today is the "big" call.... (slightly long)

amd1982

so I was put on 5 days of Provera Sunday since the nurse told me my spotting probably wasn't AF (since I did not ovulate) and we needed to bring on a w/d bleed before cycling again. Nurse emailed me last night saying "I called in a script for you of Clomid - once you get AF, take 2 pills days 5-9 instead of the 1, and then take OPK's days 12-20 and have sex for 2 days after you get a smiley face." Ummm, WTF?!?!?

Point 1 - I did NOT ovulate this last month on Clomid. Sooo, how can we have sex (and have it work) when I'm not getting the smiley face?

Point 2 - How are you so sure I do not have leftover cysts from last cycle?

Point 3 - I have a history of thin lining, and you haven't addressed 50mg vs. 100mg and s/e. So why wouldn't the doctor mention putting me on Femara for one month to see how I do, since she mentioned it in our intro appt?

going to call her today and insist on coming in for an ultrasound whenever AF comes. I need to start speaking up, because unmonitored cycles are doing nothing but stressing me out more and putting my health at risk. Any suggestions for talking to the nurse (and being assertive but not rude or crazy) would be greatly appreciated. Thanks everyone!

adoruhbul

Is this an RE or OB?  If it's an OB, I'm sure you know it's better to see an RE.  If you're seeing an RE, I really wouldn't stand for that.  Clomid cycles need at the very least 2 ultrasounds.  The first should be done as you said at baseline to make sure you have no left over cysts and the second should be 3 days after your last pill, so for you day 12.  On day 12 progress and your lining should be recorded.  If at that point your lining isn't looking good, they can add in estrogen suppositories.  At that point they can decide how to proceed, really hard otherwise.  There's quite a few decisions that need to be made at the second ultrasound.  Are you responding?  If not, cancel or piggyback?  If you are responding, how well are you responding?  If more than 1 follicle, should you trigger?  If more than 3 follicles, should they cancel on the crazy off chance they all release?  Is your lining sustainable at 9-12mm or do you need estrogen?

Without all these questions being answered, it's very hard to have a successful cycle, and a waste of Clomid.  I used up all my Clomid cycles unmonitored and never responded. I ended up needing to go straight to injects because my RE doesn't use Femara, and he may have been able to figure out how to get Clomid going!  The only thing I know is that my p4 level wasn't coming back as ovulating, so we upped the dose and started again.  Some people respond on Clomid but do not ovulate without a trigger, another thing that needs to be considered.

I would call your nurse and demand that in order for you to proceed that you'll want the baseline as well as at least one appointment for monitoring.  In reality, you really need 3 all together ultrasounds for Clomid, 4 if it's your first responding Clomid cycle so they can make sure you release without trigger. 

amd1982

Hey adoruhbul - thanks for the response. yes it is an RE - a well-respected one too, which is why my frustration level is so high. i just can't believe they wouldn't at the very least do a baseline to see if i have any leftover cysts. my mentality now is "I just want to know what's going on - good, bad or indifferent." I will call today and demand a baseline and also mid-cycle monitoring.

Quick question: can they tell (let's say on day 12) whether or not the follies are getting ready to release or whether or not I need the hcg shot? I'm wondering if it can be a gametime decision - I have a feeling I need the shot to ovulate (since I did in January but not the last month) so we'll see. Thank you again for the input....it's greatly appreciated. It's nice to have the bump as a sounding board and place for support.

pulga131

I would just call the receptionist and say that you would like to make an appointment for optional monitoring. 

pulga131

I would just call the receptionist and say that you would like to make an appointment for optional monitoring. If you can have your us with the re so you can address these concerns.  The nurse at my res office was very much like that and that is how I went around it. Everytime I got in front of re he agreed with everything I said which the nurse dismissed. This is the same nurse who dismissed my cancer symptoms   I obviously don't like or trust her

amd1982

Wow pulga - i can't believe that a nurse dismissed your symptoms and concerns. That is nuts. I appreciate the feedback - I'm just going to be very matter of fact and direct without coming off as rude. I am just so in awe that this doctor isn't concerned at all about leftover cysts, etc and is willing to waste Clomid cycles with no monitoring.

I hope you're doing well......

pulga131

My re always recommend the monitoring but after one cycle left it as optional since he was dealing with a super low income area.  But the nurse discouraged people from having it. I always insisted on making my appointments for monitoring   Could be your re thinks the same way?

katib77

Because it's standard, I call when I get AF and just say "HI, I've started my period and need to come in for cd3 monitoring u/w and b/w.  the receptionist most likely will not question it at all.  Then when you are there address your concerns to the RE.  If your office is like mine and the RE does not do those.  Repeat over and over "But the doctor said <blank>" until they say they will check with him.  I had to do that when they just wanted to throw clomid at me for my third cycle because the nurses had not bothered to read my chart.  I told them..."NO.  The doctor told me we were never doing clomid again because of how thin my lining has been the past three cycles.  I am supposed to do all injects."  They actually would say to my face later, "Oh, you're right.  I'm sorry I didn't read your entire chart."  I think since 90% is just the same old same old they forget to really look.

amd1982

That's exactly how I feel! Like they don't actually read your chart, and when they do, they don't read it well. I already calling the billing office to find out how much their u/s run. not that it matters, i'm going in anyway.....haha.

adoruhbul

amd1982:

Hey adoruhbul - thanks for the response. yes it is an RE - a well-respected one too, which is why my frustration level is so high. i just can't believe they wouldn't at the very least do a baseline to see if i have any leftover cysts. my mentality now is "I just want to know what's going on - good, bad or indifferent." I will call today and demand a baseline and also mid-cycle monitoring.

Quick question: can they tell (let's say on day 12) whether or not the follies are getting ready to release or whether or not I need the hcg shot? I'm wondering if it can be a gametime decision - I have a feeling I need the shot to ovulate (since I did in January but not the last month) so we'll see. Thank you again for the input....it's greatly appreciated. It's nice to have the bump as a sounding board and place for support.

Wow, if this is a well-respected RE's office, I am going to guess it's an oversight of the nurse.  Often these offices have a horrible patient to nurse ratio and I've often gotten inaccurate info before.  Maybe that is the plan but she was suppose to tell you this in person after your baseline?  What I would do if you want to avoid being snarky is, call said nurse, and just be like--- "hey nurse----, I got your email and it sounds like a plan!  I can get started as soon as I get cleared at my baseline ultrasound right?"  That likely will do the trick.  If she says "Oh no, the doctor never mentioned anything about a baseline ultrasound" I would just say "Do you mind just verifying that with him, I was under the assumption that before starting I'd need to be cleared of cysts."

 As far as your other question goes, it really depends on how far along you are at that ultrasound.  Lets say you're on CD 12 from a Clomid 5-9 cycle.  You likely will be at the 14-16mm range, which would be too soon to tell at that point.  What my RE does in that situation he either says come back in 2 days or take an OPK and if it doesn't turn positive by CD 15 call for a repeat ultrasound.  Let's say that happens and you go for a repeat ultrasound.  At that ultrasound let's say there are 2 follies measuring 19mm and 13mm.  At that point he will likely test your LH and if it doesn't show impending ovulation, you should be given a trigger.  Waiting to find out if you ovulated with 7dpo bloodwork is pointless because if you didn't ovulate there's nothing you can do at that point.

If the OPK did become positive, likely you don't need to trigger unless you have multiple follicles.  At that point, you'd wait for 7dpo bloodwork just to confirm you didn't just gear up to O and didn't.

Final scenario is you actually go in at say CD15 instead of CD 12 and when you get there you have a follie that's 22mm.  If there is no fluid in the Pouch of Douglas and he tests your LH and there is no rise, you would need to trigger at that point.  If he were to see fluid in the POD or a CLC (corpus luteum cyst) you know it's unnecessary.

I hope that helps!   Good luck this cycle! 

maggie2324

amd1982:

Hey adoruhbul - thanks for the response. yes it is an RE - a well-respected one too, which is why my frustration level is so high. i just can't believe they wouldn't at the very least do a baseline to see if i have any leftover cysts. my mentality now is "I just want to know what's going on - good, bad or indifferent." I will call today and demand a baseline and also mid-cycle monitoring.

Quick question: can they tell (let's say on day 12) whether or not the follies are getting ready to release or whether or not I need the hcg shot? I'm wondering if it can be a gametime decision - I have a feeling I need the shot to ovulate (since I did in January but not the last month) so we'll see. Thank you again for the input....it's greatly appreciated. It's nice to have the bump as a sounding board and place for support.

If you're in doubt, request the trigger too. Mine was only $66 for generic. They can tell if you're ready to trigger, but they can't tell if your body is going on ovulate on its own. If you aren't ready to trigger though, you'll need another monitoring ultrasound.

amd1982

Thanks Maggie - i didn't know ovidrel had a generic? mine was over $110 last time...