Weird Pre-TTC Appointment — The Bump
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Weird Pre-TTC Appointment

I know it's frowned upon to start a AW thread, but this board has been so dead lately I didn't think I'd get much feedback if I posted in my super lame Weekly Chat thread. I had scheduled an appointment for this afternoon to meet with an OB to ask questions about TTC. I specifically wanted to ask about Zika since we visited a country on the Zika list a month ago.

I also was concerned about my period being irregular since I stopped BC in December - I got it in January and February, but then nothing since February 10 up until the last few days when I've had some spotting. So 70-some days without a period. I thought that she would just prescribe me something to get my period going again, but she seemed way more concerned about it than I was. She ordered a bunch of bloodwork to test my "egg-making hormones" (her words), and she also requested a test for Zika. So now Zika is less of a concern since it's apparently really easy to just request a blood test (from my research it seemed more difficult).

She also ordered that I schedule a transvaginal ultrasound at the hospital to check for any other issues that might be causing irregular periods, like an ovarian cyst. I felt like it was all just a lot at once, especially since we haven't started TTC yet and I've only been off of BC for 5 months. I told her that we were thinking of waiting until May/June to start, but she recommended starting immediately because "your fertility tanks at 27" (I'm 26 now - again, her words).

Thoughts?? I'm just a little overwhelmed because I didn't expect her to be so concerned or to have any sort of tests done until we'd been trying for a year. Should I schedule the ultrasound or is that overkill? Thanks ladies <3 
TTC #1: May 2018
BFP: 12/19/18 :heart: EDD: 8/31/19

Re: Weird Pre-TTC Appointment

  • I think it’s all a pretty personal decision, but I’d be a little worried about your doc’s scare tactics. 

    If you can swing the expense I say the ultrasound can’t hurt.
    ME: 32  DH: 32 DD1: June '16 DD2: March ‘19 :::: Married since 2011 :::: USN Wife ::::
    picklesplease
  • I would be put off by her. She shouldn’t be pressuring you to make major life decisions against your timeline. Also you are in your twenties... it’s not like you are in your fourties and a few months is going to be fine. I’m a very level headed person and I don’t like people who start going worst case right if the bat either or start pushing agendas on me.
    picklesplease
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  • @meggyme @JLaVO888 Thanks ladies. I definitely think I’ll try to see another doctor from
    this practice when I schedule another appointment - I was pretty overwhelmed. I’m going to look into my insurance and see what the ultrasound would cost. I’m already worried about what the bloodwork is going to cost since I was originally only there for an office visit. My insurance is in open enrollment right now so might be switching to a plan with higher premiums that has more coverage.

    My H is trying to get tested for Zika this week, so hopefully if we can get results back soon we might start trying in May! :smiley:
    TTC #1: May 2018
    BFP: 12/19/18 :heart: EDD: 8/31/19
  • @dogmomma271 I’m jumping on board the find a different doc train. Even if there was a hard line at 27 where fertility drops (I think fertility is much more individualized than that), that attitude is super unhelpful and will just stress you out. I do think the ultrasound might be worth it if it’s financially feasible just to rule out any treatable reasons for the long cycle. I hope you get the insurance stuff worked out and are able to start trying soon. 




    picklespleasesnarkles
  • jcecejcece
    Name Dropper First Comment Photogenic
    member
    @dogmomma271 I'd be put off too. I'm not a fan of doctors being patronizing (can't stand when they use "dumbed down" words, etc.).

    IMO, a second opinion never hurts. Can you schedule another appointment with a different doctor or practice? It's possible that if this is your regular doc, she felt okay being pushy because you've known each other a while. But if you get a fresh perspective, I'm betting they'll tell you you're fine to wait and try first. I'd caution you to do the u/s, however, if you ALSO have other symptoms such as abdominal pain/ change in weight/ etc. 

    Also, just saying, if every doctor pushed people to get going by 27, that's crazy to me. So many people don't even find a partner/ feel ready/ have financial or emotional stability until the 30s, and plenty of women have healthy pregnancies during their 30s. I get that it sounds scary coming from a trained doc, but they're people, too, and she might just be a WAY overcautious person. 
    snarkles
  • @dogmomma271 - I would also be put off by this doctor's scare tactics. The whole "fertility tanks at 27" is extremely old and misleading. The research that states that women over 35 have a lower success rate getting pregnant is incredibly outdated. They only research they have is from France from the 18th Century, since then no one has even attempted to update this statistic. 

    I would be sure to ask what "egg making hormones" she is referring to. I have PCOS and do not ovulate without medications. When I started being tested for PCOS, the doctor I had was very straightforward and named every hormone they were testing for. Be sure they are doing the TV u/s around Day 10 of your cycle as that it when the most cysts occur. In most cases, they *should* be giving you meds to get your period going and on Day 1, you would call in to set up the appointment for Day 10. 

    If you don't feel comfortable, stand your ground. If you see red flags, be sure to ask lots of questions. It's better to be the "annoying patient" who knows exactly what's going on, rather than be unnecessarily worrying about what's going on. If she won't answer your questions, then ask to immediately see someone who will. You're paying for this, you have a right to know. It's your body. 

    Started TTGP September 2015

    PCOS dx: April 2016
    HSG: May 2016 (clear) 
    First Medicated Cycle: June 2016 - BFN
    Second Medicated Cycle + IUI: July 2016- BFP! 
    Welcome DD, E! April 2017 

    WILL START TFAS APRIL 2019

    snarkles
  • meggymemeggyme
    Ninth Anniversary 5000 Comments 500 Love Its 5 Answers
    member
    edited April 2018
    @mamawhovian so I did a quick google search for more recent studies of female fertility and age and it’s been studied more recently than the 18th century.

    @dogmomma271 This was posted in 2002 and I found it to be an interesting read that both (kind of) confirms what your doc said but also strips away the fearmongering.

    https://www.scientificamerican.com/article/study-shows-fertility-dec/

    David Dunson of the National Institute of Environmental Health Sciences and his colleagues studied 782 couples who were using the rhythm method of contraception. This approach allowed the researchers to control for both the timing and frequency of intercourse. They found that women between the ages of 19 and 26 with partners of similar age had approximately a 50 percent chance of becoming pregnant during any one menstrual cycle if they had intercourse two days prior to ovulation. For women aged 27 to 34, the chance was 40 percent, and for women over the age of 35, the probability dropped to 30 percent. "Although we noted a decline in female fertility in the late 20s," Dunson notes, "what we found was a decrease in the probability of becoming pregnant per menstrual cycle, not in the probability of eventually achieving a pregnancy." He estimates that it would take women in their late 20s or early 30s a month or two longer to become pregnant than it would have required in their early 20s.

    The study further found that both partners contribute to the increased time necessary to conceive because men's fertility also declines with age, though not as early as it does for women. When the team controlled for the age of women, they found that fertility was significantly reduced for men older than 35. In an encouraging find for older parents-to-be, the team reports that the length of the fertile window--the interval within the menstrual cycle during which a woman is most likely to become pregnant--did not decrease with age, holding steady at six days.

    Perhaps the most important thing for anxious would-be parents to remember is that fertility varies greatly from person to person. "Epidemiological studies have identified some of the factors associated with variability, including prenatal exposures, sexually transmitted disease history, smoking and occupational exposures," Dunson says, "but much of this heterogeneity remains unexplained."
    ME: 32  DH: 32 DD1: June '16 DD2: March ‘19 :::: Married since 2011 :::: USN Wife ::::
    picklesplease
  • picklespleasepicklesplease
    2500 Comments 500 Love Its Second Anniversary First Answer
    member
    edited April 2018
    @meggyme - But the first line of that statement says, "A woman's fertility begins to decline in her late 20s, but her overall chances of becoming pregnant do not start to slide so soon, a new study concludes. According to a report published in the journal Human Reproduction, female fertility starts to fall off gradually around age 27 before dropping more dramatically after age 35. The findings suggest that older would-be parents may have to wait longer before becoming pregnant." So...yes...27 is when it starts to GRADUALLY decline, but this is still fearmongering. Her doctor said it "tanks" at 27. This study shows that it doesn't "tank" but rather gradually declines...

    ETA: Also...the sample is 782 couples...that's not fully conclusive evidence...

    I would be wary of Dr. Google...

    Started TTGP September 2015

    PCOS dx: April 2016
    HSG: May 2016 (clear) 
    First Medicated Cycle: June 2016 - BFN
    Second Medicated Cycle + IUI: July 2016- BFP! 
    Welcome DD, E! April 2017 

    WILL START TFAS APRIL 2019

    snarklesizza2
  • @mamawhovian I agree. It starts to decline in late 20’s but this (albeit small) study states the difference is a matter of a couple extra months of ttc, where as her doc made is seem like it was now or never, which is untrue and unnecessarily worrisome. And it concludes saying everyone is different and this is a generalization that may not apply to everyone.
    ME: 32  DH: 32 DD1: June '16 DD2: March ‘19 :::: Married since 2011 :::: USN Wife ::::
    picklespleasesnarkles
  • meggyme said:
    @mamawhovian I agree. It starts to decline in late 20’s but this (albeit small) study states the difference is a matter of a couple extra months of ttc, where as her doc made is seem like it was now or never, which is untrue and unnecessarily worrisome. And it concludes saying everyone is different and this is a generalization that may not apply to everyone.
    @meggyme - Which is, like...why did the doctor even bother? lol! The thing I loved most about my OB was that she was straightforward, but never insulted my intelligence. I feel like this OB was just trying to scare her into starting these tests. 

    Started TTGP September 2015

    PCOS dx: April 2016
    HSG: May 2016 (clear) 
    First Medicated Cycle: June 2016 - BFN
    Second Medicated Cycle + IUI: July 2016- BFP! 
    Welcome DD, E! April 2017 

    WILL START TFAS APRIL 2019

    snarkles
  • @TJtheGoat Thank you! I looked into my insurance and it *appears* that I would only need to pay a $40 copay to get the ultrasound, so I'll probably schedule that either this cycle or next.

    @picklesplease I wish she had been much more detailed, but she seemed pretty rushed through the whole appointment. I should be getting my bloodwork results back in the next day or so, and I'll be able to see my results online (she also said she'd call either way) so I'll hopefully see exactly what hormones she tested. She also gave no suggestions as to when to schedule the ultrasound, so Day 10 is good to know! I'll try to ask her too if she does end up calling.

    @jcece I've never met this doctor before - the OB that I've seen for annual exams in previous years works at a different practice now and is no longer covered under my insurance. There are other OB's at this practice, so I'll definitely try to schedule my next appointment (maybe just my annual exam in June) with a different doctor. I agree that it sounded CRAZY to act like turning 27 is a huge deal in terms of getting pregnant - no idea why she would be wanting to pressure me into starting right away!

    @meggyme Thanks for the link - that's what I figured all along, that you're most fertile in your late teens/early 20's, but there isn't a more extreme change until you start to hit AMA. I agree that she was causing unnecessary worries - thankful for you all to talk me down with #science. You'd think your doctor would be all about the science, but oh well...


    I appreciate everyone's feedback - it helps me feel a lot better!! H is getting tested for Zika this week also, so once we get our results back we may decide to go ahead and start trying, but I'm going to try and forget most of what the doctor said because it definitely stressed me out. Hoping to just have some fun - we've never tried to make a baby before :wink:
    TTC #1: May 2018
    BFP: 12/19/18 :heart: EDD: 8/31/19
    meggymeTJtheGoatspacemountaineersnarkles
  • So I got my bloodwork results back - still waiting to talk to the doctor about them but I'm not really sure what I'm looking at. I'm not sure if there is a better place to post this, but since we don't have a Weekly Questions board or anything like that I figured I'd just add it here... Good news is Zika is negative! Still waiting for H to get tested on Thursday and hopefully get those results back quickly.

    She tested TSH, 17 Hydroxyprogesterone, DHEA-Sulfate, Testosterone Total Free, Estradiol, Luteinizing Hormone, and FSH. My testosterone (serum) number was high, above normal range, but my testosterone (free) number was right in the middle of normal. She said it would be ideal to have blood drawn on Day 3 of cycle, but my period was being so weird I don't even know if this counts. I had what seemed like a few days of spotting and then a few days a little heavier, but TMI never any red blood.

    I'm going to try and talk to the doctor on the phone or at least through the messaging service on the online portal. Relieved that Zika is negative because I did get a few bites while we were in a Zika country.
    TTC #1: May 2018
    BFP: 12/19/18 :heart: EDD: 8/31/19
    snarkles
  • I'm very curious about the "egg making hormone". From my understanding, women are born with all the eggs they'll ever have, unlike men who continue making sperm throughout their lives. Did she test your AMH? That's the hormone associated with your eggs and ovaries (I have low AMH, so I've done quite a bit of reading about it in the last nine months or so). But yeah, I'd agree that another doctor might be the best bet.
    Me: 35 | DH: 35
    Married: 9.17.16
    Diminished ovarian reserve
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