New to treatment and confused


#1

Hello everyone,

I’m new here and wondered if you could answer some questions for me. My husband and I have been trying to conceive for about a year now. The problem is I don’t ovulate for some unexplained reason. In the past year and a half, my cycles have run anywhere from 14 to 72 days long. In the past 8 or 9 months, they’ve all been excessively long. I started seeing an OBGYN who eventually put me on 50MG of Clomid. He did an ultrasound on CD13 and there was a mature follicle. He said it was a little smaller than he’d like but he still thought it was a good sign. He said it was “ready to pop.” He told me to test in three weeks (this past Thursday) if I hadn’t gotten my period. Well, I still have no period (CD 36) and HPTs are negative. I thought I would either have a positive result or a period by now. What is an average cycle length on Clomid? I still don’t completely understand what all of this means and what all is happening.

Also, I’m not sharing with people we know that we are trying. The last thing I want is people making me feel like it’s my fault for not doing some trick they read about. So, I’m wondering what your thoughts are on finding a good doctor. The office I’m with now is not good with communication. I have to call repeatedly for 3 weeks to get test results, etc. What’s the best route to take in finding a doctor who understands how emotionally painful this is and is prompt and attentive? Is there a good rating site you know about?
Thank you all so much for your help.


#2

Have you ever been tested for PCOS?


#3

He did an US and BW before he started me on Clomid. He said my ovaries were normal and he couldn’t find any reason that I wasn’t ovulating…I just wasn’t. It was frustrating to hear that something was wrong but not have a reason.


#4

[quote=babyprayers2011]Hello everyone,

I’m new here and wondered if you could answer some questions for me. My husband and I have been trying to conceive for about a year now. The problem is I don’t ovulate for some unexplained reason. In the past year and a half, my cycles have run anywhere from 14 to 72 days long. In the past 8 or 9 months, they’ve all been excessively long. I started seeing an OBGYN who eventually put me on 50MG of Clomid. He did an ultrasound on CD13 and there was a mature follicle. He said it was a little smaller than he’d like but he still thought it was a good sign. He said it was “ready to pop.” He told me to test in three weeks (this past Thursday) if I hadn’t gotten my period. Well, I still have no period (CD 36) and HPTs are negative. I thought I would either have a positive result or a period by now. What is an average cycle length on Clomid? I still don’t completely understand what all of this means and what all is happening.

Also, I’m not sharing with people we know that we are trying. The last thing I want is people making me feel like it’s my fault for not doing some trick they read about. So, I’m wondering what your thoughts are on finding a good doctor. The office I’m with now is not good with communication. I have to call repeatedly for 3 weeks to get test results, etc. What’s the best route to take in finding a doctor who understands how emotionally painful this is and is prompt and attentive? Is there a good rating site you know about?
Thank you all so much for your help.[/quote]
Babyprayers2011: :welcome:!!! My experience has shown me that Ob/Gyn’s are not the best at getting women pregnant. Reproductive Endocrinology really is very complicated and the fact that you are not understanding your treatment is only further evidence to me that your Doc isn’t giving you the best possible chances for a successful cycle.

You shouldn’t have to wait for a period. Chances are if you have to wait for a period your progesterone is likely low because you did not ovulate like you should have. You could have ovulated, but maybe the follicle wasn’t as mature as it could have been thus resulting in lower than ideal progesterone levels.

A small lesson here just in case you are unaware or someone reading can benefit: What happens in your cycle is you have the first phase which is the follicular phase because you are maturing follicles. Then once you have ovulated you have the later half of the cycle which is called the luteal phase. During the luteal phase the collasped follicle that is left over from you having ovulated (called the corpus luteum) gives off the appropriate levels of progesterone which is used to help aid in sustaining a pregnancy should you become pregnant. However, if pregnancy is not achieved then the progesterone drops drastically and this prompts your period.

Therefore, if you do not ovulate or you ovulate a less than ideal egg then the corpus luteum either isn’t there or lacks the ability to produce the rise and fall of progesterone needed for a successful luteal phase and thus there is no drop in progesterone telling your body it is time for a new cycle. The more this happens the worse the problem gets because it is cyclical in nature. Meaning that if one cycles hormones are disrupted it will not set up the hormones properly for the next as so on. This is why when the proper treatment is given the response to the meds usually get better as treatment continues (with some exceptions).

What concerns me is that your Doc could have done a cycle day 21 progesterone test to confirm or deny your ovulation for this cycle. This is a very simple and straight forward test with little to no ambiguity. You either ovulated or you didn’t and the stronger the number the better the ovulation/more mature and viable the egg.

Sadly, even if an Ob/Gyn does ultrasound and bloodwork they sometimes just don’t have the expertise to know what the results actually mean so instead they go by if the lab said it is within normal ranges or not, but labs are not consistent from lab to lab with ranges and some results depend entirely on where you are in your cycle which often labs do not take into consideration. This could be why your Doc has no explanation for why you aren’t ovulating. Also, it is worth mentioning that 30% of PCOS patients do not show up as polycystic on ultrasound.

Therefore, I recommend a Reproductive Endocrinologist (RE) for anything female reproductive organ, hormone, and/or fertility related. Ob/Gyn can be great Docs, but where fertility and hormones are concerned RE’s are a much better option. They will do more testing to find out exactly what the problem is and tailor their treatment based on their findings rather than guessing like many Ob/Gyn’s do.

Many Ob/Gyn’s will hear you and just try to placate you by throwing meds at you and doing a little monitoring and sometimes the patient gets lucky with a pregnancy, but there are better, more productive ways to treat and usually those methods that an RE uses not only boosts fertility, but also the women’s overall and future health.

Okay so–you may be wondering what if I have to stay with my Ob/Gyn due to money/insurance issues and my answer would be that…1.) I completely understand because I have been there and 2.) in this case–the best thing you can do is educate yourself as much as possible about infertility testing, diagnosis, and treatments so that you know exactly what questions to ask the Doc and how to advocate the best care for you. Sometimes all it takes is the patient simply asking if they can try this or that or if the Doc is willing to do the CD21 progesterone test? Often all you have to do is ask for and expect more.

The downside that you cannot remedy with an Ob/Gyn is that because they are not in the business of getting you pregnant they are not always going to be available when your cycle demands their attention and this can be a huge hindrance and thus take you much longer to get that pregnancy or to even sustain the pregnancy once you get it because they just lack the education needed to be as specialized as fertility really requires. Of those that are successful, in my opinion, it was more about luck than skill.

Hope this helps! :flower:

:cross: and :babydust::babydust::babydust:!!!


#5

ahhny,
Thank you for your response and for the information. He actually did have me come in for bloodwork on day 21 to test for progesterone levels. I didn’t understand, though, until a few days ago when the HPT was negative and I started doing research online that the purpose was to see if I ovulated. I never got the test results but I’ll call on Monday to confirm. What you said makes sense. I just kept hoping that maybe there was some other reason the tests were showing negative. I started seeing him in July but due to my long cycles and his office’s lack of communication, I just got to finally start treatment. I have no idea what a RE will cost. I imagine insurance won’t pay so I guess it will depend on what I can save up. We’re pretty good with budgeting if it’s not outrageous, but I worry it might be. Still, I’m going to need someone who will take time with me. Thank you for taking the time to respond. I really appreciate having someone to talk to about this.


#6

Hello baby prayers!

I completely agree with ahhny, I have not ovulated for the past year and just started my first cycle of Clomid but all of my treatment has been from my gyno/obgyn - the more I read on the subject online and in this site I am shocked!!

I realize after reading a zillion post here I should have gone to a FERTILITY EXPERT a llooonng TIME ago!!! I didn’t understand what was actually happening to my body and how the menstrual period really works until recently… Im on cycle Clomid and my gyno didn’t even mention me going for an ultrasound :frowning: to get my follicles checked and I think everyone on this site that is taking Clomid is scheduled for one… I think an RE would have verified that.
I was just in a state of shock after finding out that I asnt ovulating and I think I was in denial for the first couple of months :grr:

If I don’t get pregnant in this cycle of Clomid I am definitely going to try to find an RE or a fertility dr!!! They know more and treatment should be more effective!

praying for babies to come our way!


#7

Hey Ladies: I have to honest–I am a little bit biased on this subject based on my personal experience. I spent 1 1/2 yrs. with my Ob/Gyn and he is the best Ob/Gyn in our state for getting women pregnant. I felt that he was knowledgeable and I liked him which is why I stayed with him so long. That and, like you, I was concerned about the cost of an RE.

However, it came to a point where it was obvious to me that my Ob/Gyn was never going to do more that clomid or Femara or very low doses of Follistim with only one ultrasound per month and I was clearly spinning my wheels. Especially since I was at the whim of their office since they did not cater to my cycle.

I discovered upon moving to an RE that my Ob/Gyn should have had me on regular Metformin for my PCOS rather than the XR because it is much more effective–and that I had high prolactin. I was tested for this by my Ob/Gyn and he said the range was normal, but it looking at the labs he did I realized that he was going by what the lab said rather than interpreting the results based on his own expertise and as a result missed the diagnosis and treatment on that which is clearly counterproductive to my fertility treatment. Once I made these two changes it was confirmed by monitoring and bloodwork that I ovulated on my own the following two cycles.

Additionally, my Ob/Gyn did a laproscopy on me for ovarian drilling, but my RE says that he didn’t do it in the most effective way in fact missing the sweet spots to drill which again is counterproductive. AND to make matters worse he did an HSG during the Lap (as was clear to me by the dye I leaked for a day or so afterward and the fact that he told me my tubes were clear), but failed to indicate that he had done it in his notes so my RE insisted he do one which would not really be all that big of a deal except that it turned out to be very very intense and painful (like the worst labor pain ever and I have had three kids–at least that was my experience) AND it turned up clear which kinda pissed me off because I already knew that and if the Ob/Gyn would have just made the note then I would not have had to go through it in order to prove it to my RE.

Overall, I feel like I had the best and most knowledgeable Ob/Gyn and even with all his experience and intelligence even he failed miserably in this regard. SO–I conclude if he couldn’t cut it then the average Ob/Gyn shouldn’t even be given a chance to try. Unless they get lucky they are a waste of time, money, effort, and emotion.

Okay so having given you my experience:
BabyPrayers: I hear ya on the lack of communication. One thing I always hated about my Ob/Gyn is he would have an ultrasound tech do my ultrasounds and she was not allowed to show me the screen or tell me what she was seeing so I never knew anything about how close my follicles were all I was told was “nope you didn’t have any that were 18mm” or yes we can trigger. I often wondered if they could have done an ultrasound earlier in my cycle and then stimmed me a little harder to get what we needed. I did 8 stimmed cycles and only got two mature follicles out of it. I don’t even feel like I ever even got the chance to actually try with him.

This is in stark contrast to my RE who does the ultrasound himself and explains absolutely everything!

At least yours did do the 21 day progesterone. That is good–too bad their communication sucks. I recommend seeing what your insurance covers as far as an RE and switching.

Patruka: I am sorry to hear that your Doc is not monitoring you. This is seriously a waste of your time, in my opinion, because without some type of monitoring you have no clue if the med is doing anything. There is no way to know if the dose you are on is the right dose if they cannot see if the follicles are maturing like they should. Plus skipping a base line scan at the start of each cycle could cause them to miss a cyst that has formed from the previous stimmed cycle and you never want to stim with a cyst. This is risky.

Some Docs will give 50mg and then if no pregnancy give 100mg and so forth, but this is a good way to cause further issues with a women such as overstimming since they have no clue if you were getting mature follicles on the lower dose. The lowest dose is always best to not only avoid overstimming, but also to avoid worse side effects such as drying up you cervical mucus or thinning your endometiral linning which is counterproductive to getting pregnant. These side effects can not only cause you to lose an ovary (due to overstimming and cause ovarian torsian where the ovary twists because it is too heavy from follicles), but it can also cause cysts to form on the ovaries, and can make it even more difficult to get pregnant which defeats the whole purpose of stimming to begin with.

Clomid given correctly along with monitoring has a very low rate or OHSS (ovarian hyperstimulation), but if you aren’t being monitored you are flying blind. Not only in knowing if the drug is working, but in knowing if it is over working.

I recommend a new Doc (preferably an RE), but if you cannot do that at least insist on a 21 day progesterone to see if you are ovulating on the dose you are being given. At least then you will know if it is working or not.


#8

Patruka,
I agree. I’m glad I found this site. I’m learning a lot. I will be contacting my insurance this week to find out if anything with a RE is covered. If not, I’m just going to try to find one on my own rather than waiting on a referral from my OBGYN. I get a lot of “We’ll call you” from his office…and they rarely do.

Ahnny,
Thank you for letting me know I’m not alone in my gyn frustrations. I actually got a call back from a nurse today, telling me my progesterone was “normal.” When I pressed for details, I found out that my level was .4, meaning I did NOT ovulate, which would NOT be normal. When I started asking more questions, it was obvious that she hadn’t even bothered to look at my chart. I’ve got to find an office with more competence and caring. And before my next cycle would be great! I’ll be working on that ASAP. Now, thanks to you guys, I know the specialist name to look for.


#9

[quote=babyprayers2011]Patruka,
I agree. I’m glad I found this site. I’m learning a lot. I will be contacting my insurance this week to find out if anything with a RE is covered. If not, I’m just going to try to find one on my own rather than waiting on a referral from my OBGYN. I get a lot of “We’ll call you” from his office…and they rarely do.

Ahnny,
Thank you for letting me know I’m not alone in my gyn frustrations. I actually got a call back from a nurse today, telling me my progesterone was “normal.” When I pressed for details, I found out that my level was .4, meaning I did NOT ovulate, which would NOT be normal. When I started asking more questions, it was obvious that she hadn’t even bothered to look at my chart. I’ve got to find an office with more competence and caring. And before my next cycle would be great! I’ll be working on that ASAP. Now, thanks to you guys, I know the specialist name to look for.[/quote]

Doesn’t surprise me since your Period is taking it’s time starting. Gotta love lazy nurses! I have learned to get a copy of ALL my lab work because this scenario is very common. So ridiculously sad that you have to attempt to interpret your own results!


#10

Well, AF showed up yesterday. Has anybody noticed more intense cramping after taking Clomid? It’s been horrible this morning…and I’ve never been one to complain about cramps…but I’ve been curled up rocking back and forth. Just wondering if it had to do with the Clomid.

I had called Monday and asked about a RE referral. He never called back. When I started my period, my husband called (I’ve lost my voice) to ask if he wanted to do another round of Clomid. The nurse said he did and called it in. It’s the same dose,though. Is there a chance I would ovulate with 50 mg the 2nd time around if I didn’t the 1st? My voice is coming back slowly. (We’re out of school for break so I’m not hollering at kids for running through the halls. Lol) I plan to call the insurance about what’s covered as soon as I can. The more I read, the less confidence I have in my doctor. I just hated to have to wait another entire cycle, which could be 70+ Days for me, to do any more treatment.

Thank you all for your replies and your kindness. Here’s sending luck your way this month. :slight_smile:


#11

I had horrible cramps with my period on Clomid, too. My period lasted for only 2-3 days (usually it’s 4-5) and the cramping was worse than I’d felt with a period, and like you, I’m really not one to complain about cramps!


#12

[quote=babyprayers2011]Well, AF showed up yesterday. Has anybody noticed more intense cramping after taking Clomid? It’s been horrible this morning…and I’ve never been one to complain about cramps…but I’ve been curled up rocking back and forth. Just wondering if it had to do with the Clomid.

I had called Monday and asked about a RE referral. He never called back. When I started my period, my husband called (I’ve lost my voice) to ask if he wanted to do another round of Clomid. The nurse said he did and called it in. It’s the same dose,though. Is there a chance I would ovulate with 50 mg the 2nd time around if I didn’t the 1st? My voice is coming back slowly. (We’re out of school for break so I’m not hollering at kids for running through the halls. Lol) I plan to call the insurance about what’s covered as soon as I can. The more I read, the less confidence I have in my doctor. I just hated to have to wait another entire cycle, which could be 70+ Days for me, to do any more treatment.

Thank you all for your replies and your kindness. Here’s sending luck your way this month. :-)[/quote]

Since the 50mg didn’t work you should have been bumped up to 100mg. Since you didn’t ovulate on the 50mg the first cycle it is unlikely you will this cycle, however, if the option comes down to trying the 50mg again or sitting out the cycle I would give the 50mg another shot.

Who knows–maybe it will work–it wouldn’t be the first time I have seen a cycle with seemingly insurmountable odds end up with a BFP and a healthy baby so…

AND actually now that I think of it–I would probably call the office and tell them that I want to be bumped up to 100mg this time since the 50mg failed to produce ovulation. What is the worst they can say–No! If they do say no then you will know for sure that their office sucks and then you can still try with the 50mg so you have nothing to lose by asking, but if it works you have just advocated the best care for yourself and it would certainly be worth it if you turn up pregnant right!!!:cross:

Do what you gotta do til you can get to an RE. :flower: