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.
Showing posts with label appointments. Show all posts
Showing posts with label appointments. Show all posts
Thursday, February 24, 2011
Wednesday, January 26, 2011
Really hungry: blood test edition
Yesterday I told you about the planning I went through leading up to going off birth control, and now that I am past the six-month mark of TTC, clearly things have not been moving like clockwork. Today I am going in for a blood test (finally) to figure out what's going on, and I'm really hungry because I normally eat a big breakfast every morning when I first wake up. All in all, though, I'm thrilled to be getting blood drawn today.
Here's what got me to this point.
I went on birth control in March 2004, and up until that point in my life I had pretty normal periods. No, I wouldn't get my period every 28 days, but so few women actually do. I fell in the "normal" range because I would get my period every 30-35 days. In college I was definitely influenced by the hormones of all the girls I'd live with -- I was clearly not the alpha female -- so my body and my cycles would naturally adjust to the bodies of the women around me.
Throughout my life I have never had any gynecological problems -- no STDs, no pregnancy scares, no abnormal test results. I also have a clean bill of health -- I have no known diseases, regular blood pressure, ideal BMI. I've never been hospitalized. I have been on antibiotics twice in my life, once for a wisdom tooth that got infected and once when I got a big splinter. Besides that, the only medication I've ever taken is birth control. I've never smoked or done drugs, I drink both alcohol and caffeine moderately, I eat a well-balanced diet with lots of delicious and healthy home cooking, and I get moderate exercise. I even go to the dentist every 6 months.
So, after I went off birth control in July 2010 and got the bleeding (a.k.a. "fake period") that follows finishing a pack, I was a little surprised that it took me 45 more days until my next cycle began.
Then cycle 2 was never ending.
On day 60 of cycle 2 in late October I called the nurse at my doctor's office. I told her I'd been concerned that I was neither getting my period nor did I appear to be ovulating.
The first nurse I talked to asked, "Oh my, now are you sure you're not pregnant?"
"Well, five negative pregnancy tests and no symptoms would suggest that I'm not pregnant," I said.
She still said she thought I should come in immediately. "Can you be here in a couple hours?"
Well, no, my job is totally inflexible, so that wasn't happening, but I told her I could come in tomorrow late afternoon. She said she would have another nurse set up the appointment and call me back.
Twenty minutes later when nurse number 2 called, she asked, "Are you running many miles a week? [No.] Are you drinking daily? [No.] Did you have abnormal periods before you went on birth control? [No.] Are you sure you're not pregnant? [Yes.]." And then, the real kicker, "Honey, you're young and you have nothing to worry about. It can take up for a year after going off birth control for your cycles to regulate themselves."
I expressed dismay, seeing as this was not the same information my doctor shared with me in August 2009 when I did my pre-conception visit. Pretty obnoxious. I knew, based on some research, that it could take a few months for my cycles to be more normal, but even then I felt I was way outside the normal range. The nurse did tell me, though, that I was overdue for my annual appointment, so she scheduled me for one in early December. (Funny side note: when the OB thinks you might be pregnant, they can get you into the office that day, but for any other concern you have to wait six weeks.)
Fortunately, my ovulation predictor kit indicated that I finally ovulated on day 69 of cycle 2, and I got my period on CD 76 (which also indicates a short luteal phase, but I'll take it for now....more on that later.)
Cycle 3 lasted 65 days and I ovulated on day 54 (meaning I achieved an 11-day luteal phase...go me!). Cycle 3 is also when I got serious about fertility charting. (That's the subject of a whole different post.)
In the midst of cycle 3 I had that annual exam in early December. My doctor assured me that I needed to time sex appropriately for pregnancy achievement. Well, duh. Trust me, we are. Then she instructed me to email her as soon as I got my next period and she would be able to somehow miraculously pinpoint the 10-day window during which I am most fertile and therefore, according to her, we should be having sex every other day (we were already having sex every other day, and every day during my most fertile phase around ovulation). Somehow someone with a 45-day cycle, followed by a 76-day cycle, followed by a 65-day cycle could be told what days to have sex and it would magically work? I internally rolled my eyes and promised to email. In the meantime, she told me it wouldn't hurt to check my thyroid function just in case, so she ordered up the blood work and I headed down to the lab. Good news: normal thyroid function.
So, a week and a half ago when cycle 3 ended I emailed my doctor my cycle history since going off BC pills. She wrote back and told me, somewhat to my disbelief, that we need to get to the bottom of what is causing me to have such irregular cycles. FINALLY. So, she ordered up some blood work and told me to go to the lab as soon as I could.
That brings me to today, waiting here for the lab to open so I can get my blood drawn and then eat. I feel like today is a bit of a milestone in the TTC process because my doctor has actually acknowledged that something may be wrong. Yes, I've been a little annoyed that she hasn't taken me too seriously up to this point, and I'm still considering switching OBs, but perhaps showing her that I have been charting my information has convinced her that I mean business. Maybe, in small way, I've managed to take back a little control.
Here's what got me to this point.
I went on birth control in March 2004, and up until that point in my life I had pretty normal periods. No, I wouldn't get my period every 28 days, but so few women actually do. I fell in the "normal" range because I would get my period every 30-35 days. In college I was definitely influenced by the hormones of all the girls I'd live with -- I was clearly not the alpha female -- so my body and my cycles would naturally adjust to the bodies of the women around me.
Throughout my life I have never had any gynecological problems -- no STDs, no pregnancy scares, no abnormal test results. I also have a clean bill of health -- I have no known diseases, regular blood pressure, ideal BMI. I've never been hospitalized. I have been on antibiotics twice in my life, once for a wisdom tooth that got infected and once when I got a big splinter. Besides that, the only medication I've ever taken is birth control. I've never smoked or done drugs, I drink both alcohol and caffeine moderately, I eat a well-balanced diet with lots of delicious and healthy home cooking, and I get moderate exercise. I even go to the dentist every 6 months.
So, after I went off birth control in July 2010 and got the bleeding (a.k.a. "fake period") that follows finishing a pack, I was a little surprised that it took me 45 more days until my next cycle began.
Then cycle 2 was never ending.
On day 60 of cycle 2 in late October I called the nurse at my doctor's office. I told her I'd been concerned that I was neither getting my period nor did I appear to be ovulating.
The first nurse I talked to asked, "Oh my, now are you sure you're not pregnant?"
"Well, five negative pregnancy tests and no symptoms would suggest that I'm not pregnant," I said.
She still said she thought I should come in immediately. "Can you be here in a couple hours?"
Well, no, my job is totally inflexible, so that wasn't happening, but I told her I could come in tomorrow late afternoon. She said she would have another nurse set up the appointment and call me back.
Twenty minutes later when nurse number 2 called, she asked, "Are you running many miles a week? [No.] Are you drinking daily? [No.] Did you have abnormal periods before you went on birth control? [No.] Are you sure you're not pregnant? [Yes.]." And then, the real kicker, "Honey, you're young and you have nothing to worry about. It can take up for a year after going off birth control for your cycles to regulate themselves."
I expressed dismay, seeing as this was not the same information my doctor shared with me in August 2009 when I did my pre-conception visit. Pretty obnoxious. I knew, based on some research, that it could take a few months for my cycles to be more normal, but even then I felt I was way outside the normal range. The nurse did tell me, though, that I was overdue for my annual appointment, so she scheduled me for one in early December. (Funny side note: when the OB thinks you might be pregnant, they can get you into the office that day, but for any other concern you have to wait six weeks.)
Fortunately, my ovulation predictor kit indicated that I finally ovulated on day 69 of cycle 2, and I got my period on CD 76 (which also indicates a short luteal phase, but I'll take it for now....more on that later.)
Cycle 3 lasted 65 days and I ovulated on day 54 (meaning I achieved an 11-day luteal phase...go me!). Cycle 3 is also when I got serious about fertility charting. (That's the subject of a whole different post.)
In the midst of cycle 3 I had that annual exam in early December. My doctor assured me that I needed to time sex appropriately for pregnancy achievement. Well, duh. Trust me, we are. Then she instructed me to email her as soon as I got my next period and she would be able to somehow miraculously pinpoint the 10-day window during which I am most fertile and therefore, according to her, we should be having sex every other day (we were already having sex every other day, and every day during my most fertile phase around ovulation). Somehow someone with a 45-day cycle, followed by a 76-day cycle, followed by a 65-day cycle could be told what days to have sex and it would magically work? I internally rolled my eyes and promised to email. In the meantime, she told me it wouldn't hurt to check my thyroid function just in case, so she ordered up the blood work and I headed down to the lab. Good news: normal thyroid function.
So, a week and a half ago when cycle 3 ended I emailed my doctor my cycle history since going off BC pills. She wrote back and told me, somewhat to my disbelief, that we need to get to the bottom of what is causing me to have such irregular cycles. FINALLY. So, she ordered up some blood work and told me to go to the lab as soon as I could.
That brings me to today, waiting here for the lab to open so I can get my blood drawn and then eat. I feel like today is a bit of a milestone in the TTC process because my doctor has actually acknowledged that something may be wrong. Yes, I've been a little annoyed that she hasn't taken me too seriously up to this point, and I'm still considering switching OBs, but perhaps showing her that I have been charting my information has convinced her that I mean business. Maybe, in small way, I've managed to take back a little control.
Tuesday, January 25, 2011
Introducing me, planning to TTC
OK, now for the real back story:
I'm a hyper organized person, so I thought I could approach TTC with the same gusto I approach most projects in my life: make a careful plan, reap the fruits of my hard work. Everything in life has been ths way for me. I worked hard as a child, got excellent grades that got me into excellent schools, where I got more excellent grades and internships that resulted in an excellent job. I work hard and excel in my job, make decent money, found an outstanding man who became my husband, and together we bought a beautiful house and have raised two adorable dogs. I have so much going for me in my life, and I am a great example of how those who work hard can achieve success.
Sound familiar? Chances are, if you're reading my blog, you are also probably a person who has controlled much of your destiny up until this point.
So, in August 2009, 11 months before my husband and I were planning to start TTC, I used my annual OB appointment as an opportunity to drill my doctor on everything I should know/should be doing before we started to TTC. I'd already read What to Expect When You're Excepting back in 2008, so I came armed with questions. She told me that because I'm young (I'm now 29 with a 30-year-old husband) with a history of perfect health, I would get pregnant immediately after I went off birth control. This is, of course, in retrospect now in the Hall of Fame of Worst Advice I've Ever Received. She added that I should finish my last pack of birth control pills, and then I could start TTC immediately -- she did not recommend any wait time as some other doctors recommend because, in her words, I would be most fertile right after ditching the BC pills.
Oh, and she said I should cut down on alcohol, caffeine and mercury-laden fish, which is simply her generic advice she gives all women. I do not consume a ton of any of those items, so I didn't need to make much in the way of a lifestyle adjustment. And, in keeping with her generic advice, she also told me to start taking a prenatal vitamin three months before I started TTC.
During that August 2009 appointment she did decide to have me run down to the lab to have my blood drawn to test for Cystic fibrosis, and the test revealed I'm not a carrier, so the odds of my husband and I having a child with this disorder are exceptionally low.
After the appointment I planned our big summer trip around my periods and the date that I wanted to ditch my birth control. My husband and I picked the date we wanted to start TTC around the date that I wanted to give birth, figuring (so shockingly naively) that I would get pregnant on the first try because that's what the doctor told me would happen.
I marked my calendar religiously: start taking prenatal vitamin on April 1; finish BC pills on July 15. Then, of course, have a baby born in March or April. I started imagining the conversations I'd have with coworkers when I'd announce in October that I'd be giving birth in March, the time of year that my job becomes most insane. Frankly, I couldn't wait to abandon my work and take care of a newborn.
As you can imagine, October (and November and December and now January) came and went with lots of big fat negatives on the pregnancy tests, and lots of other annoying surprises about my body to boot.
I've named this site Resigning Control because that's been the biggest lesson I've had to learn in the six months so far my husband and I have been TTC. Up until this point, I have controlled everything in my life and gotten everything I've ever wanted. Clearly the process of having a baby is something I cannot control, no matter how much I would like to.
I'm a hyper organized person, so I thought I could approach TTC with the same gusto I approach most projects in my life: make a careful plan, reap the fruits of my hard work. Everything in life has been ths way for me. I worked hard as a child, got excellent grades that got me into excellent schools, where I got more excellent grades and internships that resulted in an excellent job. I work hard and excel in my job, make decent money, found an outstanding man who became my husband, and together we bought a beautiful house and have raised two adorable dogs. I have so much going for me in my life, and I am a great example of how those who work hard can achieve success.
Sound familiar? Chances are, if you're reading my blog, you are also probably a person who has controlled much of your destiny up until this point.
So, in August 2009, 11 months before my husband and I were planning to start TTC, I used my annual OB appointment as an opportunity to drill my doctor on everything I should know/should be doing before we started to TTC. I'd already read What to Expect When You're Excepting back in 2008, so I came armed with questions. She told me that because I'm young (I'm now 29 with a 30-year-old husband) with a history of perfect health, I would get pregnant immediately after I went off birth control. This is, of course, in retrospect now in the Hall of Fame of Worst Advice I've Ever Received. She added that I should finish my last pack of birth control pills, and then I could start TTC immediately -- she did not recommend any wait time as some other doctors recommend because, in her words, I would be most fertile right after ditching the BC pills.
Oh, and she said I should cut down on alcohol, caffeine and mercury-laden fish, which is simply her generic advice she gives all women. I do not consume a ton of any of those items, so I didn't need to make much in the way of a lifestyle adjustment. And, in keeping with her generic advice, she also told me to start taking a prenatal vitamin three months before I started TTC.
During that August 2009 appointment she did decide to have me run down to the lab to have my blood drawn to test for Cystic fibrosis, and the test revealed I'm not a carrier, so the odds of my husband and I having a child with this disorder are exceptionally low.
After the appointment I planned our big summer trip around my periods and the date that I wanted to ditch my birth control. My husband and I picked the date we wanted to start TTC around the date that I wanted to give birth, figuring (so shockingly naively) that I would get pregnant on the first try because that's what the doctor told me would happen.
I marked my calendar religiously: start taking prenatal vitamin on April 1; finish BC pills on July 15. Then, of course, have a baby born in March or April. I started imagining the conversations I'd have with coworkers when I'd announce in October that I'd be giving birth in March, the time of year that my job becomes most insane. Frankly, I couldn't wait to abandon my work and take care of a newborn.
As you can imagine, October (and November and December and now January) came and went with lots of big fat negatives on the pregnancy tests, and lots of other annoying surprises about my body to boot.
I've named this site Resigning Control because that's been the biggest lesson I've had to learn in the six months so far my husband and I have been TTC. Up until this point, I have controlled everything in my life and gotten everything I've ever wanted. Clearly the process of having a baby is something I cannot control, no matter how much I would like to.
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