After a long series of emails back and forth between myself and my doctor and a refreshing five days in the tropics, I did some soul searching and have made some decisions.
First, though, a little background.
I am grateful for the fact that even though I may not love my OB/GYN, I can at least email her and she will respond quickly and deal with my crap. You may remember that I was arming myself with a series of questions to ask my doctor. I now have answers to everything I need to know for the time being. Specifically, in my doctor's words...
Regarding being thin with PCOS and taking Clomid:
You are correct that a large number of women with PCOS are overweight. It is good that you are not overweight, but the treatment would be the same even if you were. However, though I don't have any hard numbers for you, the Clomid will probably be more effective for you since you are not overweight.
Regarding insulin resistance:
We did not check to see if you are insulin resistant because it is no longer recommended to do so routinely. This is because the insulin resistance tests are not reliable. And even if they were reliable, the treatment would not change based upon the results. Sometimes we screen for diabetes in overweight patients with PCOS. You had a normal diabetes screening test less than 18 months ago. Since you are not overweight and do not have a family history of diabetes (please let me know if this has changed recently), you do not need to repeat the test at this time. I can check it if you want, but it is not necessary now.
Regarding Metformin vs. Clomid:
Metformin has fallen out of favor as routine treatment for PCOS. We used to use it as a first line treatment for PCOS in women not desiring pregnancy, but it was not very good at regulating periods. We used to use it in conjunction with Clomid to improve ovulation, though this never panned out. So, currently it is not recommended to use Metformin routinely in women with PCOS. The exception is in women with abnormal fasting glucose, which you do not have. So, the Metformin would not be helpful for you for fertility treatment.
Regarding lifestyle/diet changes:
Since you are not overweight, there are no lifestyle changes that you would need to make prior to taking fertility medication.
Now, maybe my doctor doesn't have all the answers. In fact, I am convinced she doesn't, but I'm also now convinced that no one has all the answers to the situation I'm dealing with. She's not a fertility specialist, and I shouldn't expect her to be one. For now she seems knowledgeable enough, and nothing in our recent correspondence has been out of sync with the copious amounts of information I've been reading lately from other sources, so this is a good sign.
Now, for the decisions:
I've decided that I am willing to try Clomid. I'll give it a shot in June when I am not working, and provided it doesn't work on the first try (unlikely, the pessimist in me says) and depending on how it makes me feel, I'll either stick it out through the three rounds back-to-back in the summer or choose the take the Clomid in between attempts to get my body to ovulate on its own or even quit the Clomid if I have too many intense side effects. Even though my doctor will only prescribe me three rounds of Clomid, that doesn't mean I have to take the drug for three continuous months.
This does mean that I have to go in for some expensive appointments and additional tests before I can start the Clomid. Goodbye, $15 co-pays and free lab work. Hello, ridiculously expensive visits and tests because anything with the "infertility" label stamped on it means big business and minimal, if any, insurance coverage. (I would like to point out the irony here: that I have cost our nation's medical establishment and insurance companies virtually nothing in my entire life thanks to my perfect health and general fear of doctors, and yet the ONE TIME in my almost 30 years of existence that I ACTUALLY NEED intervention is the ONE TIME I can't get coverage. This is the salt in the wound of infertility.)
The next step:
So today I officially made my first infertility appointment, an infertility consult. This is a 20-minute in-person appointment where my doctor gets to tell me answers to the questions I've already asked over email for free, expect now I get to pay $75 for the in-person greeting and several hundred dollars for another blood test she'll schedule after my appointment for whenever day 3 of my next cycle should be (your guess is as good as mine!!! -- right now I'm at CD 38 with no signs of ovulation close by). If you're surprised about this required visit, so am I. I figured that because I already have a diagnosis -- that is remarkably accurate given my symptoms -- that I wouldn't need to go in for a consult. Turns out this is the first of no doubt many hoops I'll need to jump through before I can get what I want.
Here's the info, straight from my doctor:
Though your diagnosis is accurate, the infertility consult is necessary to get the ball rolling so to speak. I can't order your lab work or HSG without it. The infertility consult is the beginning of the process, during which we discuss the parts of you and your husband's medical history that may relate to fertility. There will be an additional co-pay of about $75 for the visit. Husband's often attend this visit, though it is not required. All I need to know from him is if he ever got anyone pregnant in the past, if he has ever had the mumps, if he has ever had pelvic or genital surgery, if he has any medical problems or takes any medication for any reason and what he does for a living. If you can answer those questions for him, then he does not need to come. Though, he is welcome if he wants to come.
Of course, my doctor already has my complete (and extremely limited) medical history, and I've asked every question in the book, and my husband has no prior medical problems or other concerns listed above that would be interfering with our ability to conceive. All this she already knows, but I have to tell her in person so she can check a box. Now I'm starting to understand why people get annoyed with the medical establishment.
But I will suck it up. I am a fighter, but I am not in the mood to bring down the system. I will quietly show up at my March 8 appointment, pay my $75, and hope that all this will be worth it in the end. Because right now I have to believe it will be.
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