Singles Trying to Conceive...


#10721

Jen - I’m glad you’re home and Abigail is recovering from her surgery.

I’m wondering how all of you chose you RE? I originally consulted with mine because I was diagnosed with PCOS years ago and her clinic specializes in treating PCOS patients. After some testing she told me that she does not believe I have PCOS. We spoke about my desire to start IF treatments at the same appointment and she gave me a treatment plan.

The original plan was just to take clomid days 4-8 and then test with ClearBlue until I get a positive and call them to schedule an IUI. I was really concerned that doing IUI without knowing how many folicles matured would mean a high chance of multiples, so she agreed to switch from clomid to letrozole, which has a lower chance of multiples and add a US on CD12.
I notices that many ladies on this forums get much more monitoring. I’m specifically interested in the CD 21 blood test that can determine if I ovulated. Since I don’t ovulate on my own, I want to be sure that its actually happening with meds.
I wonder if any of you spoke to several different clinics before deciding which one to use? I have been googling reviews for my clinic and very few come up, most of those negative.


#10722

I called around. For me, the biggest factors were personal attention and an open schedule at the clinic. I didn’t want to be a number at a big clinic but I also didn’t want to go to a clinic that was closed on weekends or holidays because, inevitably, I always seemed to be ready to go right on a weekend, especially those three day weekends!! It doesn’t sound like you are comfortable with what your current RE is suggesting. I wouldn’t be either. WHY does she not think you have PCOS? If you don’t ovulate is she planning to have you take a trigger shot? How do you know you aren’t ovulating (Temp change is a poor indicator by itself)? I would say that given your history, maybe having frequent monitoring and tests would be good. If she is wrong about your PCOS, taking clomid or any of the other follicle stimulating hormones could definitely lead to lots of follicles and you really should be getting scans and at least a baseline blood test. My RE would base the IUI on follicle size, uterine lining thickness and then have me take trigger and do the IUI 36 hours later. Timing is critical! With the cost of this, you don’t want to just be taking blind shots at this.


#10723

[QUOTE=silverbrumby]I called around. For me, the biggest factors were personal attention and an open schedule at the clinic. I didn’t want to be a number at a big clinic but I also didn’t want to go to a clinic that was closed on weekends or holidays because, inevitably, I always seemed to be ready to go right on a weekend, especially those three day weekends!! It doesn’t sound like you are comfortable with what your current RE is suggesting. I wouldn’t be either. WHY does she not think you have PCOS? If you don’t ovulate is she planning to have you take a trigger shot? How do you know you aren’t ovulating (Temp change is a poor indicator by itself)? I would say that given your history, maybe having frequent monitoring and tests would be good. If she is wrong about your PCOS, taking clomid or any of the other follicle stimulating hormones could definitely lead to lots of follicles and you really should be getting scans and at least a baseline blood test. My RE would base the IUI on follicle size, uterine lining thickness and then have me take trigger and do the IUI 36 hours later. Timing is critical! With the cost of this, you don’t want to just be taking blind shots at this.[/QUOTE]

I agree with Ona.
You need to be comfortable with the plan. For my iui’s my doc used clomid. He wasn’t concerned with a high risk for multiples but he did do US eval around day 10 or 12 and then based on that scan he would either ask me if my ovulation kits had come out positive or he would do a trigger shot with iui 36 hrs later.

Jen
Glad you and Abigail are home again, do you have any friends or family that can help so that you can get some rest?

Has anyone heard from Gullivergal ?

Maloo sending you lots of :babydust: :bsv:


#10724

Maloo - sending you :bsv:. Are you going to test at home before your Beta?

Ona - RE doesn’t think that I have PCOS because my testosterone level was normal. I also brought the results for my last 2 pelvic USs and the last one, which was done in June, did not show cysts. The one before that did show bilateral cysts, but that was a few years ago. Both Ultrasounds were abdominal, I asked if an internal one would be more accurate, but RE said it didn’t make a difference.
I think I don’t ovulate (or if I do, its extremely rare) because I have been charting BBT. I know its not very accurate as far as actually pinpointing the day of ovulation, but I think if I actually ovulated I would see the temperature stay higher for a few weeks afterward and that just does not happen. All the temps have been in the 96.7-96.8 range. I occasionally get a higher one on a weekend because I sleep a bit later, so I take the temp later. It’s back to the same low range on Monday morning instead of staying higher for the 2 weeks, so I know it’s just the time difference of testing. I heard that doing the 21 days progesterone test maybe the way to find out for sure if I ovulated, but RE never brought it up and I didn’t find out about it until I started reading this forums. I will ask OB about it when I see her. RE also never mention the option to do the trigger shot, and again, I didn’t know that it was possible at the time, so I didn’t bring it up.

I live in a big city, so the plus is that there are several clinics to choose from, but the minus is that they are all pretty busy. After the RE gave me my treatment plan, all of the other conversations have been with a nurse and she just reads back from the same treatment plan every time I ask a question.

I would like to get a second opinion before I start the treatments. This is why I’m trying to get a diagnosis, so my insurance will at least pay for the consult. It can get expensive quickly if I start paying $300 just to talk to someone to get their opinion. However, it I can’t get insurance to pay, I might go to a different clinic anyway. It is a lot of $$$ per treatment - DS alone is $750/vial + shipping and of course the cost of IUI and monitoring. I want to give it the best chance possible to work, which means getting the timing right.


#10725

@hopeforthebest I took a recommendation for a RE from another single gal who got pregnant on her 6th IUI, so you might try finding people on these forums who are in your town. (I’m in the SF Bay Area in case you are). From what you’ve said, if it were me I’d get a new RE if that what your instincts tell you.

Even with decent monitoring and using the OPK’s 2 or 3 times a day, I still think for my first set of IUIs, we probably inseminated too late and in one case probably triggered too late, as I ovulate closer to day 12.

My clinic monitored much more for injectables than letrozole, which I think is standard protocol. If you ovulate before you take the trigger shot, the shot won’t make a difference. Those were a few things I learned in my first IUIs. If your clinic doesn’t routinely do weekend ultrasounds get a new one for sure. Also my clinic didn’t do baselines ultrasounds for my first IUIs (mistake, but minor in my view) - but make sure to get them and have them tell you exactly what your antral follicle counts are on each side, don’t accept a “it all looks fine.” Ask them if they are having any trouble counting the number of follices or not. I found out that one doctor couldn’t see around a cyst, and put “?” for one side, which was probably legitimate but it was months before I realize that the AF number they were giving me was for one side only.

I cancelled two IUIs - one because we only had one mature follicle and I think the other because I ovulated too soon.

Also ask for the best vial of sperm your bank has available for your donor. Usually it will be washed before freezing (maybe always) but if not note there are different sperm washing methods, and the one that is done in a RE’s office is older, less effective technology. You want it done at a more advanced lab.

Also right before they do the IUI, they should count and tell you the number and the motility.

Hope that helps.


#10726

Hope,

My advice is to go to a new RE and let them know you have a previous diagnosis of PCOS. Don’t bring up the current REs conclusions and bring in your older medical records. Tell them you want to do IUIs first and be monitored closely because of your PCOS. If you have a previous diagnosis then that should be enough for them to use the billing codes for previous diagnosis. I do not think that testosterone levels is a good indication of whether or not you have PCOS. There are different presentations of PCOS, some women with PCOS have normal testosterone levels:

Defining PCOS - The University of Chicago Medicine

My advice is to search around in your area for another RE who specializes in PCOS.

As far as your ovulating, I really would not pay any attention to BBT. In fact, I’d throw away my thermometer if I were you. There are so many factors that go into just taking the measurements accurately that there is a high change you aren’t getting an accurate reading. Also, if you do a search for BBT charts and google “ovulating but no BBT change” there are many where women have low to no change in temp. Some women “run colder” and some women “run hotter” and just like we all have different ways to cycle some of us have different ways of thermoregulating and different responses to the hormones within our cycles. That said, having a body that doesn’t do the thermal shift can decrease chances of success as the reason your body ups the temp is to help that embryo grow and implant (there are several studies out there on this). But I wouldn’t worry about that either since you are going to be helping mother nature along anyway.

I think that given you have had multiple cysts in the past, and may have some form of estrogen resistance, you should get more monitoring rather than less. I’d start over and make sure you only share what they need to know to get you into the swim lane you need to be for bill codes so that your insurance will acknowledge that you have fertility issues.

If you are in the DC metro area I know a great RE.

Best of luck!!!


#10727

Hi all,

Ona, I think that is great advice.
Hopeforthebest, if you are in the Houston area, I can refer you to someone too.

As for me,
The nausea and morning sickness has kicked in to high gear, this morning I had to go get some Zofran. I am still trying to find a balance in what I can eat to help nausea without affecting my gluten issues.
I finally decided to stick with the Endometrin 100mg PV twice daily and paid for the medication cash, I didn’t want to risk it with the prometrium. I also refilled the Estradiol, apparently it helps decrease the risk of miscarriage.

Jen, how is Abigail holding up?


#10728

Latina - sorry to hear you are dealing with nausea, but at least its a good sign of a healthy pregnancy. Can you find any gluten free crackers to help? I’m seeing more and more gluten free products on the shelves lately.

AFM - I live in Philly area, so not near any of you ladies. I just posted on the General Support forum to see if I can get feedback on Philly fertility clinics. The one I’ve been using just send me the script today for the FDA panel testing. They put all the testing under the “Irregular menstrual cycle” diagnostic code. How can that be correct? I don’t see insurance company paying for HIV and Hepatitis testing because I have irregular cycles. I will ask GYN for the same tests and see how she codes it.

Ona - I think I will take your advice and not mention that my current RE doesn’t think its PCOS. I’ll just let the GYN and new RE come to their own conclusions. The problem is that my insurance company wants IF diagnosis in writing before I can even see RE, so I still have to get GYN to put it on paper. I was originally diagnosed many years ago and I never though about asking for the paperwork. I was told the only medication they can give me was BC pill to regulate the cycles, but I decided against taking it. BC has its own risks and side effects and I didn’t want to take it just to manage my cycles. I just took provera a few times when AF was 4-5 month late just to get it started. The GYN I saw at the time is no longer in my area, but I’m going to see someone new from the same practice.

Sasha - thank you for sharing your experience with IUIs. Can you tell me the reason behind baseline ultrasounds and antral follicle counts? What would I learn from doing those?


#10729

Hope, insurance should cover the FDA testing. My advice there is to see your gyn and get your anual exam (if you haven’t had one in the last year you’ll need one) and you can get some of the testing done during that (all if your gyn has ability to do blood draws and labwork). Most insurances also cover infertility workup. That is not considered part of infertility treatment.

I’ll chime in on antral follicle count. Basically, antral follicles, or primordial follicles are an indication of your ovarian health and can be predictors of how well you’ll respond. In healthy ovaries, several antral follicles will start to grow at the beginning of your cycle and then one will become dominant and suppress the others and keep them from growing. For IUIs it really is not critical to know it every cycle. A single check of antral follicles combined with AMH levels can give a good indication of your ovarian health. And here is the kicker… getting an antral follicle count is hard. It requires an advanced u/s machine (which many REs don’t have) and it requires a certain level of skill to find all the follicles and get an accurate count because they are small. Baseline U/S are important though because your RE should be checking to make sure you are cyst free. Some docs get baseline bloodwork too. Then with the PCOS, regular checks are important to make sure you aren’t being overstimmed (which is easy to do with PCOS).


#10730

Welp, no AF and surgery postponed AGAIN. Only this time the doc was clever and did an u/s first to see where my lining was before canceling (had she done that last time I probably would have been able to have the surgery! grr). The u/s showed I had just ovulated so she gave me prometrium to take for 5 days to give the ol’ af a kick in the pants. So, looks like surgery is now sometime at the end of April/beginning of May. Oh well. Staying positive and visualizing a March baby!!!


#10731

Oh no, Ona! Hope it works and you can actually get it taken care of soon. A March baby would be lovely…

Abigail had her 9 month checkup yesterday and all was a-okay. She has regained all the weight she lost in the hospital and then some.

Going for a follow up with the cardiologist tomorrow and the appointment cannot come too soon. I am a bit (okay, quite a bit) worried as some of Abigail’s pre-surgery symptoms (you know, the heart failure ones) have returned. So scared. So lots of positive vibes please!!!


#10732

Keep us posted on how Abigail is doing!!! I hope everything is okay! :cross:


#10733

Ona - Sorry to hear about another delay. This process seems to have delays at every turn. At least you have a time frame for the surgery now. How long do they have to wait after surgery to do the transfer?

Jen - I hope Abigail is OK. How did the cardiology appointment go?


#10734

So… the cardiology appt was somewhat delayed due to a call to emergency roadside assistance and somewhat rushed due to us being very late, but it was okay. The cardiologist says she is looking great (I knew that!) and he thinks her symptoms are mostly related to her heart still healing. Sure hope so… the last time such symptoms appeared it meant the surgery had been unsuccessful… so I am watching it but temporarily reassured, at least.


#10735

Super Happy for you and Abigail!
Think Positive!:cheer:


#10736

Jen - Happy to hear that cardiologist gave you good news :cheer:. Sending healing thoughts to Abigail.

Latina - How did your US go?


#10737

[QUOTE=HopeForTheBest]Jen - Happy to hear that cardiologist gave you good news :cheer:. Sending healing thoughts to Abigail.

Latina - How did your US go?[/QUOTE]

Hi hope,
The ultrasound confirmed twins. We saw both heartbeats :slight_smile: I am excited and will be sharing the news with the rest of my family when I go visit them in New York.

Have you found a new RE yet?


#10738

Well thought I would post a quick update here. I have a consult scheduled with one of the other RE’s at the clinic since mine is no longer there. It’s scheduled for about two weeks from now. :cross: it goes well.

I had an interview day before yesterday that was really weird and after sitting there ALL day (8 am to 2 pm) I didn’t end up getting the job. I was really upset because it was a good paying job! Even part time I would have been making more than I was full time at my previous job. I was worried about their flexibility (of which they expected a lot from you but seemed willing to give none) but I didn’t let on that it bothered me and figured once I had the job I’d work that out. But in the end I didn’t get it anyway. Extremely frustrated. This is the third interview I’ve had since losing my job (although, granted, one was just for a temp agency) and nothing has panned out as of yet. I did get accepted at the temp agency but they haven’t found anything for me so the point is moot.

Guess I better put my nose back to the grindstone. My unemployment is going to run out in about 2 1/2 months so I’m really feeling the pressure.


#10739

WOOHOO! Welcome to the club Latina!!! I am so looking forward to hearing your updates. So excited for you!

Nickelle, hang in there. It took me over a year to find a job and even then it was so not the right job. Luckily, I eventually found the one I have now and feel so blessed. It will happen. Just be vigilant and patient. If you are interested in parttime work I have a friend looking for someone to set appointments. It’s only 8-10 hours a week at 10/hr but it’s flexible hours and totally telework. You could maybe work out to do more work for his business as well if you are good with computers and interwebs type stuff. Not sure what you’re looking for exactly but I figure this pays the same as your weekly unemployment checks and its better than nothing. Plus, you could keep doing it even after you find a job so it could be your RE fund.


#10740

[QUOTE=silverbrumby]WOOHOO! Welcome to the club Latina!!! I am so looking forward to hearing your updates. So excited for you!

Nickelle, hang in there. It took me over a year to find a job and even then it was so not the right job. Luckily, I eventually found the one I have now and feel so blessed. It will happen. Just be vigilant and patient. If you are interested in parttime work I have a friend looking for someone to set appointments. It’s only 8-10 hours a week at 10/hr but it’s flexible hours and totally telework. You could maybe work out to do more work for his business as well if you are good with computers and interwebs type stuff. Not sure what you’re looking for exactly but I figure this pays the same as your weekly unemployment checks and its better than nothing. Plus, you could keep doing it even after you find a job so it could be your RE fund.[/QUOTE]

Thanks Ona!

This weekend kind of sucked I got food poisoning and that was not fun. However, after two days I am finally starting to feel better.
I am definitely excited.

Did AF show?

I think it is awesome that you are helping Nickelle out, I think that is a great flexible job she could use. Let’s see what she says.