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TTC After a Loss
gscoville
member
OB Appointment: The Good, the Bad, and the Clomid Ugly (sorry, super long)
gscoville
member
So, the long awaited appointment was today - cue the wild and scary nightmare last night, where the doctor took polaroids of my vag and showed me what was all up in there, a creepy zombie-creature thing that crawled out of the picture a la that lovely gal in The Ring. Nothing like having to wake yourself out of a night terror and stay awake for an hour or so afterwards for fear of returning to that horror!
Anyways, here's how things went down at the appointment
The Good:
Hubby's numbers from his SA this summer are good. Hia total count is actually excellent, doc said 20 is good, hubby's at 40. His morphology is just over 2%, which is a bit on the low side, but with his good overall count so high that combo makes for pretty decent numbers especially given his age and some health factors (like the Type 2 diabetes he was diagnosed with 6 years ago, but through weight loss and exercise he is no longer considered to be anymore).
My testing all looked good, HSG was perfectly clear, Progesterone, FSH and LH are right where he likes to see them, in the good to excellent range, and he considers anything below 200 for Estradiol to be well within the good range (I'm at 161). Blood pressure, heart, everything looks and sounds great, I'm in good overall health. He said there's no real reason he can see that we're not conceiving, we obviously did once last December so we at least know together it is possible for us. Given my age (40) we do probably need to move along, if down the road IVF is what we need that doesn't become any more viable the older I get, so sooner would be better if we were to go that way eventually.
The Bad:
He wasn't at all interested in my charts, other than he could tell I knew what I was talking about, that I was ovulating, and that we weren't just trying all willy nilly. That said, even though I mentioned I temped and knew when exactly I was ovulating, he kept making comments like 'most women aren't exactly sure when they ovulate so they need to have sex more than once a week throughout the month" (in the pre-questioning we were asked how often we have sex - I said 3-4 times a week during my FW, but other times of the month more like once a week). I brought up the spotting several times and he didn't seem concerned, other than to say 'blood acts like a spermicide' and that with progesterone that would probably clear up.
The Clomid Ugly:
We were asked if we'd like to continue to try on our own for a few months or move on to next steps. I pointed out that I've had 10 cycles of actual TTC since my loss (short cycles) with pretty good timing most of them, so didn't feel like keeping on would be of any use. So next steps is Clomid. He was writing out the script and telling me about taking it CD 5-9, some of the risks (chance of multiples), I'd need to do CD21 bloodwork, blah blah blah...and then said he'd given me enough for six months, and if I didn't get pregnant in that six months to come back and see him and we would discuss options. Uh, what? I asked about the possibility of cyst formation and doesn't he do ultrasound monitoring, and he said no, in his many years doing this he's only ever seen cysts happen to one woman. He's had a high success rate with Clomid with few issues, and feels confident things will be fine. And that was basically that.
So, here I sit with a mixed bag of good and crappy news. It's good to know that our numbers are all good, for our age especially. However, living where we do options are limited. This OB is the best around, everyone raves about him, he's highly recommended...if anyone were to do clomid monitoring it would be him, but he doesn't. No one here does. Clomid is the furthest we can do here, the closest fertility clinics with any other options are an 11 hour drive or $600+ flight away. Fertility treatments are not covered here in BC, so if we do end up trying IVF, it'll be $13-15,000, plus of course the cost of flights, hotels, etc. Add to this the fact that hubby is laid off from his job at the end of November, and the new job he's got a good shot of getting involves him being out at the mine for a week at a time with every other week off, timing anything according to my cycles with that in play will inevitably be tricky too.
Not really great choices here. If I wasn't 40, of course I'd just wait things out and hope for the best, I'd have the luxury of time. But I don't. 40 is a pretty scary place to sit knowing options are limited and time is working so quickly against you. As the OB said, most clinics won't work with women very much past 40, chances of success at my age and older decline pretty rapidly, so waiting to see if something just happens on its own will simply eat into my viable IVF window. If we even decide we want to or can afford to go that route. A part of me says screw it, just take the Clomid and see what happens, damage to my future fertility is probably not much of a consideration if my longevity TTC is ticking to a quick close. But of course I know the Clomid horror stories, and that other part of me is shying away from it. I'd love to think life's great irony factory will just have me end up KU this cycle after finally getting in to the OB, so I don't even have to make such a choice, but given the spotting which started 1DPO and is just getting worse as my LP progresses as it has every other BFN cycle, I'm not at all hopeful. What a shitty fucking situation!!
At any rate, so sorry for the long long book here, if you've made it this far you more than deserve these:
Anyways, here's how things went down at the appointment
The Good:
Hubby's numbers from his SA this summer are good. Hia total count is actually excellent, doc said 20 is good, hubby's at 40. His morphology is just over 2%, which is a bit on the low side, but with his good overall count so high that combo makes for pretty decent numbers especially given his age and some health factors (like the Type 2 diabetes he was diagnosed with 6 years ago, but through weight loss and exercise he is no longer considered to be anymore).
My testing all looked good, HSG was perfectly clear, Progesterone, FSH and LH are right where he likes to see them, in the good to excellent range, and he considers anything below 200 for Estradiol to be well within the good range (I'm at 161). Blood pressure, heart, everything looks and sounds great, I'm in good overall health. He said there's no real reason he can see that we're not conceiving, we obviously did once last December so we at least know together it is possible for us. Given my age (40) we do probably need to move along, if down the road IVF is what we need that doesn't become any more viable the older I get, so sooner would be better if we were to go that way eventually.
The Bad:
He wasn't at all interested in my charts, other than he could tell I knew what I was talking about, that I was ovulating, and that we weren't just trying all willy nilly. That said, even though I mentioned I temped and knew when exactly I was ovulating, he kept making comments like 'most women aren't exactly sure when they ovulate so they need to have sex more than once a week throughout the month" (in the pre-questioning we were asked how often we have sex - I said 3-4 times a week during my FW, but other times of the month more like once a week). I brought up the spotting several times and he didn't seem concerned, other than to say 'blood acts like a spermicide' and that with progesterone that would probably clear up.
The Clomid Ugly:
We were asked if we'd like to continue to try on our own for a few months or move on to next steps. I pointed out that I've had 10 cycles of actual TTC since my loss (short cycles) with pretty good timing most of them, so didn't feel like keeping on would be of any use. So next steps is Clomid. He was writing out the script and telling me about taking it CD 5-9, some of the risks (chance of multiples), I'd need to do CD21 bloodwork, blah blah blah...and then said he'd given me enough for six months, and if I didn't get pregnant in that six months to come back and see him and we would discuss options. Uh, what? I asked about the possibility of cyst formation and doesn't he do ultrasound monitoring, and he said no, in his many years doing this he's only ever seen cysts happen to one woman. He's had a high success rate with Clomid with few issues, and feels confident things will be fine. And that was basically that.
So, here I sit with a mixed bag of good and crappy news. It's good to know that our numbers are all good, for our age especially. However, living where we do options are limited. This OB is the best around, everyone raves about him, he's highly recommended...if anyone were to do clomid monitoring it would be him, but he doesn't. No one here does. Clomid is the furthest we can do here, the closest fertility clinics with any other options are an 11 hour drive or $600+ flight away. Fertility treatments are not covered here in BC, so if we do end up trying IVF, it'll be $13-15,000, plus of course the cost of flights, hotels, etc. Add to this the fact that hubby is laid off from his job at the end of November, and the new job he's got a good shot of getting involves him being out at the mine for a week at a time with every other week off, timing anything according to my cycles with that in play will inevitably be tricky too.
Not really great choices here. If I wasn't 40, of course I'd just wait things out and hope for the best, I'd have the luxury of time. But I don't. 40 is a pretty scary place to sit knowing options are limited and time is working so quickly against you. As the OB said, most clinics won't work with women very much past 40, chances of success at my age and older decline pretty rapidly, so waiting to see if something just happens on its own will simply eat into my viable IVF window. If we even decide we want to or can afford to go that route. A part of me says screw it, just take the Clomid and see what happens, damage to my future fertility is probably not much of a consideration if my longevity TTC is ticking to a quick close. But of course I know the Clomid horror stories, and that other part of me is shying away from it. I'd love to think life's great irony factory will just have me end up KU this cycle after finally getting in to the OB, so I don't even have to make such a choice, but given the spotting which started 1DPO and is just getting worse as my LP progresses as it has every other BFN cycle, I'm not at all hopeful. What a shitty fucking situation!!
At any rate, so sorry for the long long book here, if you've made it this far you more than deserve these:
Married August 2012. Me: 41 DH: 42
Daughter from previous marriage: 20
BFP 12/19/12:
Ectopic discovered at 8 weeks, right tube removed 01/18/13
June 2013 Testing Results: Progesterone: 31.7, LH: 5, FSH: 5, Estradiol: 161
Clomid cycles Nov. 2013 and Jan, Feb, and March 2014
TTC journey over as of the end of October 2014
All ALers welcome!
This discussion has been closed.
Re: OB Appointment: The Good, the Bad, and the Clomid Ugly (sorry, super long)
EDD 5/2/14, NMC 9/11/13
EDD 10/15/14, CP 2/8/14
IF Diagnosis: PCOS, MFI
Current Cycle: 5 mg Femara/1000mg Metformin + TI = BFP, EDD 4/23/15 Please be our RAINBOW
**ALL AL/IF Welcome**
My Chart
Married August 2012. Me: 41 DH: 42
Daughter from previous marriage: 20
BFP 12/19/12: Ectopic discovered at 8 weeks, right tube removed 01/18/13
June 2013 Testing Results: Progesterone: 31.7, LH: 5, FSH: 5, Estradiol: 161
Clomid cycles Nov. 2013 and Jan, Feb, and March 2014
TTC journey over as of the end of October 2014
TTCAL BLOG
All ALers welcome!
1 cancer diagnosis. 1 victory.
I guess you'll have to decide if the risk is something you can handle and if you can handle the consequences...good or bad.
I am praying for you and wishing you luck as you decide how to move forward. Trust your gut. (((Hugs)))
09/2007: Ectopic with rupture - lost right tube | 09/2012: Ectopic - saved the left tube
08/05/2013: BFP not ectopic | EDD: 4/22/2014 | 09/15/2013: Miscarried at home
Burned the bench 01/20/15 - Medicated Cycle with Clomid and HCG trigger shot on 02/08/2015
++++ BFP 2/17/18 ++++ EDD 10/26/2015
BFP 11/18/13. EDD 7/25/14. It's a BOY!
Surprise BFP 7/30/13. EDD 4/7/14. Natural MC 8/24/13
I will likely check in with my GP, he used to do obstetrics way back when and might have something to offer in the way of advice. Worth a try anyways!
Married August 2012. Me: 41 DH: 42
Daughter from previous marriage: 20
BFP 12/19/12: Ectopic discovered at 8 weeks, right tube removed 01/18/13
June 2013 Testing Results: Progesterone: 31.7, LH: 5, FSH: 5, Estradiol: 161
Clomid cycles Nov. 2013 and Jan, Feb, and March 2014
TTC journey over as of the end of October 2014
TTCAL BLOG
All ALers welcome!
You are definitely between a rock and hard place and I know how much AMA plays into this. Ugh.
How high is your tolerance for risk of multiples?
Would he be willing to let you have ONE monitored cycle? Just to see what kind of response you have so you know if you respond like crazy and have a ton of eggs and if your lining is okay?
I'm trying to think what I would do and, as long as I was comfortable with multiples (gulp), I might risk it given the AMA, as well as your DH's morph. If it isn't successful in a matter of a few months, you are probably going to move to IVF and (I think?) they can give you drugs to build up your lining (although, I'm not sure if Clomid can screw it up to the point of no return?)
One idea: you might ask him if letrozole is an option. Letrozole (Femara) has a lower incidence of multiples and also doesn't impact the lining as much. It is a bit more expensive, but it might be worth it. I did a lot of research into Clomid vs. Letrozole when my RE suggested it. It got a bad rap from a poor study that has since been discredited, but it comes with scary warnings as a result. It actually has a shorter half life than Clomid and is out of your system faster and before gestation. PM me if you want any more details.
Ugh, my heart goes out to you. I hate these grey areas made all the more complicated by AMA. (((hugs))))
BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12
BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until August 2013
IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN
BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014 Please stick and grow, LO!
Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis
******All AL always welcome******
My Ovulation Chart Fruit
TTC #1 since Sept 2011
BFP#1 1/31/12. Empty sac discovered 3/5/12. MTX due to location in uterine horn.
BFP#2 2/27/13. Empty sac confirmed 3/20/13. Mifepristone + Cytotec.
Operative hysteroscopy to remove septum 9/18/13.
BFP #3 12/24/13. Natural m/c 1/17/14.
BFP #4 3/20/14. Natural m/c 4/3/14.
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Formerly known as MrsE07
PgAL/PAL Welcome
Married August 2012. Me: 41 DH: 42
Daughter from previous marriage: 20
BFP 12/19/12: Ectopic discovered at 8 weeks, right tube removed 01/18/13
June 2013 Testing Results: Progesterone: 31.7, LH: 5, FSH: 5, Estradiol: 161
Clomid cycles Nov. 2013 and Jan, Feb, and March 2014
TTC journey over as of the end of October 2014
TTCAL BLOG
All ALers welcome!
(discovered @ 11 weeks. Poppy measured 7 weeks)
~Married August 27, 2011~
k: My Ovulation Chart
~All Welcome~
TTCAL February siggy challenge: Olympic Fails:
BFP#1 9/9/12 -- EDD 5/14/13 -- MMC 10/10/12 Miso 10/19/12
BFP #2 9/17/13 -- EDD 5/25/14-- CP confirmed 9/21/13
BFP #3 2/1/14 -- EDD 10/5/14 -- NMC 2/10/14
Dx: low progesterone & mild hypothyroidism
My Chart
~*~All AL Welcome~*~
PPs have pretty much covered everything but my bigger concern on clomid is that it will thin your lining and it sits in your system so by cycle two or three there can be issues - especially if not monitored.
I'm going to throw another option at you to think about. The doctor said that the blood from your spotting may be creating a hostile environment for sperm. I think that would need to be taken care. I'm not sure if pre-seed would help with restoring a more friendly environment. Also, what if you try a couple cycles with progesterone sups after O to see if that takes care of the spotting?
The day the Bump died - Jasper is wise
BFP #1 : 3/20/13 | EDD: 12/1/13 | MC: 4/15/13
BFP #2: 1/9/14 | EDD: 9/21/14
Welcomed our rainbow bear on 8/31/14
My Chart | All are Welcome
I don't know what I would do if in your shoes, but I will support you in whatever decision you make. I suppose the Clomid (or Femara) is worth a shot for a couple cycles. I agree that maybe make an appointment with an RE for a few months for now just in case.
I just want to give you the biggest ((HUGS)) right now!!! I'm so sorry that you are between a rock and a wall here. Know that I'm always here if you need to vent!
DX Endometriosis 2/2002 (lost left tube due to a cyst), PCOS 6/2010
BFP - 10/18/2012, EDD - 6/26/2013, Baby Girl lost at 22 weeks (T21), D&E 2/15/2013
BFP - 4/23/2014, EDD - 1/2/2015 Twin Boys lost at 12 weeks, M/C 6/25/2014
My chart here All ALers welcome!
BFP 08/14/13 EDD 04/18/14 Natural MC 08/19/13
BFP 10/15/13 EDD 06/24/2014 Natural MC 10/23/13
Recurrent Miscarriage Panel done 11/06/13. Results= All normal
BFP 12/2/13 EDD July 30, 2014
Beta 12/3/13: 19,261!
U/S 12/13/13 heart rate 143 bpm!
My Blog
Off BC, NTNP since June 2011
Started acupuncture/herbs July 2012
First BFP 9-8-2012,EDD 5-15-2013, heartbeat of 175 at 8w2d, mmc discovered on 10-26-12 (11w6d) Cytotec on 10/26/12
8/23/13 DX with non-IR PCOS
Second BFP 9.12.13, EDD 5.29.14, heartbeat of 114 at 6w1d, mmc discovered on 10-18-13, D&C on 10/23/13 (baby girl/Trisomy 10)
Third BFP (surprise at Beta draw after d&c) on 1/10/14 (15dpo), EDD 9.20.14 Please be our RAINBOW!
"It's, not, where you are, it's where you're going,
And it's, not, about the things you've done, it's what you're doing, now"
TTC Journey Began 8/12
BFP #1 11/9/12, MMC/D&C 12/21/12 @ 9w2d, EDD 7/24/13
SAs: 2%-3% Morph - RE Official Diagnosis Unexplained
BFN = IUI #1 (Clomid) | IUI #2 (Letrozole)
BFP #2 4/19/14 = IUI #3 (Letrozole)
Expecting Our Elf 12/27/14
~All Welcome~
BFP#1 4/17/2013 EDD 12/25/2013, MC 5/17/2013 8 weeks 3 days D&C 5/18/2013
BFP#2 1/20/2014 EDD 9/28/2014, Baby Evie born on 9/23/2014 at 8:50pm. 6 lbs 15 oz!
BFP #1 ended in MMC. Discovered Oct 2005 @10w5d, baby stopped growing around 6w. D&C.
BFP#2 Nov 2005. Baby's heart stopped @ 8w3d. D&C Jan 2006. Trisomy 18
BFP#3 Nov 2006. My "miracle baby" DD born 7/25/07
BFP #4 11/6/12. EDD 7/16/13~my birthday! No sac found @ 5w1d, betas not increasing. Natural m/c started 11/20/12.
BFP#5 11/9/13. EDD 7/21/14 Our beautiful rainbow born on his due date!!
Married August 2012. Me: 41 DH: 42
Daughter from previous marriage: 20
BFP 12/19/12: Ectopic discovered at 8 weeks, right tube removed 01/18/13
June 2013 Testing Results: Progesterone: 31.7, LH: 5, FSH: 5, Estradiol: 161
Clomid cycles Nov. 2013 and Jan, Feb, and March 2014
TTC journey over as of the end of October 2014
TTCAL BLOG
All ALers welcome!
TTC since March 2012
BFP #1 1/29/13, EDD 10/9/13
BFP #3 8/11/14 EDD 4/22/14
DD Born 11.27.2011
BFP 9.19.2013 - EDD 6.1.2014 - MMC @ 8 weeks 3 days
ETA I just called and got an appointment for Tuesday with my GP, we'll see what's what and go from there.
Married August 2012. Me: 41 DH: 42
Daughter from previous marriage: 20
BFP 12/19/12: Ectopic discovered at 8 weeks, right tube removed 01/18/13
June 2013 Testing Results: Progesterone: 31.7, LH: 5, FSH: 5, Estradiol: 161
Clomid cycles Nov. 2013 and Jan, Feb, and March 2014
TTC journey over as of the end of October 2014
TTCAL BLOG
All ALers welcome!
I hope you 're able to come up with a decision you're comfortable with.
BFP #2: EDD 9/3/13~~Slow HB at 1st U/S~~MMC -Loss on 2/13/13
Began trying for a baby January 2012
BFP 4.25.2013 EDD 1.3.2014 MMC 6.3.2013 D&C 6.19.2013
BFP 11.3.2013 CP 11.6.2013
BFP 3.31.2014 EDD 12.10.2014 Baby boy Carlson born 12.19.2014