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Infertility
ramzlau
member
Advice for next steps
ramzlau
member
Hi! I haven't been very active on this board because we have been in a holding pattern with our RE, trying to wrap our heads around next steps, so I thought I would ask for your advice/questions we should be asking since many of you have been through this process. I have been enjoying the TTGP board, but for this topic I felt this board more relevant.
We started to TTC in October of 2015. The first few months were NTNP, and very quickly moved onto TTC. By October of 2016, we decided it was time to get started on fertility testing. The first month our RE put me on a trigger shot of hcg and progesterone for 12 days following ovulation (an ultrasound showed a follicle at 18mm at our consultation). They did a full battery of blood tests, the only abnormality was a slightly elevated prolactin level, for which they prescribed cabergoline. The following month I had my HSG that came back clean, and we did another round of trigger and progesterone (again another follicle at 20mm). The third month my husbands SA came back with good results, but we skipped the trigger because we were traveling and couldn't be monitored, but continued with the progesterone.
Since the third round of medicated cycles, my RE has been non-responsive. We called 9-10 times before an RN finally went through our chart to give me updates on outstanding test results (they were all normal), and still haven't been able to arrange for an appointment with the RE. The RN said she could have the doctor's assistant prescribe me clomid over the phone as that would be the normal next step in their process (she said it would be 3 rounds of what we had been doing with adding the clomid). Their only concern was with multiple follicles because my history of follicles has been good, so they wanted me to come in 2-3 times prior to ovulation for monitoring via ultrasound. My DH and I decided we would rather meet with the RE again after all the mixups before we move forward with the next step of treatment, so we didn't pick up the prescription from the pharmacy. The RN mentioned that by her standards we fall into the unexplained category, but we haven't even had a chance to talk to the RE about what that means.
My questions are:
1) Is it normal to have Clomid prescribed over the phone?
2) Is it normal to have trouble getting a response from your RE? Would you switch even after completing the tests with one?
3) What questions should we be asking before moving onto next step?
4) What would be the best timing for meeting with an RE? Every month I start thinking about the next step during the TWW, then decide to wait it out, by the time AF shows up, I feel it is too late to start the new process.
Thank you for your advice in advance! I really appreciate any insights and wisdom you can share!
*Edited forgot one of my questions
We started to TTC in October of 2015. The first few months were NTNP, and very quickly moved onto TTC. By October of 2016, we decided it was time to get started on fertility testing. The first month our RE put me on a trigger shot of hcg and progesterone for 12 days following ovulation (an ultrasound showed a follicle at 18mm at our consultation). They did a full battery of blood tests, the only abnormality was a slightly elevated prolactin level, for which they prescribed cabergoline. The following month I had my HSG that came back clean, and we did another round of trigger and progesterone (again another follicle at 20mm). The third month my husbands SA came back with good results, but we skipped the trigger because we were traveling and couldn't be monitored, but continued with the progesterone.
Since the third round of medicated cycles, my RE has been non-responsive. We called 9-10 times before an RN finally went through our chart to give me updates on outstanding test results (they were all normal), and still haven't been able to arrange for an appointment with the RE. The RN said she could have the doctor's assistant prescribe me clomid over the phone as that would be the normal next step in their process (she said it would be 3 rounds of what we had been doing with adding the clomid). Their only concern was with multiple follicles because my history of follicles has been good, so they wanted me to come in 2-3 times prior to ovulation for monitoring via ultrasound. My DH and I decided we would rather meet with the RE again after all the mixups before we move forward with the next step of treatment, so we didn't pick up the prescription from the pharmacy. The RN mentioned that by her standards we fall into the unexplained category, but we haven't even had a chance to talk to the RE about what that means.
My questions are:
1) Is it normal to have Clomid prescribed over the phone?
2) Is it normal to have trouble getting a response from your RE? Would you switch even after completing the tests with one?
3) What questions should we be asking before moving onto next step?
4) What would be the best timing for meeting with an RE? Every month I start thinking about the next step during the TWW, then decide to wait it out, by the time AF shows up, I feel it is too late to start the new process.
Thank you for your advice in advance! I really appreciate any insights and wisdom you can share!
*Edited forgot one of my questions
Re: Advice for next steps
In regards to your next steps, it's so hard to know what to do. We're in that same situation and both have appointments for tests tomorrow- more tests.
A few bigger picture questions? Did your doctor explain why you were put on hormones? Do you ovulate on your own? I'm no expert but would find it strange that's what he did as you were being tested. I had quite a few tests done before any treatment was discussed, although it turned out to be male factor. Also, it sounds like your doctor isn't being responsive. I would either just make an appointment to go in or find a new one. We dealt with a similarly difficult to reach doctor and finalize accepted the fact that we cant talk to him unless we go in for an appointment in person. Hence another appointment tomorrow. If you are not comfortable with the way your case is being handled then you could always find another doctor. I wouldn't let tests keep you from switching. You just have to ask for your medical record and you shouldn't have to start at the beginning. Bring the tests with you
1) I would not feel great about getting a new med over the phone but it is convenient.
2) I would weigh pros of this doctor with difficulty getting in touch with them. I wouldn't stay because of tests.
3) I would ask do you have any certain info on your diagnosis. Are they giving hormones to see if it might help or do they have a specific diagnosis? What tests have you each had that are normal and what other tests could help you get a diagnosis?
4) I don't think the timing matters. I'm seeing my OBGYN tomorrow even though I'm on my period and can't get a pap I also need cause I need some other blood etc tests done to get more info on what ivf protocol and cost would be. You might not be able to get everything done at once visit anyway.
I hope this is helpful. Unfortunately, you may find that fertility challenges take a while to sort out, regardless or cause. One piece of advice the women on this board have given me is to be your own advocate. Ask the doctor why and how and when and don't let them leave until you understand all you can. Try to be patient but stay persistent on next steps. Good luck!
I do ovulate every month on my own, that is part of the hesitancy of moving forward with the Clomid. In regards to why she prescribed the hormones, a) the trigger because I have a moving ovulation day between cd 12-16, so she thought that maybe the egg is sitting around and aging a bit too much due to not a sharp enough LH spike, it was an easy thing to test through process of elimination * tw b) the progesterone because of the previous mc, she wanted to offset the trigger with a steady LH phase tw*
#2 and #3 are helpful, maybe it is worth going in for another appointment if I can get an in person with her.
Trying to find the balance of persistent and patient
So much of this, particularly for those of us who are unexplained, is just throwing attempts at a wall and seeing what sticks.
So for me:
1) In your case, yes, it'd be normal to have clomid prescribed over the phone
2) My clinic is huge, so it's normal for us to deal with someone other than the RE for the day-to-day things like testing/monitoring. Sometimes I see my RE, but just as often I'll see one of his partners for the ultrasound, and then nurses for IUIs and bloodwork.
3) What questions do you have? Are you worried about something specifically? If I were you, I'd ask my RE if he/she would recommend anything other than just clomid - like, should we be doing an IUI in addition?
4) We will meet with our RE 2x - once before starting any treatment (when he gave us a run-down on what our best bet for next steps would be), and once before starting another course of treatment, like IVF. So by that logic, it makes sense to meet with your RE next, to discuss all the different treatment options you could take, and why he/she would advise you to do a specific one.
Good luck!
After hearing your feedback along with @greenhillgirl I think you guys are right that I should just try to have another sit down with my RE to try to get better understanding of the game plan. I want to be my best advocate, but just don't feel like an expert on this subject yet. Making the appointment now
@funkykey I see you are benched this month, hope the cysts resolve soon!