome advice!  Thank you for sharing that and those questions.  I will call my insurance company tomorrow to ask.  You're a lifesaver! 

meld42

I just wanted to add my personal experience, to the pro-RE team!

I did my IUI with my OBGYN because I was impatient and knew what testing and monitoring was necessary in order to be safe. BUT, my OBGyn definitely lacked the RE expertise when it came to timing my trigger shot. I was given my trigger shot in office by her nurse, and my IUI was scheduled for 1pm the next day.. So timing was not great, and I didn't really know that we could do better if I have myself the trigger at a better time.

Not to mention, insurance wise my OBGYN's office was a piss off. I am lucky to be covered for a lot of IF stuff, but my insurance requires a pre-approval for everything IF related.. So my OBGyn office didn't really take care of that appropriately, and I ended up OOP for a few items due to timing. In contrast, my RE had it dealt with essentially the same day they wrote the prescriptions and I had my meds order processed flawlessly- REs are the best use of your time. I don't want you to waste 2+ months like we did!

BunnyBerry

Good luck at your appointment today! It's always good to think ahead. Hopefully you'll be pregnant very soon and it's always important to get a reminder from the OB to start taking that folic acid.

If your OB offers some testing and treatment plan with complete monitoring, it's not necessarily DANGEROUS to your health, but the problem you run into is wasting medicated cycles (I'm especially talking Clomid here, which can only be taken a limited # of times total). <-- Edited to Add: And Money!

An OB literally cannot do all the testing and pinpoint all the subtle hormonal factors that may be influencing yours and your SO's fertility, so starting with an OB is like saying, I'll assume I have steady hands and just start painting my own nails while lounging on the couch watching TV. Maybe you'll end up with a decent manicure, but maybe you'll end up with polish on the couch, wiping messes off your cuticles and starting over at the salon.

williegsocks

Thank you for the advice.  Seriously loved the nail analogy!  That was a really great and creative way to put it.  It makes perfect sense and I seriously do not want to waste any more time.  The days are already going by so slow, I can't imagine wasting months!

williegsocks

Well I'm pretty bummed.  I just got off the phone with my insurance company and I am not covered for any fertility treatments whatsoever.  Not sure what to do from here.  My DH has made it clear that regardless of this he wants me to go through fertility treatments, but I have no clue how to even guess how much this might cost us!  Anyone have any estimates?  I know that's asking a lot, but any estimates would be great.

LindseyM2012

I'm sorry you don't have coverage    I hate hearing that for people!

The cost review SHOULD be part of your RE consultation.  Ideally, they'll verify your benefits before your appointment and review that with you.  Since you already know, they'll tell you that unfortunately you don't have any coverage and then probably go over general procedure pricing for testing and common procedures.  Your ob/gyn probably won't go over that because they don't do the testing everyday.  But the RE does this all day, every day so they'll be able to give you a ballpark.  You may not know how much procedures might be because they'll have to go through the tests to get a treatment plan solidified.  But I'm sure some of the ladies here might be able to tell you what they've paid for meds, IUIs, IVF, etc.

EmilieT10

 An OB literally cannot do all the testing and pinpoint all the subtle hormonal factors that may be influencing yours and your SO's fertility, so starting with an OB is like saying, I'll assume I have steady hands and just start painting my own nails while lounging on the couch watching TV. Maybe you'll end up with a decent manicure, but maybe you'll end up with polish on the couch, wiping messes off your cuticles and starting over at the salon.

@BunnyBerry I like this analogy!

@williegsocks I have to join the others and say that you were smart to keep your RE appt. I started out by scheduling an RE appointment and also consulted my OB/GYN. I am so grateful that he was upfront and honest with me by offering to do testing, but advising that I go straight to an RE that specialized in fertility treatments. He even called to get us in to our RE a month early! Looking back from where we are now in the process, I am so grateful for the advice as it has saved us a lot of time and money. Good luck at your appointment and let us know how it goes!

tweetyknicks

I'm not covered for fertility treatments because of stupid insurance policies about reversed vasectomies still negating insurance benefits. (Normally I would have coverage.)

Anyhow, I went to my regular OB's office for u/s and lab monitoring and only saw the RE for a few essential items. Insurance picked up the monitoring even though it was related to infertility. It might be a difference in how it is billed or might be because my DH isn't directly involved. Essential point: monitoring can get expensive, but you might be able to finagle some coverage.

Oral meds are fairly cheap for me (<$20 for clomid, letrozole, or estradiol; $77 for 30 days of prometrium). A few of them are kind of covered by insurance, but I don't think they're all that expensive to start with. You'd probably start with some selection of these. Injects are not covered, but I get Bravelle for ~$53/75IU dose at Freedom Pharmacy.

The actual IUI was $275, including sperm wash. Altogether, oral meds IUI was ~$400 and injects IUI was ~$1000 OOP. YMMV

Not bad at all compared to the $12k-$20k I'm looking at now for IVF.

catlover790

williegsocks said:

Well I'm pretty bummed.  I just got off the phone with my insurance company and I am not covered for any fertility treatments whatsoever.  Not sure what to do from here.  My DH has made it clear that regardless of this he wants me to go through fertility treatments, but I have no clue how to even guess how much this might cost us!  Anyone have any estimates?  I know that's asking a lot, but any estimates would be great.

I do not have any coverage for IF either. When you see the RE they will go over the costs I would think. Now, going through your OB I'm not sure how it would work. My RE has prices that are "package" deals for the monitoring. For a IUI cycle it's 750, but on my EOB form when it came from my insurance normally it would be around 300 per visit and there's at least 3 visits each month. So, it would be a lot more even though 750 does seem expensive. Although it's hard to do I really had to try not to think about the costs until we had all of our results back and knew what treatments we would need. Good luck!

shirleymaeby

Each of my IUI cycles have cost me about $1K total including all the meds, the IUI itself and the monitoring ultrasounds.  You can check with your RE's office to see if they have a payment plan to help alleviate some of the up front costs.

I was covered for all my diagnostic tests so I'm not even sure how much the bloodwork and the HSG came to.

Good luck!  I am VERY happy you're going to see the RE.

williegsocks

All I can say is "Wow" while I am reading your responses.  It actually is making me tear up.  You are all so amazing and helpful.  It makes me feel so good and I no longer feel so lost and lonely as I did a few weeks ago.  I ended up cancelling my OBGYN appointment after reading everything you all put.  I am tired of wasting my time and waiting!  I want to go straight to the absolute best source, so I am only going to the RE.  This Tuesday can't get here fast enough!  Also, many of you said they would consult me about the price and you were absolutely correct.  I actually laughed on the phone when they called me right after reading all of these comments today to give me a run down on my benefits and the cost of the appointment.  I was pleasantly surprised to find that the cost was not as bad as I had imagined and that once I meet my deductible my insurance will actually kick in and help!  Happy day and so blessed to have all of you!  THANK YOU SO VERY MUCH!  Love to all!

LindseyM2012

Yay!!!  Tuesday will be here before you know it.  I hope you let us know how it goes 

kristyn831

I'm glad you're keeping your RE appt!  I'll share my personal experience.  After a year of trying, my OB scheduled CD3 blood work and HSG while I was waiting for my RE appointment (so I didn't have to wait another cycle).  They're both at the same hospital so both could access the results, etc.

My HSG was pretty uncomfortable and I have a very high pain tolerance (had 2 surgeries in the past and only took pain meds the day of surgery, then felt fine).  Anyways, I go to the RE and he's looking at my HSG and said the catheter the OBGYN used is the "torture device of HSGs" and he hadn't used one of those in 5 years.  He uses something more comfortable and newer and RE's are more up to date on things in their specialty.