A look back at WHY you need an RE and NOT an OB for treatment of infertility issues

I was just referencing my sticky post (of why you need an RE) on TB, and it made me realize that so many things my OB dismissed were true issues. So I wanted to go back to that conversation and update it with what my testing revealed

Me: so what are the steps from here?

OB: Well, we need to get you ovulating. So as long as the biopsy looks good, we'll start you on Clomid after your flow arrives.

          

Me: Will we do any testing first?

OB: That is unnecessary

Me: But what about an HSG for me and a SA for DH?

OB: Those aren't necessary at this point in the process. Again, we want to do minimal cost  first. There's no reason for that much testing this soon. You're worrying too much.  We will do an ultrasound on Day 14 to see how you are responding.

Test Results: DH had poor motility and poor morphology. So yes, the semen analysis WAS needed!

 

Me: But no CD 3 ultrasound? What if there are cysts?

OB: That's normally not an issue.

Me: But what if there *are* cysts, since you said I have PCOS tendencies- I'd prefer to not end up in the ER with a very large cyst rupturing.

OB: It's not our normal protocol. That's a lot of money that doesn't need to be spent. 

Me: But what if I have a blocked tube? The Clomid won't do me any good

OB: That's probably not your issue

Test Results: My right tube was completely blocked. I also ended up having an SHG done after my HSG because there was a shadowed area on the HSG. Which could have been a fibroid that would have prevented pregnancy on my good side. But luckily the SHG showed nothing that we didn't already know about

Me: But what if it is- how do you know it's not, and I don't want to waste one of my 6 cycles of Clomid

OB: The "6 cycles of Clomid" is a myth. As long as you respond well, there's no max

Test Results: I was a poor responder on Clomid- and we switched to femara for our 2nd cycle. My OB did not even consider femara to be an option. 

Me: My biggest concern is thinning my lining

OB: Research shows that a thin lining has no effect on achieving a pregnancy

               

Me: But what about bloodwork and an SA?

OB: The SA isn't necessary- you're clearly not ovulating

Test Results: See above- abnormal semen analysis. Even if I was ovulating normally we'd need at least an IUI to have success

Me: but what if we're in the 30% of couples who are dealing with issues from both of us, again, I'd prefer to not waste time and resources if we don't resolve all underlying issues.Plus, we're going on vacation in July, and if DH has any sperm issues, I'd prefer he avoid the hot tub

OB: That's not necessary. A hot tub won't affect his sperm count.

Test Results: RE said no more hot tubs or saunas for either of us due to his issues

 Me: And as for bloodwork,  wouldn't it make sense to do a CD3 blood draw with DHEA-s and LH/FSH to rule out adrenal hyperplasia, since we know I'll be on CD 3 soon? 

OB: You present with typical PCOS symptoms. I don't think that's necessary.

Test Results: Hashimoto's thyroiditis- which may have caused my two prior miscarriages. Which would have been diagnosed had she bothered to run bloodwork.

I sure hope this is my period

Somewhat Wordless Wednesday Post

This is how I currently feel. I can't handle gaining any more weight right now, so I really hope this is AF. Though I've never had period bloat in my thighs before.

This is what I probably look like right now

Christmas for Fertiles- a suggestion guide

It's the most wonderful time of the year. Families are getting together, people are sending out Christmas cards, and generally folks are happy and excited to talk about life changes: new jobs, graduations, and of course babies.


This is the first year that I've been hit hard by pregnancy announcements in the form of cards. I've put together a list of things to avoid doing during the holidays that might inadvertently hurt someone going through IF.

1) Don't announce your pregnancy at the dinner table. You  never know who in your family may be struggling to start a family, and they'll be forced to either come out about their struggles as they sob at the table, or they'll be forced to eat a meal in very uncomfortable silence.

2) Don't push your womb-fresh baby on others. Some women may have mustered up all the strength in the world to show up at your holiday gathering. They love you and your baby, they just don't want to hold it and be reminded of what they don't have.

3) Don't ask someone if they're not drinking because they're pregnant. They may be DD'ing, or perhaps they're not drinking because they're going through treatments and feel that they have too much $$$$ on the line to risk blaming a drink on not getting pregnant that month, regardless of if that is the cause or not.

4) Avoid saying "so when are you going to give your mom/MIL a grandbaby?" or any other conversation asking about someone's sex life and reproductive capabilities. Frankly, what they're doing behind closed doors is none of your damn business.

5) If you know someone is going through fertility struggles, do NOT announce your pregnancy via a Christmas pic/card/letter to them. Reach out to them 1-1 first (I prefer email or IM as it gives me time to process and cry) and let them know. Nothing sucks more than opening card after card of "squee, guess who's knocked up".

6) Respect the fact that the holidays are hard. Of course we love you/your pregnant belly and/or our niece/nephew/godchild to pieces, but it may just be too hard to come to family gatherings this year. Please respect our need for space and privacy as we mourn what we lack. It doesn't mean that we're jealous of you, per se- it's just hard knowing that we're NOT in the knocked up camp.


Most of all- love EACH of your family members for who they are, and not for their ability to spawn.

Long Distance Monitoring- a primer

So last week, I really thought AF was on her way. I woke up in the middle of the night with gas pain and cramps, which is normally a surefire sign that AF is on her way.

So I called my clinic, and then looked at the calendar. Oh shit- we'd be in my hometown for Christmas during monitoring.

No problem, my clinic says, as long as I can find a clinic back home to monitor me.

Fat chance- I grew up in the sticks and the nearest RE is 1.5 hours away. But it was worth a shot.

I'll spare you the boring back and forth details- but it took 4 phone calls to get everything coordinated: if AF showed up, I'd be set for monitoring back home. We would be out of pocket for the monitoring appointment ($280 for US+ bloodwork) and have to pay my clinic another $150 or so for "long distance case management" but it was more than worth it knowing we wouldn't have to skip a cycle.

And then I got my meds ordered which was another praiseworthy moment. OOP cost would have been $978 for the follistim (75iu daily, ordered two 300 IU pens). Thank GOD insurance picked up 50% of the cost. Which bought it down to $488.

And then I had a coupon for $300 off from my RE.

Final cost- $188, and it will arrive on Wednesday!

And the best part- this first IUI should end up costing less than $850 out of pocket!



Of course AF didn't show up after all of this, but regardless we are set for IUI #1 as soon as she shows up. We're doing a hybrid cycle with Femara on days 3-8, and then follistim day 8 forward

Like this lamb...

Stark white on the FRER with FMU

But it was fun getting to the point of peeing on the FRER. Woke up having to pee like a racehorse. So I did a urine catch in a dixie cup like normal, and dipped the extra blue dye test. I don't know if I've got line eyes or just hopeful, but I thought there was a little squinter. So I decided it was time to break out a FRER.

And then realized I didn't have time to go buy a FRER, come home, dip, and then drive to work.

So the urine sample got transferred into a disposable plastic water bottle. The bottle of piss, dixie cup, blue dye test I took this morning, and the one I tore apart like a crazed drug fiend looking for a fix at 2AM and I all got into my car, and drove to the grocery store.


I must say I've gotten spoiled with Amazon prime. I've not had to buy a HPT *in person* in close to 2 years. And even though I'm married and we're hoping to be pregnant, it's still the most awkward walk from the condoms and HPT aisle up to the cashier. I mumbled a holiday greeting and went back out to the car.

Broke open the FRER, transferred the urine sample from the bottle back into the dixie cup. Time to dip the test. Dumped the extra urine back from the dixie cup into the water bottle. Put all the trash into a plastic bag, and dropped it in the McDonalds drive-through trash can after grabbing my mocha.


Tick. Tock. Tick. Tock. Stop at a stoplight. Squint at the FRER.

Drive a mile. Stop at another light. Squint harder. Put on the map light and hold it up, hoping to see a shadow.

Drive another two miles. Stop at a few more lights. Squint even harder.


Arrive at the office....

Tear the FRER apart like a crazy person.

Hold the test strip up to the fluorescent lights in my cube. Still nothing.


CD 29, no positive OPK this month. Time to call the RE and come up with a game plan for January. 

I just broke the three cardinal rules of HPT's

Sorry for the long silence. The friend I posted about in my last post has been going through a worse time than I thought, and it's been a lot of late nights helping them deal with their grief.


But on to tonight. I just broke the three cardinal rules of HPT's. I was out of wondfo's and stopped at the dollar store on my way home. This is the result:


1) Thou shalt not use blue dye tests
2) Thou shalt not look at the test after the time window has elapsed
3) Thou shalt not disassemble a HPT to get a better look at the lines


Yeah. Currently sitting in bed obsessing over a 6 hour old blue dye test. That clearly has a second line. That is clearly blue, albeit thin.


It's probably an evap or false positive.
I'm probably not pregnant
I don't know why I'm even letting myself get my hopes up.


I'm going to pick up a FRER in the morning. And I solemnly swear I will never buy a blue dye again.