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Timing of seeing an RE

chicagobride_07chicagobride_07 member
in TTC after 35

My insurance only pays for one round of initial diagnostic testing with an RE, so I want to be careful about when I do this.

Last month (before DH and I were TTC), my GYN's office ran some tests and I came back with extremely low AMH (less than 0.16).  All of my other tests were normal (prolactin, TSH, US).  Because of the AMH value and my age (41) the GYN's office referred me to an RE.

I've been calling a few RE offices and the conversations with the receptionists have been a bit awkward.  Mostly because DH and I have just started trying.  I get the feeling that most of the women seen in these offices have long and complicated histories and they are a bit unnerved that I am calling them in the first weeks of TTC.

Anyway, I am assuming that with my AMH, my only options would be IVF with DE.  I have no insurance coverage for this, and realistically, we'd only be able to do this late this summer or early Fall, for financial reasons. 

In this case- maybe we should wait until then to see an RE?  I am trying to avoid doing diagnostic testing now (when we are not ready for IVF) and the RE asking for it to be repeated (which would not be covered by insurance) again in the Fall.

What would you do?  I am not sure the benefits to me seeing an RE now if my only option is the DE. 

image
DOR and AMA
2/12-5/12: 4 IUI cycles = all BFN;
7/12: DE IVF # 1 (with ICSI)- 20R, 16M, 14F, 5DT of 2 blasts; 6 frosties = BFN;
Lupus anticoagulant initially high, then found to be normal on hematology consult;
Follow up testing in September all clear;
Started synthroid for "high normal" TSH;
FET # 1- late October 2012- BFP on FRER; beta # 1- 21(low), beta # 2- 48 (still low), beta # 3- 132, beta # 4- 1,293; beta # 5- 5,606; last beta- over 100,000. First u/s 11/21- heard heartbeat
12/12- Officially an OB patient!
Level 2 ultrasound at 20 weeks shows vasa previa and VCI
Referral to MFM and mandatory c section for delivery
Beautiful baby girl born at 34 weeks
Finally home after 15 day NICU stay!
Trying for sibling: FET # 2- May 2014; beta 5/31, BFN
FET #3, early July 2014; beta 7/14, BFN
DE IVF # 2- August 2014; 14R, 13M, 11F, 5dt of 2 blasts (3 AA), 5 frosties = BFN
FET #4- December 2014, yet another BFN

Dr. KK work up shows borderline uterine blood flow, elevated NK cells, and MTHFR mutation (homozygous for c677t)

Added baby aspirin, prednisone, supplements, Metanx, and intralipids

Switched to large clinic for final attempt; had endometrial receptivity testing in January; FET March 2015 = yet another BFN

Likely OAD- NBC

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Re: Timing of seeing an RE

  • tfkre8ivetfkre8ive member

    I'd go for a consult with an RE as soon as you can. They won't run tests at the first consult anyway. Have copies of your records and tests sent to them prior. Many will review results from tests already performed. They are also more well versed in reading and interpreting test results than an OBGYN is. Also, don't assume any course of treatment until you have a consult. My RE suggested a much less aggressive approach based on our test results than I had anticipated. Also, at age 41, I would not wait, I would want to know ASAP what course of action to plan on.

    Good luck.

    Baby #1 due 2/10/14!
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  • MelleTXMelleTX member

    Your RE may not immediately recommend IVF with DE. He will want to do a complete work-up first which is more than just the bloodwork.

    I had my initial work-up with my RE in July of 2010 and will just now be doing IVF in March 2012. I did 6 IUIs in between. The only tests he is making me retake are my infectious disease test and day 3 bloodwork because they are over 1 year old. It will cost me about $350 out of pocket for these tests because I do not have insurance coverage.

    You should be fine to go now. I would recommend going sooner than later as you will find that testing can eat up several months of the process. I started my testing in July and did my first IUI in November. It could have been October, but I had a cyst we had to wait out. And if your insurance pays for all diagnostic testing - get it all done. It will be worth it to have the best starting picture to work with.  Then, you and your DH and RE can discuss the best course of action for you.

    Low AMH does not always equal DE. 

    Good luck! 

    Single Mother by Choice. Life didn't work out the way I planned so I did it on my own. IUI #s 1-3, unmedicated = BFN, IUI #s 4-6, 50mg Clomid, Ovidrel = BFN IVF #1: 23R, 20M, 17F. 5 day transfer 2 blasts. 2 Snowbabies BFP 6dp5dt, Beta #1 7dp5dt = 58, Beta #2 9dp5dt = 114, Beta #3 10dp5dt = 187 1st Ultrasound = 5/3, not much to see yet. 2nd Ultrasound = 5/17, TWINS!!! Hospital Bed Rest at 32 weeks due to pre-ecclampsia and severe edema. Audrey Grace, 5lbs9oz, & Lydia Louise, 6lbs, born via emergency c-section on 12/6/12 at 36w1d My IVF Journey
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  • chicagobride_07chicagobride_07 member

    Thanks- I'll move forward and do this now, then.

    image
    DOR and AMA
    2/12-5/12: 4 IUI cycles = all BFN;
    7/12: DE IVF # 1 (with ICSI)- 20R, 16M, 14F, 5DT of 2 blasts; 6 frosties = BFN;
    Lupus anticoagulant initially high, then found to be normal on hematology consult;
    Follow up testing in September all clear;
    Started synthroid for "high normal" TSH;
    FET # 1- late October 2012- BFP on FRER; beta # 1- 21(low), beta # 2- 48 (still low), beta # 3- 132, beta # 4- 1,293; beta # 5- 5,606; last beta- over 100,000. First u/s 11/21- heard heartbeat
    12/12- Officially an OB patient!
    Level 2 ultrasound at 20 weeks shows vasa previa and VCI
    Referral to MFM and mandatory c section for delivery
    Beautiful baby girl born at 34 weeks
    Finally home after 15 day NICU stay!
    Trying for sibling: FET # 2- May 2014; beta 5/31, BFN
    FET #3, early July 2014; beta 7/14, BFN
    DE IVF # 2- August 2014; 14R, 13M, 11F, 5dt of 2 blasts (3 AA), 5 frosties = BFN
    FET #4- December 2014, yet another BFN

    Dr. KK work up shows borderline uterine blood flow, elevated NK cells, and MTHFR mutation (homozygous for c677t)

    Added baby aspirin, prednisone, supplements, Metanx, and intralipids

    Switched to large clinic for final attempt; had endometrial receptivity testing in January; FET March 2015 = yet another BFN

    Likely OAD- NBC

    Report Reply
  • mtlaurelmtlaurel
    I just want to echo that thing scan move slowly at the REs office. It was 5 full months between our first consult and our first treatment. And, most clinics seem to require that diagnostic and other screenings be from within a year of treatment. Good luck.
    TTC #1 since June 2010
    Me: 36, DH: 42
    Dx: DOR and MFI

    DH: low count + very low motility; hormones all normal; Sperm DNA Frag. test = poor to fair; male karyotyping normal
    Me: FSH 13.4 + AMH 0.26 + hypothyroidism; Scratch the hypothyrodism (?); Blood clotting and immune panel all negative; endometrial biopsy normal

    IVF #1 (MDLF - Jul/Aug 2011): BFN (9R, 5M, 3F with ICSI, 3dt of 1 10-cell grade 2, no frosties)
    IVF #2 (EP-antagonist - Sep/Oct 2011): BFN (6R, 4M, 3F w/ ICSI, 3dt of 1 6-cell, 1 7-cell, grade 4s, no frosties)
    DE IVF #1 (shared cycle - June 2012): c/p (6R, 6F w/ICSI, 3dt 1 8-cell grade A- and 1 7-cell grade A-; no frosties)
    DE IVF #2 (shared cycle with new donor - Nov/Dec/ 2012): - BFP!!!!! 12/14/12. U/S on 12/27 shows twins!!!!!

    SAIFW/PAIFW
    Report Reply
  • genmalonegenmalone member

    The standard is that tests are good for 1 year.  I would go ahead and have the consult but let the RE know your timeline.  Hopefully, you'll get a BFP before summer.  Good luck!


    After more than 2 years of fertility treatments, FET did the trick!
    IVF March 2012 - BFP! - Severe OHSS = 8 days in the hospital in kidney failure
    No heartbeat at 10w6d
    FET August 27,2012 = BFP!
    It's a boy!
    My Blog - 3 Dogs, No Baby

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    BabyFruit Ticker
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