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@Shutterbug: Well, I do get u/s to see how many follicles I have and look to see how my lining is. I just don't get blood work.

@Mrs.Someone: Oh, wow. I can kinda see where your ND's comment was coming from. Luckily, it's time and not money, although if they were wasting money and running unecessary test, I would probably more be pissed. I do know that my RE has changed nurses. The one I have currently is just okay. I can't remember how the nurse was before her was.

This is just a guess but maybe when they looked at my b/w initially everything looked normal so maybe that's why they didn't do periodic b/w.

I did do a google search and found this thread. http://forums.fertilitycommunity.com/forum/infertility/infertility-treatments/intrauterine-insemination-iui/64880-my-doctor-never-did-blood-work-during-my-last-iui-is-this-normal

Looks like it's up to the doctor to do b/w.

@bluestriped bee: just b/w. I call on CD 1, they give me med instructions and schedule a monitoring appointment for CD 12. Then on CD 12 I get b/w and u/s, and the nurse calls me that afternoon to either schedule another monitoring appointment (if needed) or give me instructions to trigger and schedule the IUI and HCG beta (2 weeks after IUI). The first month I had to go in 3 times to do b/w and u/s because my dosage was too low and I wasn't responding. After that I've only gone in once a cycle and then triggered.

@Shutterbug: Oh, wow. Cool. I really hate those OPK tests. The one thing that is different is they actually inject the trigger shot.

I would call on CD1, they tell me to start meds on CD3-7, then I would come in on CD10-11 for an u/s. Both times, they triggered after my u/s and scheduled the IUI the next day. Then I would wait til AF would come.

I always had dreams of becoming a nurse or a doctor, so I was a little disappointed I couldn't inject myself. Though, if I get to an IVF, I'm sure I'll get my chance then.

Thanks! I see my RE in a little over an hour. I'll make sure to demand b/w. I want blood! I want blood! Haha!

@Mrs.Someone: No, insurance does not cover IVF. Does yours? I don't think we have those privileges in the state of WA.

I'm pretty sure, I'm going to have at least one more IUI before IVF. Maybe more IUIs.... who knows. Although, I kinda feel like I'm done with IUIs and want to aggressively go with IVF.

Though, I'll wait til I get b/w results on my next cycle and see how I feel.

@bluestriped bee: We're pretty lucky, our insurance covers up to $15,000/each for IF stuff. So far, I haven't seen anything I've had done come out of that amount yet. Also, the clinic said they can bill anything outside of my body to DH's record so we can use more of the $30,000 together.

@bluestriped bee: I guess they are each good in different ways I only get $750 towards acupuncture, which is gone quick. And really thankful that my ND isn't considered "alternative" on our new insurance.

@bluestriped bee: Yea, I thought I remembered you mentioning working on Eastlake. You'd save tons on parking if you could walk there! I'm going to give you a few different ratings:

HSG Overall Experience: 9. I really liked the doctor who saw me. She even thought she saw something on the x-ray, so took me over for a quick ultrasound and checked my ovaries when she was in there. Plus, I wasn't billed for the bonus ultrasound. They were very empty that day though. If you want to switch, I can give you this doc's name (and tell you which to avoid!)

2nd Doctor + blood tests: 5. The doctor was aloof and not sensitive. I wasn't too fond of her nurse either. Also, they ran progesterone without checking whether or not I wanted it done, and what day I was on. Nothing major, but enough for me to want to switch to the original doctor.

I have liked the medical assistants, the one who drew my blood (and maybe made the mistake?) was probably the at it that I've ever had. But they are always running like 20mins late.

A woomen with an IF question is a ticking bomb....lol

@spaniellove: @Mrs.Someone: @Shutterbug: So my appointment was okay. RE said that we can go ahead and do another IUI next cycle. Since I've had a history of enlarged follicles, I'll mostly likely have to do a medicated cycle followed by an unmedicated (natural) cycle. RE looked over my history and wants us to do the trigger and IUI closer to CD14 (instead of CD10-11, we've done in the past). She wants my lining to be thicker. She said she was okay with us doing a IVF cycle if we wanted to in January. (This is was the plan I had in my head. Which is good!) Although, she says that she would feel better if we tried one more IUI after this upcoming IUI cycle. She would like 4 IUIs before going to IVF but she said it's up to us.

She's going to dose down my Femera from 5mg to 2.5 mg for this cycle.

She did not recommend another HSG because the one I had last year showed no signs of blockage. She only repeats it for patients with history of blockage. (It's is a relief for me, since I didn't have the best experience because of post op pain that made me stuck in bed all weekend.)

Even though, she said I've had a history of not responding well with OPKs, she does want me to continue using them. Just to make sure I don't ovulate earlier than CD14. Oh, they want me to test only in the morning after my SECOND morning urine. (I've never heard of second urine before. I thought it was always first morning urine.) Also, I asked her if I should check in the afternoon, like I thought I was suppose to. They said no, only check second urine and test once a day.

Sorry for the buildup but I spoke to her about the blood draws. For her (and maybe at this clinic?), they only do Day 3 blood draws once every 6 months. Since it's been 6 months since my last one, I will have my blood drawn this cycle. They don't do monthly/continuous blood draws. I asked the nurse and then the RE about 4 separate times. They feel as though the blood draws are too expensive and the ultrasound with OPKs are a better indicator of ovulation. Also, this is based off of my blood tests, in the past, being normal for AMH, estrogen and FSH. I asked about whether blood draws could better monitor how my estrogen and progestrone levels were. They said the femera and trigger shot should be enough progesterone in my system and therefore should not need to be monitored. I asked about blood draws being able to better measure LH surge. She said it does but I would have to get blood draws every 12 hours and that could get expensive. She said ultrasounds were better at seeing ovulation. I asked if I could have more ultrasounds then. She said I could but once again it could get expensive.

Prices for tests (each additional ultrasound- $180; each additional blood test with LH testing-$100+)

As for IVF, we did meet with the financial counselor and the numbers weren't that bad. Thanks to @JustDarling: for sharing me her RE's website for IVF plans. Also, @spaniellove: for giving me ballpark figures for IVF. Pretty much spot on for my RE's office. I didn't have much of a sticker shock when I saw their numbers. Thanks guys!

So, in summary, I was disappointed that my dr/clinic doesn't do more blood tests and that their reasoning was that it was unnecessary and expensive. Which I value that they didn't want to make my treatment too expensive. I can still do more ultrasounds and blood draws, if I want to pay for it. Maybe they adjust their IUI process based on if you are paying out of pocket or if it's covered under insurance. Or maybe they don't and it's standard for them.

I am hopeful for IVF in January.

Oh, I asked the financial counselor about the refund plan and the multi-cycle IVF plan. I apparently have to bring this up with my dr to be approved for those plans. I guess I'll bring it up the next time I'm in.

So here is an overview of what's to come.
CD1: call office
CD3: blood draw
CD3-7: Femera at 2.5 mg
CD10-14: OPKs once a day at second morning urine. If I get a positive, I'll come in for HSG trigger shot. (Maybe ultrasound, too?) Followed by IUI.
CD14- If I have all negative OPKs, I'll come in for ultrasound and they will trigger. IUI will be schedule the following day.

So that's that. Sorry for the super long update. Thanks for reading.

So what do you guys think? Should I pay to have more ultrasounds and/or blood tests?

@FaithFertility: @bluestriped bee: that's true! My first IUI cycle I had a mature follicle but my estrogen was low, so they had me wait another day and then my estrogen went up. Without the b/w I probably would have triggered too soon.

@bluestriped bee: sounds like a good plan! I'm most likely doing IVF in January as well

@bluestriped bee: It sounds like the doc is at least listening to you and answering your questions. But I don't like how her reasoning for not doing things is because its too expensive. Its also too expensive to keep having more and more IUIs if one isn't monitored correctly. As for what is the correct protocol, I would trust anything that @spaniellove: recommends

@FaithFertility: @Shutterbug: @spaniellove: @Mrs.Someone: Yeah, I'm kinda at a loss of what to do. The DH even mentioned to me that the nurse and Dr was getting rather annoyed that I brought up the blood work so many times during our meeting. I was annoyed for about 20 minutes that the DH didn't support me.

On one hand, I want to trust my RE but, on the other, I've read things from you and the internet that makes me think I should get blood work.

I just don't know what to do. I don't really want to change clinics because I might have to do all the tests over again (including the HSG). Plus, getting into another clinic will delay our timelines.

As for my clinic, I guess I'm looking at their stats compared to other clinics and they both seem to making babies. Whatever their process is is working. The poll I asked, it seems like at least 3 people had IUIs where blood work was not taken every cycle. So this practice might not be completely abnormal and unheard of.

I don't know. I don't know. I'll admit it, but I'm stuck between trusting my doctor and trusting you guys. I don't really have a gut feeling on who to go with. You both have valid reasons. I'm torn.

ETA: Maybe I can request that they take blood at my CD14 ultrasound to confirm my estrogen levels. Although, can they interpret how my E2 levels are based off of CD3 blood and CD 14 blood? Or will they need a series of blood draws to see how my E2 levels are really behaving. Is it worth it to spend $400 on just two blood draws or more if they want more? What happens if it's normal? Will they just give me a look of 'I told you so?' I guess it's a part of me that thinks my RE knows what she's doing and she has my results to determine the best plan of action. I know you guys are looking out for me and giving me your experiences, but I don't know your past history and diagnosis. I don't know how your results might have affected your treatment course.

I really do love all of our input and support and I'm know I would lost without you guys.

Just back from the RE for a CD 21 ovary check, and it was not so good. Lining close to 6, but not quite. She thinks it's time to move on to injectables. I appreciate that she said, "Maybe you'll be pregnant!" but I don't have a lot of hope.

I did that bad TTC things where you start to get hopeful that this cycle is the one, and I thought how fun it would be to tell our family at Thanksgiving.

@Mrs.Someone: We got our 23andMe results back and boy am I glad I did it. I initially did it because I wanted to know which mutation I have (since I'm too lazy to just request my clinic records), and not only did I learn that but I found that DH is compound heterozygous. His grandfather died of heart issues and his father has major heart issues as well so maybe this will help us.

@Mrs.Someone: I don't really know yet what I can look for! My DH wants to take the same things I take since MTHFR-related symptoms factor so prominently in his family history and his own life. I love data though so having this at my fingertips is amazing. We laughed at the ancestry part that said I'm only 99.6% East Asian while he's only 90% Jewish and 0.1% East Asian.

Finally back in the game afyer such a long month it seemed....CD 4 today had my base u/s and b/w and fot the clear so I started clomid last night .... joy joy I go back on Halloween to check where I am at!!!! Goes sooo fast one you get started!

@TheSwissWifeStyle: Thank you! How are you?

Good luck as well :)))

@Mrs. Jump Rope: Let me.know how it goes :)))))