I have a consultation tonight with my general ob/gyn to discuss next steps for us. We've been TTC since December of 2012 with one chemical pregnancy and that's it. I don't want to be entirely conservative going forth. I have a couple ideas of what to expect at the appointment. But are there things I should be sure to ask or have addressed? Any suggestions?
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I have had 2 unassisted pregnancies, but have been unable to conceive for the past year. I am not sure what the next step should be. Following.
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Have you had any testing done yet? I'd ask for CD 3 and CD 21 bloodwork, and a SA for your DH if they're able to order that. I'd also ask what kinds of treatments you can do there, and what you would need to be referred out for.
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Has your husband had an SA done? Ask for one if he hasn't.
Have you both had full panels of blood work done? Ask if you haven't.
I refused to go on any medications without proper monitoring. My OBGYN did not provide 7 days/week monitoring so it was straight to the RE.
Good luck!
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@Shutterbug: @swedishfish: We have had nothing done yet. DH is completely on board with a SA. And, AF just arrived today which is kinda perfect timing for other blood work. I don't think my ob/gyn does 7 days/week monitoring. So I guess, how do I know whether to stay with her/that office versus going to a RE?
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I would definitely request the full blood tests to determine your AMH ,FSH, check thyroid, etc. and ask about getting your husband tested as well. Then possibly start with Clomid, and also consider a hysteroscopy (I've had two) which checks the uterus to make sure it is clear (no fibroids, etc.) I would also suggest making sure your tubes are clear (HSG), but since you had a chemical, perhaps that isn't needed. Although, it is good to make sure both tubes are clear, not just one. These are just my initial thoughts off the top of my head. Good luck!!
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@LindsayInNY: my decision was made for me when the OBGYN suggested taking Clomid and trying an IUI. I asked what happens if I ovulate on a weekend and she said we just can't help you that cycle then. Clomid is a powerful medication and I wasn't comfortable with that. You have to be comfortable with treatments and game plans.
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@LindsayInNY: I imagine she'll be able to give you a prescription for Clomid or Femara, plus the progesterone that you're already taking, without any monitoring. If all your tests come back normal, you could go that route for a couple cycles if you don't want to be too aggressive. If you have IF insurance coverage I would 100% just skip straight to the RE, but that's me.
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I'd ask about testing such as an HSG, blood work, sperm count, etc to get an idea of any possible fertility issues. My RE closely monitored me on each cycle, which I would definitely recommend. Good luck!
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@Jenn23: oh good point about the AMH. That's not standard for CD 3 BW I don't think, so make sure to specify that one. It measures egg reserve.
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I agree with SwedishFish in that I would move on to an RE now that it has been a year. They truly are the experts on infertility and getting women pregnant! Definitely look at going to an RE! And yes, it is better to have monitoring with Clomid, etc. I wouldn't do it without. What if you have five follicles and don't realize it? Would you still want to risk getting pregnant with that many multiples for example? Def. recommend seeing an RE. Mine was fantastic and knew right what to do to help me get pregnant.
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@swedishfish: So if Clomid is mentioned, make sure that they will actually monitor me on it and not just leave me be?
@Shutterbug: Like above, should I be considered with taking any medications and NOT being monitored? I do have IF coverage but I don't know to what extent. Something I'll have to look into at some point.
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@Shutterbug: Yep, the AMH in my case was very low, yet the FSH wasn't. Had my RE not tested the AMH, I wouldn't have known I had low reserve. Not sure if all RE's test that one, though. I think some don't? I agree, if insurance covers, go right to the RE.
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@Jenn23: Why would I want a RE over my normal ob/gyn at this point? I have one nearby and don't mind going that option, just curious!
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I never had an HSG done. My RE didn't think it was necessary for me. My husband had to see a urologist though after his SA. Keep in mind, my RE wanted us to redo all of our testing so my husband did 2 SAs.
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@swedishfish: Might be worth calling the RE to ask... No point in doing the testing just to have to redo it again.
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@LindsayInNY: honestly, it's about what you're comfortable with. It's an easy first step because it's non-invasive, but as swedishfish mentioned, you could respond very strongly and wind up with multiples, or it could be thinning your lining without you realizing it. I did two unmonitored cycles of Clomid, and I didn't find out until my 3rd cycle on the same dose (monitored this time) that the dosage was too low. I could have saved myself a couple cycles if I had been monitored. I didn't want to be too aggressive when I was starting down this path, but now that I'm so far into it, my advice would be that if money isn't the deciding factor, I'd probably be more aggressive.
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@LindsayInNY: I had more extensive testing done at the RE than the gyn... the gyn did the routine hormone panels on days 3 and 21 (which should actually be 7dpo, not day 21, fyi) and the RE did that and also genetic testing (CF, tay sachs, etc) and AMH, as well as a pelvic ultrasound to do an antral follicle count and an HSG to make sure my tubes were open. I heard someone say once that the ob/gyn's job is to care for you once you are pregnant, and the RE's job is to GET you pregnant, if that makes sense.
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just wanted to tell you good luck
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@LindsayInNY: yes, monitoring is important like @Jenn23: said. A medicated IUI cycle without monitoring is a perfect breeding ground for higher order multiples.
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Because RE's are experts on getting women pregnant over OB's. OB's can give Clomid (but without monitoring which as I said I don't recommend) but RE's can do everything from that up to IVF and they specialize in getting women pregnant every day. You mentioned you don't want to be all that conservative and since you said it has been a year, I would move straight to the RE. At our first RE appt., he basically laid out the plan of what we would do (start with Clomid, then IUI's, then IVF, etc.) and we know exactly what the plan was and what we were in for and we felt so confident knowing we were with a fertility expert. I would meet with your OB tonight, see what you think, but start researching RE's in your area.
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@Shutterbug: Given that AF just started, if my ob/gyn doesn't want to push testing right away this cycle, I might call the RE tomorrow to see how soon they can get me in. Your last sentence made perfect sense!!
@psw27: Thank you
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like @Shutterbug: and other's have mentioned, being monitored throughout your cycle is very important. I did a couple Clomid cycles and had lining issues, they also measure follicle size and make sure you don't produce too many and end up with an entire basketball team.
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@LindsayInNY: do you live in the city? I used Long Island IVF and they have a location in Brooklyn. They were fabulous! But you probably want an RE close to your home too if you choose to go that route.
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@LindsayInNY: I think that's a good plan. Also call your insurance company and ask for the infertility coverage policy (mine just emailed me the PDF) so that you have some idea of what will be covered. I know that the initial consult was $350 so I wanted to make sure that would be covered before I went to the appointment!
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@LindsayInNY: I would never be comfortable taking IF meds with an OB. I was told you can only have six lifetime cycles with clomid. If your OB doesn't do any monitoring, how do you know what's working? How do you know if you need a stronger dose, if your lining is okay, or how many follicles you have?
I'd be asking what kind of monitoring is involved and what they do on weekends, and how many clomid cycles you can so with her before having to move on to am RE.
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Oh, just saw above that you have an RE nearby. Is that the only one? Good reviews? Definitely make sure the one you see is good because that really is important. My practice has 3 and we selected the one based on two friend referrals, plus online positive reviews. We really liked him. It's really important to like your RE since it can be such an emotional (and physical) process.
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@Mrs. Jump Rope: I've been told 6 cycles as well. I wasn't messing with that!
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@Jenn23: One step ahead of ya!
There's a RE office within walking distance of home which is awesome. And they seem extremely reputable too which I like. Depending on how tonight goes, I might call first thing in the morning to see how soon I can get in. AF just started today so I would love to do blood work ASAP, if possible.
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@swedishfish: @jenn23: I'm in Westchester. Some of the REs from NYU Langone work with Greenwich Hospital too and their IF office, which has a Westchester location. The location couldn't be more perfect really!
@Shutterbug: Oooh, good to know!!
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if your ob/gyn suggests bloodwork I say go for it, even if you're going to meet with the RE soon. My RE took my initial bloodwork results and just added in the things he wanted tested. If your insurance covers diagnostics/lab work then it's no big deal if you have to redo the tests.
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@LindsayInNY: awesome! I hope everything goes really well tonight!
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@swedishfish: exactly -- better make it COUNT!
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@LindsayInNY: No advice here. Just good luck!!!
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Same as others, no advice, but good luck! I hope you get some good news! I'll be thinking about you!
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Walking distance...wow! Now that is awesome! Definitely give them a call and see when you can go in for a consult. Wishing you all the best!
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@Jenn23: Yeah, it's surprisingly close thankfully! DH drives our only car to work so any doctor has to be public transit accessible. I couldn't ask for a better location!
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No advice, lady, but good luck. Thinking of you!
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@LindsayInNY: I went to my OB/Gyn first and in reality there is only so much they can do. I would highly suggest RE because you will have to get a ton of testing done and it's easier to get it done with early so you can move on. The way DH explained it, it was nice having an OB/Gyn help us at first but he prefers working with RE because it's his "job" to help get you pregnant.
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@LindsayInNY: Also, I second what @Shutterbug said, call your insurance company and see what is covered.
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