A blog about babies: the babies I lost, the babies I never had, the baby who made me a Mama.

Wednesday, September 15, 2010

Re Consult #1; or, Decisions, Decisions

Thanks so much for all the support and well-wishes you left on my post yesterday. It means the world to see the faith you all have in this process and where I'm going. On my better days I feel the same way, and on my worse days it's good to have reminders that there are people out there who believe this can happen for me.

So...on to the appointment recap!

I guess I'll start by saying that Dr. Man (at NY.U) was very nice and approachable, as well as direct and informative. He wasn't a major cheerleader but he gave us the information he has at this point about our situation, ventured some supposition into what might be going on, and laid out some possible options for the future.

The first bit of (good) news was about my CD 3 bloodwork from a few days ago. My FSH was 5.2, which Dr. Man said was really good and an indicator that I've got lots of healthy eggs. He didn't tell me the estrogen number (and I forgot to ask) but that's probably just as well, because that's less for me to google.

We discussed my cycle history. I told him the lengths of each of my fourteen cycles of TTC and whether I had confirmed ovulation or not on any of them. Dr. Man also said that given the amount of time we've been trying, our likelihood of success without assistance in any given month is about 3%, a disappointing statistic to say the least.

He did an ultrasound and said that my uterus looks good, my lining is thick, and my ovaries look healthy. He showed me the corpus luteum on my left ovary where I ovulated over the weekend (And btw, this totally confirms my little theory about my ovaries. Last cycle I ovulated from my right ovary about 5 days late. In the cycle I got pregnant, the same thing happened. And now I had normal--for me--day 21 ovulation from the left ovary. I think that right ovary is a lazy slacker!)

Thanks to my somewhat irregular cycles, Dr. Man suggested I may have some (mild?) form of polycystic ovaries. He emphasized, however, that he didn't want to call it a "syndrome" because I *am* ovulating most months and that cysty ovaries at the start of a cycle are quite common and don't mean there is anything wrong with the way my body is working (he feels that women are overdiagnosed with what can be a relatively normal condition). He doesn't want to run the tests for insulin resistance because he thinks I am basically normal, and as I'm not overweight, not terribly hirsute, and have no family history of diabetes, he doesn't want to needlessly worry me. He also believes the link between PCOS and miscarriage has not been adequately proven (or not proven at all). He thinks I have lots of good, healthy eggs that take a bit longer to pop out and that we can shorten that time and give me more chances to get pregnant each year.

He ordered an HSG for next cycle, even though he said he doesn't think we'll find any major abnormalities of my uterus or tubes.

He also ordered Lawyer Guy an SA (of course) and confirmed our suspicion that the pregnancy means he definitely has sperm, but it might be of borderline quality, which would help account for our difficulties.

He ran us through our options from least to most invasive and expensive. I know you're all familiar with them, so I won't bore you with the recital. He stressed that he's willing to go at our pace and according to our comfort level, both emotional and financial.

He also told me that I can do a clomid cycle with or without insemination next month even though I'll be getting an HSG, which was good news, as I'd assumed October was out for any treatments given the additional testing I'd need.

I asked him before we finished the consult if he was optimistic about our chances of getting pregnant, and he said he was. He said egg quality was the toughest thing to overcome, and that we seem to be okay in that regard.

It was an intense morning, and Lawyer Guy and I did some talking afterward. I liked all the nurses we met and found Dr. Man approachable and professional. He wasn't super warm and touchy-feely, but he was good about giving us information and data and talking us through different possible actions to take based on that data.

I think Lawyer Guy was a little bummed by Dr. Man's professional caution. Some friends of ours were told by their RE at their first appointment, "We are going to get you pregnant," and LG mentioned to me he was hoping to hear something like that. But I don't fault Dr Man from holding back from that kind of enthusiasm, especially because we don't know anything yet about how I respond to medications or LG's sperm quality. When put to the point, he seemed optimistic, so that's good. But LG's desire for a more aggressively optimistic doctor is something for us to keep in mind as we continue our search.

Lawyer Guy didn't want to talk about any of the specifics of treatments until after our meeting with Clinic #2 on Friday, which I can understand. We'll make our decision that night and get set for what comes next.

But of course, I've done some thinking. I'd like to start with a clomid cycle in October, especially because we've got to put treatments on hold for November and December in anticipation of my sister's wedding. If LG's sperm numbers come back good, then I think I'd like to try clomid with intercourse; if they're borderline or bad, then try an IUI.

We have unlimited IUI coverage with our insurance and zero IVF coverage, so doing a large number of medicated IUIs makes sense for us, until we just can't take anymore. And then we'll need to think hard about IVF and adoption and how we want to use our money. But we're not there yet.

I guess I'm feeling cautiously optimistic right now. I entertained a brief daydream about giving birth to twins and holding them at the hospital after the consult, which is positive. I also recognized that I am sad to be here. Part of me secretly hoped we'd show up and Dr. Man would say, "Are you crazy? You're not infertile! Get outta here!" But we're going to make the best of this, and maybe even get some twins out of the bargain.

RE appointment #2 coming up in two days, and then we'll really be able to make some decisions.


  1. my first RE said to me "you're a SURE THING with ivf". and look how f'd up my cycle was!! that a-hole. i'm still so angry. any doc who tries to guarantee you anything or sound too promising, probably can't back it up. so no worries that dr man didn't say the words lawyer guy might've wanted to hear. glad that consult #1 is done and that #2 is almost here. you're closer than ever now, so feel hopeful in that :o)

  2. Sounds like a good first consult. I'm leery of doctors who say things like "We'll get you pregnant!" The first time I saw my doc, he said "You want me to give you this pink pill that will keep you pregnant. I don't have that pink pill. I wish more than anything that I did. But I don't." And I thought to myself, "I like this guy." Realism is a beautiful thing, but a lot of people are like Lawyer Guy and want optimism. Good luck with consult #2!

  3. None of my (three) REs have volunteered a "You're definitely going to be pregnant some day!" much to my dismay. When pressed, they all thought it could be so. I understand your husband's desire for a super-positive doc (my hubs tells me I needed a cheerleader not an RE), it is not a crucial element for you to get your baby.

    I think this appt went really well and I'm so excited for you. Heck yeah for beginning the Clomid next month. (Shocker: Clinic #1 wouldn't let me cycle in the same month as the HSG.) I know you don't want to be here, and I wish you didn't have to be, but I believe in my heart of hearts this is going to work for you, Slopie. xo

  4. Tell Lawyer guy that my first RE, a total quack, assured he would get me pregnant. He also then told me that endometriosis does not cause infertility. I left him after two medicated IUI cycles for an RE who I love (who didn't get me pregnant, but also never promised me pregnancy).

    It sounds like the appointment went well, and that's wonderful that you have IUI coverage. It'll save you a ton of money! E-mail me if you want/need some tips about the HSG.

    And good luck with your next appointment.

  5. I'm glad consult #1 is out of the way. I know I felt much better after mine. And yeah for good eggs and a Clomid cycle! I'm popping one of those myself as I write this. (Clomid, that is.) I got pregnant on my very first Clomid cycle after a few late ovulation cycles. We know how that ended, but I still think it's a pretty good drug and really believe that it at least increases my chances every month.

  6. I'm glad to read the appointment was so thorough and that there is the beginning of a plan. Great news about your lovely eggs! Looking forward to hearing how RE#2 is.

  7. Well, neither of my REs have said "I can definitely get you pregnant!!" in my consult with them. They were both more subdued and quoted some stats for my age group, etc. So, it sounds like this RE is realistic.

    Overall it sounds like a great appointment and you have a great plan moving forward. Hope everything looks good on both the HSG and the SA and you're a go for clomid w/ IUI.

    Excited for you! Good luck on Friday :-)

  8. I know the uber-confident reassurance of an RE would be awesome, but I think most of the good ones are quite reserved...they are scientists after all and are all about the stats, and unfortunately not everyone will get a baby. BUT, sounds like you have great chances since your only problem seems to be late ovulation. Sounds like a good appointment and phew on the good FSH!
    I was a late ovulater (around day 21) and short luteal phase...Clomid definitely helped. My ovulation day moved to day 17 and luteal phase lengthened by a few days. I didn't get pregnant on Clomid, but I wasn't monitored either. I'd strongly recommend being monitored on a Clomid cycle so you don't waste precious time if you're not responding.
    Good luck on Friday! I think you're getting very close to a plan of action and then success!

  9. I am genuinely stoked to hear this update. Even though there's thinking still left to be done, I can understand that feeling of promise that comes with having direction and guidance. Cautious optimism = perfectly appropriate.

    My RE never gave us the We're Going To Get You Pregnant pep talk, BUT, our nurse did once say to us in the beginning, "Dr. G said, 'We're going to get a baby out of this.'" And I didn't find it reassuring at all... Even though my nurse was wonderfully supportive and insightful, I begrudged her cheerleading. I am a bit of skeptic, though. ;)

  10. I'm glad you had a good appointment. it feels good to be looking forward and making progress.

    I highly recommend you ask your doctor (whichever you go with) about using Femara instead of Clomid. It's much easier to tolerate (fewer side effects) and my pre-IVF doc, who literally wrote the book that ob/gyns use in medical school, thinks it's superior in every way. I hated Clomid.

    Good luck!

  11. My first RE said "worst case scenario, you'll be pregnant by Dec." That was said over a year ago. My new RE hasn't made any promises, just that he is willing to try as much as I'm willing to try.

    Everything sounds pretty standard (in regards to tests and such) right now so it may come down to whom you have a better comfort level with. Clomid may just be the ticket for you! Good luck!

  12. I think realistic REs are much better than those who make promises that they can't necessarily keep. I agree that cautiously optimistic is the way to be!

    Hope the second consult goes well and I hope, if that's the way you decide to go, that the Clomid is easy on you and does its job.

  13. This sounds like a lot of positive things!! Good luck with this cycle!

  14. Yay for trying something new in October!!! Another thing you could do (although it sounds awful to go through) is the post-coital test. In case your eggs are all good, LG's sperm is all good, but you have hostile CM. Of course you'll be going straight to IUI shortly anyways, but if you know about the hostile CM, you could go straight to IUI NOW and thus be bringing a baby to your sister's wedding.

    I am super thrilled that things are moving forwards. And I totally agree with these other ladies that I would not want to hear empty promises from my RE. But I understand that when confidence is flagging that you need a little cheerleading, too. Looking forward to hearing about consult #2!!!

  15. Sounds like it was a very good appointment!! And I think its great they'll let you cycle right away. I agree to get monitored with clomid if at all possible, and maybe even use a trigger shot. I know they time that more with IUIs but I think i've read where people trigger and have sex too. I was a late ovulater, and when I went in for monitoring it was like my eggs were ready size wise but just weren't popping, so I always wondered while trying naturally if my eggs were just getting overmature or something by the time they popped? Totally my own diagnosis, but may be worth asking about monitoring and trigger shot!

  16. I was thinking of you yesterday! I'm sorry not to have let you know via comment; I need to get my commenting organized now that the school year has begun. I'm glad you had a positive experience with Dr. Man. He is indeed not the warm-fuzziest, and as you've noted, different people have different needs as far as that goes. I'm still not totally sure where I stand. Best of luck tomorrow with RE #2; I'll be interested to hear how it goes (and where it is!). Thinking of you and, by the way, loved the Scandi wrap-up. Take care and hooray for what sounds like some potentially good news.

  17. It sounds like Dr Man is a realist and not going to pump you up with false hope. At the same time, he's also saying you have a good chance at getting pregnant with help - maybe the clomid will be all you need. Maybe the IUI will do the trick.

    I hope you both feel comfortable with whomever you pick! Looking forward to your update!

  18. I agree with others--TOO optimistic can be a bad thing.

    This doc sounds like he's being really down-to-earth, which I would find appealing.

    I hope #2 goes well!

  19. This is great news, Sloper. I am a big fan of realistic and forthright doctors. I am eagerly anticipating the next visit on your behalf. It's going to happen for you two. It must!

  20. My original RE said "we're gonna get you pregnant" and I've found after a failed FET and IVF that I really resent this. I want reassurance that there is a possibility that we can get pregnant and that we don't need to move to donor eggs/sperm/adoption, but after all I've been through and read about...there are no certainties in life. I'm glad you are moving forward w/ clomid. Are you going to do the monitored cycle where they assess when you are going to ovulate and trigger you?

  21. That's a lovely, low FSH - excellent news, Sloper. It sounds like he is being very thorough with what he is testing/planning to address. But I do think that it's very smart to get that second opinion, as well. For comparison's sake - and also to confirm a few things.

    On the optimistic vs. cautious thing, I can understand your husband. Often, I've just wanted someone to be...for lack of a better word, exuberant. Fully confident that he could make things happen. But at the end of the day I'd rather have someone who's the best of both worlds: cautiously optimistic.

  22. The appointment sounds like it was fantastic-- I really respect a doc that doesn't slap a PCOS label on every patient who has trouble getting pregnant. My doc was the same way-- said I had some symptoms of it, but didn't label me.

    I think that the protocol that the doc suggested (and what you are considering) sounds PERFECT! How awesome is it that you get unlimited IUI coverage with your insurance? That's amazing news.

    I can't wait for your next appointment tomorrow so that you and LG can make some great decisions about where to go next!!


  23. Thanks for sharing all this. As I'm curious, and mostly clueless about treatment details -- since you seem to be ovulating on your own (most of the time), why Clomid?
    Anyway, good luck with appointment #2. Maybe LG will feel better taken care of there?