What to ask at 2nd opinion appt? (long, loss mentioned)

whoberry

I've got a list of questions already, but I was wondering if anyone has advice on what else to ask at my 2nd opinion appointment. I realize that this may be hard since it's probably specific to my situation, so here's some background: 

 I like my current RE but his office does not have anyone on call on Sundays so no IUIs (and presumably no IVF stuff on Sunday either?). I did not ask about this when I first started with him so that's one question I already asked when I called the new RE's office.

I do O on my own. On unmedicated cycles I don't O until between CD 33 - CD 41 and my LPs are 8 - 9 days.  I was told my progesterone levels are normal and my RE doesn't believe in LPD.  He said it is a controversial diagnosis but the treatment is Femara/Clomid so I'm being "treated" for it.  He also wants to add in progesterone now after my 11 day LP last cycle.  I don't really understand why if my progesterone levels are normal.  

Now that I'm on Femara I O around CD 14-17 and my cycles are about 27- 28 days. 

I was also annoyed b/c I don't think my RE adequately prepared me for the pain I experienced during my miscarriage with cytotec.  It was incredibly painful and he didn't even mention taking any OTC pain meds or offer me any prescription ones. Maybe I just had a bad reaction to it, I don't know.

We are officially Unexplained IF but I worry about my egg quality with my late O and short LPs.  I'm not sure if there are any tests for this.  I looked at the Resolve website and they recommended anyone with unexplained IF get a second opinion so that is part of what prompted me to do it (and them not being open on Sunday!).  My siggy shows all the tests I've had so far.  I opted not to do a postcoital, the RE thought it was not necessary since we'd had one BFP.  Are there any other tests I should be asking about?

 Thanks for any input! 

ETA: Cycle info on Femara. 

amd1982

First off, I'm very sorry about your loss. I am no expert, but I would definitely get a second opinion. My RE maintains that an LP under 13 days is considered a deficiency in most cases. I've not had that happen to me, so I am not an expert, but I know there are many ladies on here who have short LP's and go on supplements to try and lengthen that phase. Also, I would be concerned about your late O as well - with Femara and/or Clomid, ovulating at day 33+ seems too late.

Anyway, I'm sorry you're going through this. I would ask beforehand if your doctor treats for LPD and what their school of thought is on it. I have a friend who has been through many IF treatments and she was telling me the other day that although they did a post-coital, the results are not as solid as RE's used to believe. I would mostly focus on the late O/short LP and what they think is going on, what the solution is, etc. I hope you find someone who can make a great plan for you!

whoberry

amd1982:

First off, I'm very sorry about your loss. I am no expert, but I would definitely get a second opinion. My RE maintains that an LP under 13 days is considered a deficiency in most cases. I've not had that happen to me, so I am not an expert, but I know there are many ladies on here who have short LP's and go on supplements to try and lengthen that phase. Also, I would be concerned about your late O as well - with Femara and/or Clomid, ovulating at day 33+ seems too late.

Anyway, I'm sorry you're going through this. I would ask beforehand if your doctor treats for LPD and what their school of thought is on it. I have a friend who has been through many IF treatments and she was telling me the other day that although they did a post-coital, the results are not as solid as RE's used to believe. I would mostly focus on the late O/short LP and what they think is going on, what the solution is, etc. I hope you find someone who can make a great plan for you!

 Thanks for the insight.  I may have been a little unclear in my original post so I'm going to go back and edit it, but with Femara my O is now around CD 14 and my cycles are around 27-28 days so the drugs def. helped.  I just wonder why I was Oing so late on my own.  It really makes me feel like there is something wrong and we are not just "unexplained."

pulga131

First of all I'm sorry for your loss.  When I had my second opinion I basically asked questions about treatment (since we already knew a diagnosis). I wanted to see if he agreed with my old RE in ways of treatment and he didn't.  And I liked him better and felt more comfortable so I stayed there.  I would just ask him if you think any tests need to be repeated (if its been a while) and what his recommended treatment plans would be. GL

ETA_ I would def mention your ovulation issues in the second opinion.  That may provide some important insight or at least lead in the right direction of treatment 

Jezebell26

GL at your second opinion. I remember how scared and hopeful I was. I was hoping this would be our last stop. Well basically I sent my medical records before the appointment so the dr had time to review them. I made notes and hand wrote out all my questions. I wanted her opinion on the opinions I had formed about my losses and why they occured. I wanted to know what her plan of action was and how she would proceed. I didn't ask specific questions until much later (specifically about protocol) since we had a few road blocks in the way. Just write it all down and make sure you cover each question. Even if you feel silly, they appreciate your thoroughness. I was asked to teach a seminar on how to stay organized and be your own advocate lol. My dr was really impressed with my approach to this. My medical history is in a binder separated into categories so I can easily reference it, and it has copies so I can give them out if need be. Sure i've been laughed at, but this stuff is too important for me to remember it all in my head.

Getting a second opinion is scary and thrilling at the same time. I am all for it and am so glad we did it. I am also glad that I am comfortable with our 2nd opinion. It took me a while to make an appointment and get the ball rolling again. GL!!!!

Mich1724

Are you open to alternative medicine? I too have unexplained infertility after 3 years TTC. I also ovulate later than "normal", although usually day 20 with a 10 to 11 day luteal phase.

I've been receiving acupuncture off and on (due to out of pocket expenses) and have been diagnosed with kidney yin deficiency, liver yin deficiency, blood qi deficiency, and now most recently a spleen one as well. I was told that your follicular phase and luteal phase should be relatively balanced, not one being 20 days and the other 11, more like 16/14 (and alike). Also being told that "the egg should not be taking that long to get ready or it may not be of very good quality anyways".

My very first treatment of acupuncture was performed on cycle day 10 over a year ago, I ovulated on day 14 and had a 14-day luteal phase. That continued for 4 months until hubby lost his job and I stopped going. I recently started going again to help balance my body again to aid with IUI. Well the injectibles caused me to have a cyst and really effed my body up so now I'm undergoing acupuncture to put my body back in balance again. 

If at all interested, I would suggest looking into it. I've seen wonders with myself, although just still waiting to get the BFP!

whoberry

Mich1724:

Are you open to alternative medicine? I too have unexplained infertility after 3 years TTC. I also ovulate later than "normal", although usually day 20 with a 10 to 11 day luteal phase.

I've been receiving acupuncture off and on (due to out of pocket expenses) and have been diagnosed with kidney yin deficiency, liver yin deficiency, blood qi deficiency, and now most recently a spleen one as well. I was told that your follicular phase and luteal phase should be relatively balanced, not one being 20 days and the other 11, more like 16/14 (and alike). Also being told that "the egg should not be taking that long to get ready or it may not be of very good quality anyways".

My very first treatment of acupuncture was performed on cycle day 10 over a year ago, I ovulated on day 14 and had a 14-day luteal phase. That continued for 4 months until hubby lost his job and I stopped going. I recently started going again to help balance my body again to aid with IUI. Well the injectibles caused me to have a cyst and really effed my body up so now I'm undergoing acupuncture to put my body back in balance again. 

If at all interested, I would suggest looking into it. I've seen wonders with myself, although just still waiting to get the BFP!

 I have thought about acupuncture, but I'm not sure I'm ready to add the additional cost in yet.  I think I will wait a few more cycles and see how things go before I start, but I'll ask the RE about it at my 2nd opinion appt.  Thanks for the info!  Just curious- what did your RE say about your late O?  My RE mentioned egg quality but I don't know if there's anyway they can test for that.