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.