Trying to understand everything still....

dogshowgirl

Hello all,

My husband and I have ben TTC since the day we got married (6/2013). I wasn't diagnosed with PCOS and Thyroid issues until I thought that I was pregnant last January (2014) (hadn't had a period since the November before that). I am on multiple medications including Metformin, and Synthroid.

On September 12th I went to an appointment with a new OBGYN in hopes of finally trying a fertility drug. My last cycle had just begun on September 1st and lasted about 5 days. The Dr. put me on Clomid 50mg and he said that the next time that I had ANY sort of bleeding (even spotting) to consider that CD1 of my new cycle. Anyone ever heard of this? The VERY next day (9/13/14) I was spotting so bad I needed a tampon. Called my OBGYN and they said to consider this day 1. I took the Clomid on CD5-9 and my husband and I BD CD 8,10,12,14,and 16. They did my 20 Day Progesterone test and my level was at 4.5 which I was told that I did not ovulate as it needed to be in the 10-15 range. But I have read some posts about women concieving with levels as low as 3 but had to take progesterone supplements thruout their pregnancies?

I am so confused. Does anyone know about this subject?

 

Thank you to anyone who offers help!

 

MARISAV77

Ditch your OBGYN and get your care from a RE especially if you are going to be on medicated cycles. I made the mistake of taking clomid from my OBGYN, and after researching more about infertility I am so happy I stopped seeing my OBGYN for fertility issues. Fortunately I had no Bad effects from the 2 cycles of clomid I took from my OBGYN, but there are many women who do have horror stories.

BethKate2

You need to have an HSG done prior to taking Clomid to make sure your tubes are clear. There's no sense in taking a medication to stimulate ovulation if your tubes are blocked. You also need to have monitoring ultrasounds done throughout your cycle to make sure your lining looks ok (Clomid can thin it) and that you don't have cysts since Clomid can cause that too.

Additionally, that CD 20 blood work you had done is supposed to be done at 7dpo, but since you weren't being monitored, they didn't know when/if you ovulated.

As pp said, ditch the OB and get an appointment with a RE.

BunnyBerry

Hi there, so sorry you are struggling with this! I'm glad your thyroid/PCOS issues were found so you can get treatment.

Your doctor has made some very poor decisions, including having you start Clomid without seeing what was going on with your body on that odd cycle, and without monitoring to see if you were developing a follie, and with assuming CD20 progresterone proves anything (what medical professional would ever assume that ovulation occurs on CD14? That's just foolishness). As previous posters pointed out, you took Clomid on the later days that are recommended so why didn't the doctor think that an iffy number like 4.5 couldn't mean you have ovulated later than CD14?

A reproductive endocrinologist would be a perfect next step. I would not continue Clomid with the OBGYN because they are not taking care of your health (Clomid can thin the uterine lining, which can be a long-term problem; cause dangerous/painful cysts, especially if new cycles of Clomid are started without checking for cysts on ultrasound; and as there is a recommended limit of 6 Clomid cycles for health, it seems foolish for the doctor to waste them without knowing your real situation). 

There are a whole set of tests that can make sure exactly what your diagnosis may be (HSG to show your uterus and tubes are clear, sperm analysis to see if your partner's sperm has a chance of getting you pregnant with timed intercourse, and other hormones that an RE can analyze to predict your response to meds and the health of your eggs). My husband had a pretty bad SA years ago and we assumed that was the problem, but when we finally did testing with an RE we found that each of us had multiple issues going on, and I needed surgery, he needed meds, and IUI at least was needed.

Good luck, I hope you do find a doctor that takes good care of you and that you can trust!

dancerspose

I also second everything Bunny said.  For the sake of your reproductive health, please see an RE.

Good luck!

Radiantly

Good luck! I agree with the ladies who have spoken up, it's the best advice possible. I personally have a blocked tube (the re sent me to HSG first thing) and he said he would not do clomid because of that. My next step is surgery and IVF but I'm hoping I get pregnant naturally first. Have been trying since wedding 7/2013. Oh AND I think I'm finally ovulating this month and it's day 20!

dogshowgirl

Oh my Gosh everyone! I have never had so many responses to a question! I do truly feel so loved here. Thank you SO MUCH. I didn't even know that such a thing as an RE existed and it wasn't until the later comments that I actually had it spelled out for me lol. WOW, just WOW. I go to am endocrinologist for my Thyroid and PCOS. Do you think SHE can do it or are there different levels of endocrinologists? Also, what is a HSG? Do any of you think I STILL could have ovulated then!? If so, when do I take a Pregnancy Test? I don't know which day exactly I ovulated.....

yepitsme215

Oh girl. I just got the "you need an RE and not an OB" talk only a few days ago from these ladies, and let me tell you they had some scary stories out there.I was taking clomid with OB, but after reading some stories decided it was best to see an RE instead (not only do they treat you more vigorously, they will also monitor you). 

Also: I just got my bill from OB. It was a LOT; like we might as well have gone to RE to begin with. Hard lesson learned right there, but we're still learning this process. You are too.

4.5 is considered as weak ovulation I think; like maybe you released an egg, or your body tried to, but the liklihood of concieving is pretty low. It sounds though too like you don't really know when you O'd and since you're not being properly monitored, you might have O'd late than you thought.

dogshowgirl

Thank you for your insight! I'm hoping I just Ovulated later. When does one usually run a Pregnancy Test after ovulation? How many days? I had A LOT of cramping on CD16 on my left side so I thought maybe that was the day I ovulated? My husband and I also used preseed as I had read online that it can help the sperm's vitality and mobility.

dogshowgirl

Thank you for ALL the information. I will call the place where I go for my endocrinologist and ask for an RE. I guess I will just wait and see if I get a period and if not, test on the 13th as then it will have been a month. Thank you so much ladies!

BunnyBerry

dogshowgirl said:

Oh my Gosh everyone! I have never had so many responses to a question! I do truly feel so loved here. Thank you SO MUCH. I didn't even know that such a thing as an RE existed and it wasn't until the later comments that I actually had it spelled out for me lol. WOW, just WOW. I go to am endocrinologist for my Thyroid and PCOS. Do you think SHE can do it or are there different levels of endocrinologists? Also, what is a HSG? Do any of you think I STILL could have ovulated then!? If so, when do I take a Pregnancy Test? I don't know which day exactly I ovulated.....

Endocrinologists can work hand-in-hand with an RE if needed. For example, my RE said that if an MRI showed a pituitary tumor was causing my elevated prolactin hormone, then he would send me to an endocrinologist to treat it. And the thyroid/PCOS is something they can both work on, although if your purpose is to be more fertile instead of just controlling symptoms, you'd want an RE making the decisions for meds.

HSG = hysterosalpingogram, they inject dye through the cervix into the uterus and watch on Xray as it fills your uterus and hopefully spills easily from both your tubes (the colored dye can show if your uterus has fibroids, and if your tubes may not be completely clear, or even if they are totally blocked). Since women with PCOS often do eventually get pregnant on their own, it's important to make sure there aren't other issues that have been keeping you from getting pregnant.

The guidelines for progesterone levels that indicate ovulation are based on being 7 days after ovulation occurred. Since you (and your doctor) have no idea when that was, the progesterone number they tested is meaningless, unfortunately. You could have O'ed before or after, or never. It does seem to match up that you may have O'ed on CD16 when you felt something, and then 4 days later a progesterone level of 4.5 might make more sense, but you really can't know for sure.

Taking a pregnancy test at the one-month mark isn't any kind of guarantee either. If you did O on CD16, a test might show positive as early as CD26-27, or not until CD 32 sometimes. But if you O'ed later, you might not see a positive test until well after. And of course, if you didn't O, you might see your period come really really late but still not be pregnant.

I hope this ends up being our month after all and you never have to worry about all this stuff!! But it sounds like a great plan to ask your endo for a referral to an RE. If your period comes, you will likely schedule a CD3 ultrasound and bloodwork (to see how your ovarian reserve is among other things), then around a CD7-10 HSG. And of course you'll have to get your partner to go in for his sperm analysis!! That's always a fun battle.

dogshowgirl

BunnyBerry said:

dogshowgirl said:

Oh my Gosh everyone! I have never had so many responses to a question! I do truly feel so loved here. Thank you SO MUCH. I didn't even know that such a thing as an RE existed and it wasn't until the later comments that I actually had it spelled out for me lol. WOW, just WOW. I go to am endocrinologist for my Thyroid and PCOS. Do you think SHE can do it or are there different levels of endocrinologists? Also, what is a HSG? Do any of you think I STILL could have ovulated then!? If so, when do I take a Pregnancy Test? I don't know which day exactly I ovulated.....

Endocrinologists can work hand-in-hand with an RE if needed. For example, my RE said that if an MRI showed a pituitary tumor was causing my elevated prolactin hormone, then he would send me to an endocrinologist to treat it. And the thyroid/PCOS is something they can both work on, although if your purpose is to be more fertile instead of just controlling symptoms, you'd want an RE making the decisions for meds.

HSG = hysterosalpingogram, they inject dye through the cervix into the uterus and watch on Xray as it fills your uterus and hopefully spills easily from both your tubes (the colored dye can show if your uterus has fibroids, and if your tubes may not be completely clear, or even if they are totally blocked). Since women with PCOS often do eventually get pregnant on their own, it's important to make sure there aren't other issues that have been keeping you from getting pregnant.

The guidelines for progesterone levels that indicate ovulation are based on being 7 days after ovulation occurred. Since you (and your doctor) have no idea when that was, the progesterone number they tested is meaningless, unfortunately. You could have O'ed before or after, or never. It does seem to match up that you may have O'ed on CD16 when you felt something, and then 4 days later a progesterone level of 4.5 might make more sense, but you really can't know for sure.

Taking a pregnancy test at the one-month mark isn't any kind of guarantee either. If you did O on CD16, a test might show positive as early as CD26-27, or not until CD 32 sometimes. But if you O'ed later, you might not see a positive test until well after. And of course, if you didn't O, you might see your period come really really late but still not be pregnant.

I hope this ends up being our month after all and you never have to worry about all this stuff!! But it sounds like a great plan to ask your endo for a referral to an RE. If your period comes, you will likely schedule a CD3 ultrasound and bloodwork (to see how your ovarian reserve is among other things), then around a CD7-10 HSG. And of course you'll have to get your partner to go in for his sperm analysis!! That's always a fun battle.

Thank you so much for your advice! Luckily, husband already said he would go in for a SA. He does have a 5 year old daughter that we see every other weekend, but anything could have happened to his sperm in the past 5 years, right? He is on board for anything that could result in a baby.

Shauntee

I agree with PP about running to an RE. I was stupid and wasted 3 &1/2 years with horrible OB/GYN's who had no idea what to do with me. I would hate for you to waste precious time too. Also, there are different SA's my husband got one in 2012 that reveled his levels were awesome. This July he redid an SA, but they also did a Kruger test which reviled he has too many gentlemen and not enough soldiers. We would have never known that if we didn't redo his SA.

BunnyBerry

Shauntee said:

This July he redid an SA, but they also did a Kruger test which reviled he has too many gentlemen and not enough soldiers. We would have never known that if we didn't redo his SA.

@Shauntee That is soooo funny! Never thought of them as "gentlemen." This week DH was making all sorts of jokes about his "soldiers" (like, hey give me my helmet back! - No, I need it, I have two heads!, and Come on guys, follow your captain to the egg! -Don't listen to the captain, he swims in circles! - That's not an egg, it's a bomb, run!).

dogshowgirl

Lmao Now I am going to HAVE to make a military reference fto my husband. That just made my night!
TMI- I am starting to have (dare I say it) purpleish/browning discharge. But in what looks like EWCM. This is only when I wipe though..... WTH? :-S