Newbie. Ob/gyn vs. RE vs...

BorderGirl

Hi all!  January marks the one year mark for me with TTC.  Sorry in advance I haven't updated my charts in a long time.

I have a history of several health problems:  pituitary microadenoma (last couple of MRI's have not shown it though) with hormonal imbalances (testosterone and cortisol primarily) and possible lupus (+ ANA and +Sjogrens antibody) are the most significant.  Also developed post-infective IBS over a year ago out of NOWHERE.  Got really really sick with that.  But I'm on a super strict anti-infammatory diet now which has really helped.

 Anyways, at my annual my ob/gyn told me to give it another six months of trying and then come back, at which point she said endometriosis would be her first suspicion.  I have extremely painful and long periods.

Because I am a devout Catholic, I've known that my options for possible interventions are going to be more limited (no offense to anyone here).  So a little over a month ago I started to see a Creighton Method teacher so that I could be open to the possibility of Napro Technology. 

So I guess my main question is do I go back to my ob/gyn or immediately ask for a referral to an RE?  I guess I am a little worried that my ob/gyn will want to do a lap, and I may want to go to a very very experienced doctor for that, since it may be one of the few things that I can do that will potentially help.  I have a friend with endo that has highly recommended one of the RE's in my area.  I am very polite though   So if my ob/gyn says she can do the surgery, I'm not sure what I would say.

Are there things an RE can do for me other than IVF/IUI?  And does anyone think it will be possible for me to at least consult with the Napro thing at the same time?  They typically require 3 months of charts before you can see their doctor, but my teacher is asking them to expedite it for me because of the painful periods, pre-menstrual spotting, and post-menstrual brown bleeding.

I guess overall I'm feeling very torn about whether to pursue Napro first, since that is kind of where my heart is.  Or go traditional medicine first, exhaust the options that I can do, and then turn to Napro if it doesn't work.

Thanks for any advice

Neesey

I don't know what napro is but with your medical history, I would see a specialist RE. You can have your HSG, SA and blood work done and then get your options for moving forward with what you are comfortable with.

Aurora1181

Hi, there! I agree with the PP- I would go to an RE so you can get a CD3 ultrasounds, bloodwork, SA and an HSG. Sometimes RE's have you redo those tests if you did them with an OBGYN first (mine had me re-do the bloodwork and ultrasound).

Sounds like you might want to also get a lap, as well. An RE can monitor your cycles (natural or medicated) and let you know what's going on. The RE might prescribe progesterone to help with your spotting, for example. While an RE might suggest something, some RE's are more conservative than others, and of course they can't "make" you do anything you don't want to do. They will just suggest a course of action and help you find a plan that works with your priorities.

All that said, I'm sorry you have to be here, and we wish you all the luck in 2013! 

Shortie24

Aurora1181:

Hi, there! I agree with the PP- I would go to an RE so you can get a CD3 ultrasounds, bloodwork, SA and an HSG. Sometimes RE's have you redo those tests if you did them with an OBGYN first (mine had me re-do the bloodwork and ultrasound).

Sounds like you might want to also get a lap, as well. An RE can monitor your cycles (natural or medicated) and let you know what's going on. The RE might prescribe progesterone to help with your spotting, for example. While an RE might suggest something, some RE's are more conservative than others, and of course they can't "make" you do anything you don't want to do. They will just suggest a course of action and help you find a plan that works with your priorities.

All that said, I'm sorry you have to be here, and we wish you all the luck in 2013! 

Very well said! Good luck to you!

BorderGirl

Thank you all for the advice!  Not going to lie... I am extremely terrified of the HSG thing.  To the point where I am actually significantly less afraid of having a lap than having that (crazy, I know!)   Do you think it helps to time that when you are right around ovulation?  I'm thinking it must be less painful when the cervix is more open?  I am actually not a person that is usually terrified of a little pain, but I do have issues with the idea of something going up past my cervix  

My Ob/gyn hinted that she would skip that test on me (which I know from lurking is not a popular opinion around here!)  At my annual when we were discussing the fact that I hadn't gotten pregnant, she asked me some questions then said "Well you don't have any risk factors for a blockage so my first thought is going to be endometriosis."  I guess that is another reason I am questioning going back to her, as much as I am afraid of the HSG.

 PP, Napro Technology was created by a Catholic ob/gyn to help with infertility issues and overall ob/gyn health.  From what I've read, they are heavy on surgery and natural hormone supplements.  They have an extremely detailed charting system (way more detailed that your typical sympto-thermal method) and use your descriptions of CM to help figure out what is going on.  I have a friend who finally got pregnant after turning to them after 5 years of infertility and traditional doctors, so obviously I'm hopeful it could work for me too   But if my problem is endometriosis (and I think there is good reason to suspect that is at least part of the problem!), I may have the same or better luck with an experienced traditional doctor.

MrsSmith414

Hi! Welcome! With what you have said above I would suggest going directly to an RE. They are more in tune with what needs to happen and they can work with you regarding IUI/IVF there are different options out there for you. I would even ask the person you are seeing for Napro Technology if they have a referral to an RE, as they might know of someone who has worked with people in your situation.

The HSG is not that bad. It is discomfort I will not lie but you really shouldn't skip the test or even assume endometriosis. I have rough cycles also, they are horrible.. very painful and heavy it stinks a lot as you know I am sure lol. Take some Tylenol an hour before this will help with the pain. They normally do these between days 5-10 in your cycle and that can be close to ovulation. Mine was very closed and they had to use a smaller cath but it was over quickly and knowing my tubes were open gave me so much hope!

Good luck with everything! 

ccollins06

I actually see a Napro doctor and am glad to connect with someone else here who knows what the heck it is.  I started with a traditional RE, but we parted ways because I was concerned that he wasn't treating my condition (PCOS)  and basically just treating me as a number.  (9 medicated/unmonitored cycles!) I was also concerned that his treatments were too aggressive for me (meaning I'd soon find myself in line for IVF).  I am Catholic as well, and while I've bent the rules in the past, (use of BC and IUI)  I just don't think I am morally/mentally/physically equipped to deal with everything that comes with IVF. 

 

I really like my Napro doctor and was impressed from the beginning with how thorough she was in taking my GYN history.  My initial consult was an hour and I think we ran over.  She is also my Creighton Model Trainer (not always the case)  and those appointments are also an hour long, so I feel my treatment is really individualized.  She also ordered more blood panels than my previous RE ever had, and then took the time to go over the results in detail with me.  So, i guess in a nutshell, I feel my napro doctor is extremely competent, takes the time to answer all my questions, and is attempting to treat my GYN health issues, as opposed to simply getting me pregnant.  The down side is that while Napro is proven very successful, it also takes longer than traditional ART methods. 

That said, I recently met with a new RE, (with over 30  years experience) ,not to change treatment, but just to get plan in place if I decide if I want to go back to IUI at some point. The good news is that when I laid out the napro treatment plan, he completely agreed with everything we are doing and wouldn't mind working with her (although I don't think the Napro doctor would have that if we were talking using any ART). 

I know this is long and rambling, but again, just so excited to talk with someone else who is thinking of using Napro!  The last thing I wanted to mention, that I can't necessarily speak to is Napro surgeons and endometriosis.  If I'm not mistaken, Napro surgeons (my doc. isn't one)  undergo a special fellowship and additional training and are considered highly specialized in laps (and even boast fewer adhesions than other traditionally trained surgeons).  So, to answer your question I would, get the RE referral from your OBGYN, but also seek out the Napro doctor and start the Creighton Model training ASAP, and ask for a surgeon referral from the Napro doctor.  Here is where I found mine:https://www.fertilitycare.org/

GL in the New Year!

Aurora1181

BorderGirl:

Thank you all for the advice!  Not going to lie... I am extremely terrified of the HSG thing.  To the point where I am actually significantly less afraid of having a lap than having that (crazy, I know!)   Do you think it helps to time that when you are right around ovulation?  I'm thinking it must be less painful when the cervix is more open?  I am actually not a person that is usually terrified of a little pain, but I do have issues with the idea of something going up past my cervix  

My Ob/gyn hinted that she would skip that test on me (which I know from lurking is not a popular opinion around here!)  At my annual when we were discussing the fact that I hadn't gotten pregnant, she asked me some questions then said "Well you don't have any risk factors for a blockage so my first thought is going to be endometriosis."  I guess that is another reason I am questioning going back to her, as much as I am afraid of the HSG.

 

 

If you're going to have a lap, they will probably just do the HSG during the lap, so you'll be knocked out the whole time and won't feel a thing. So nothing to worry about there. Definitely NOT a test you can skip!!!!! 

BorderGirl

Oh wow!  So excited to hear from someone doing Napro!  How long have you been seeing that doctor?  I have heard it can be a long process.  Heck, even the fact that they want us to avoid during the fertile times for the first 3 cycles while I learn their charting method is REALLY testing our patience.  We have one cycle under our belts, and chose to cheat once when we knew I was most fertile.  We did 'fess up to cheating, but I didn't tell her we did it 100% on purpose rather than just in the heat of the moment lol   I did have cloudy CM the next day, so we are going to try not to cheat this cycle, and maybe cheat again the third cycle   But I am very hopeful that one of the doctors will take me before the 3 months is up, because that is also hard to wait for.  I wish we had met with the teacher sooner.  I just really didn't understand that they would not be able to use my sympto-thermal charts at all.

I hope we can keep in touch, since there aren't all that many people out there trying Napro   And I definitely appreciate the advice about still seeking out an RE.

To the last poster, I had wondered if they might be able to do the lap and HSG at the same time!  Glad to know that is not a crazy idea   I would be totally supportive of them doing all the uncomfortable tests at the same time and while I'm out!!!

Thank you everyone for all the helpful responses and warm welcome!

ccollins06

We started seeing  her at the end of October.  But that was for the Creighton Model Teaching.  So, we have been seeing her twice a month since then, but mainly just for the training.  I have had two separate medical appointments with her to go over labs and discuss treatment, etc.  I guess we are lucky in the sense that the doc and the trainer are one in the same. 

I am getting impatient though, which is mainly why I chose to see another RE.  I really liked him, but ultimately I'm not willing to switch treatment plans (meaning IUI) until I give this Napro thing a fair shake.  I tried to keep it from the Napro doc that I was seeking another opinion, because at this point I just wanted reassurance that we are on the right track, and to get a plan in place if I do go another route. She found out anyway since I had to end up requesting my labwork from her office.  She called me out at my last appointment and wanted to know if I was abandoning the method.  I reassured her that I was confident and on board with everything, just that I am super anxious to be preggo! I also reminded her she is my 2nd opinion and we already tried an entire year before seeing her, so we are just ready for something to happen already!!!

I know exactly what you mean about the abstaining and "seminal fluid instructions."  DH and I did exactly the same thing and "cheated." It doesn't help that with my PCOS i don't ovulate regularly, so my last cycle was 107 days.  I tried explaining to her that was enough reason to send me running back to an RE who would rx provera and femara to get my cycles on track and at least give us a fair shot every month. Alas, she wants to get my body back into cycles on its own (well with the help of Metformin), so I will accept her expert opinion for now.

I am confident, that at the very least, this method will help me understand my body and my obstacles to conception in a way I never have before.   I am excited to continue charting and look forward to working with her to attain our ultimate goal.  DH and I have agreed to give it until the end of the school year (I'm a teacher) and then reevalute early summer when I might have more time for IUIs and everything that comes along with that.  

 

Sorry I got long-winded again!  KIT!

BorderGirl

So good news!  My teacher emailed today to say the doctor has looked at my chart.  When I see my teacher in two weeks she will help me set up a consult with the doctor and they are already giving me two supplements to address the pain and spotting.  No idea yet what the supplements will be, but super excited things are moving along!