1st Dr. Appt Yesterday & Questions

whoberry

Had my 1st dr. appt. yesterday. I wasn't able to print my charts so I wrote down a quick summary of cycle length, day of O, LP length etc.  She took one look at my notes & said I wasn't going to get pregnant the way things are going.  She suspects I have low progesterone.  She said my LP is too short, cycles are too long and I'm ovulating late so the egg is likely too old.  She gave me the rundown of what a normal infertility work up is and it was all the things I had heard about here- bloodwork, ultrasound, SA for DH, clomid, hsg, referral to RE.

The plan: Go in for bloodwork & ultrasound 7 days after my first + opk. Have DH do a SA and then I could probably start Clomid my next cycle. She said I could try Provera for 3 months before doing Clomid if I want to.  I would take Provera to end my cycle at CD32. She said sometimes that helps people get pregnant but it sounded like a long shot.  She also told me the average time to conceive is 4 - 7 months. 

I was really glad she was so matter of fact about how what I'm doing now is not working and its time to move on.  I had already come to that conculsion myself and I'm glad I did not wait any longer to go in for the appointment.

When I told DH, he was not interested in doing Provera and wants to start Clomid.  He is more anxious to get pregnant than I thought.   I am going to do some more research on both options and of course we will wait on the results of the bw and u/s to see what the doc says.

I always get the impression from this board that people are hesitant to start Clomid.  Why?  Also, the conventional wisdom on this board is to make sure you are monitored on Clomid.  Why is that? Also, what constitues "monitoring?" Bloodwork?  Doctor visits?  I am curious to hear opinions from others and if anyone has good links or other resources to read up on Clomid and Provera I would appreciate it.  I have been googling stuff all morning and I'm not really sure what I should be looking for. Thanks ladies!

CallieSam

I don't have any direct experience with Clomid, but my sister went that route for a while and had to be very closely monitored because Clomid can cause you to produce too many eggs, leading to high order multiples.

whoberry

jefa621:

As one poster put it, Clomid is not candy.  It is a very serious drug and can only be taken a few times in your entire life.  To take it is not a decision to be made lightly.

 https://community.thebump.com/cs/ks/forums/thread/50035262.aspx 

 

 

Thank you!  That is exactly the kind of thing I was looking for. Judging by the responses it sounds like when everyone suggests "being monitored" they mean you should be seeing an RE and NOT an OBGYN. 

brookelynpaisley

Clomid should only be taken under the careful monitoring of an RE, NOT an OB. Monitoring included BW and ultrasounds to make sure that hyperstimulation of your ovaries isn't occuring. If you go check out the Trouble TTC, their newbie link at the top takes you to a new page with a lot of helpful info.

I wouldn't be doing infertility stuff with an OB/gyn. It's the job of a reproductive endocronologist to get you pregnant, as they more deeply understand the balance of hormones and cycles and various other options. Rather than going forward with anything with an OB/gyn, I'd ask your doctor for a referral to an RE.

brookelynpaisley

Also, you mentioned that you would be having BW done 7 days after your first +OPK. Some docs also refer to it as CD21 BW, because they assume O on CD14. The bloodwork should be done on 7DPO, and therefore that may not coincide with your first +OPK. You need to keep up with the charting to make sure the BW is done the right day.

Mrs.Slick

Monitoring on clomid should consist of this: 

Baseline u/s & b/w around CD 3, then take the clomid CD3-7 (or 4-8 or 5-9) and then start follie checks (u/s & b/w) around CD10-12 and continue with these until O. There shouldn't be much guess work of when you O on monitored cycles. 

The reasons you should be monitored are that with Clomid there are increased risks of ovarian cysts, thinned uterine lining, and HOM (risk of overstimulation, aka Kate+8). There is also a lifetime limit of clomid cycles that respectable doctors will let you do ( I believe it's 6 cycles). This is due to the thinning of the uterine lining, I believe. 

Clomid is NOT candy. And if you have LP issues, the first thing should probably be adding in progesterone after O is confirmed.  

whoberry

brookelynpaisley:

Also, you mentioned that you would be having BW done 7 days after your first +OPK. Some docs also refer to it as CD21 BW, because they assume O on CD14. The bloodwork should be done on 7DPO, and therefore that may not coincide with your first +OPK. You need to keep up with the charting to make sure the BW is done the right day.

Good to know.  I told her I have gotten multiple + OPKs in a cycle before and asked how to time it.  She specifically said that I should come in 7 days after the first positive so now I am really questioning her advice. 

brookelynpaisley

whoberry:

brookelynpaisley:

Also, you mentioned that you would be having BW done 7 days after your first +OPK. Some docs also refer to it as CD21 BW, because they assume O on CD14. The bloodwork should be done on 7DPO, and therefore that may not coincide with your first +OPK. You need to keep up with the charting to make sure the BW is done the right day.

Good to know.  I told her I have gotten multiple + OPKs in a cycle before and asked how to time it.  She specifically said that I should come in 7 days after the first positive so now I am really questioning her advice. 

As you should. Unfortunately, OB's and their nurses aren't always familiar with this stuff. I got my paperwork to have "CD21" at my visit on CD17... only I hadn't ovulated yet. When I told the nurse this, she said "okay, then CD25." I O'd on CD22. I would have wasted time and blood following the advice of either of them. Use your charts.