First meeting with the fertility doctor - feeling down.

Miscellaneous and Personal Stuff I Must Share
1

Well, after 2 years of not-preventing, we finally had our first appt with the RE (Reproductive Endocrinologist, ie Fertility Doctor) yesterday. Afterwards I felt…I dunno. Let down? Scared? Something?

The RE talked a lot, very quickly, and he had a really thick accent. He asked us questions, but it seemed like he was just asking to tic off boxes “yes” or “no”. I didn’t feel like he wanted to hear from us, except to tic the boxes off. A couple of things we had followups on - “Yes, but…” things, and he barely let us explain and didn’t seem to listen at all.

I brought in all the temperature/ovulation/symptom/intercourse charting I’ve done for the last 3 months, because I’d been told that they would be useful. He didn’t ask for them - when I brought it up and showed him and said that I was worried that I didn’t know whether I ovulated or not a couple months, he said that yeah, I probably had, and one month he pointed to a point in the chart that was like 2 weeks after I thought I’d maybe O’d…I said no, I thought it was over here on this date, where the temp change actually corrolated with my fertility monitor readings, and he said well, yes, it could be, but he was all dismissive. He said that charting was really very old fashioned, and that it didn’t measure the quality of an ovulation which is what is really important. But (and here he sounded oh so generous) it would be fine if I want to keep doing it, as a diary if I like. Golly, thanks.

He also didn’t seem to get the difference between a Clearblue Fertility Monitor and a Ovulation Predictor Kit…kept talking about “when your monitor kit says positive” when the CBFM doesn’t have a positive/negative reading, it has low, high, and peak.

Anyway, as of next cycle he wants me to go in for FSH tests, plus get the HSG, plus start Clomid, plus do an IUI…all in the same cycle! I can understand wanting to save time - at 38 time is not something I can spare much of - but it just seems all very sudden.

Is it normal to jump straight to IUI without trying the “usual way” plus Clomid first? Oni no Husband doesn’t have any sperm issues. Honestly, if I have the choice I’d rather know my kid was created when her parents made sweet, sweet love than when her daddy spooged into a cup and then the doctor cleaned up the spooge and put it into mommy… of course, that may be the way it has to be but it just leaves a bit of a bad taste in my mouth.

Am I being realistic to be disappointed in the RE’s bedside manner, and to be disappointed in his rush to maximize interventions? Or is he just trying to help us out as much as possible, as fast as possible?

I have Kaiser, and there are only two RE’s in my local clinic. I’m thinking of asking for the other one (a woman) next time. Unfortunately, Kaiser doesn’t do IVF so if it comes down to that we’re out of luck - we can barely afford the 50% copay on fertility visits that Kaiser gives us, no way can we afford a private doctor for IVF, which as I understand it can run thousands of dollars per cycle.

sigh headdesk grump

2

I have to say upfront I did not have any trouble conceiving, but trying to conceive and having a baby are really emotional issues. My gut reaction would be that if you are not comfortable with the doctor and you can change to another (hopefully more attentive, understanding) doctor, then you should do it. I went through three different ob-gyns when I was pregnant with my daughter, until I found one who was prepared to listen to me and not treat me like a 15 year old. The whole “doctor knows best” thing wears thin very quickly when you are an intelligent, grown woman who has done enough research to know what you want.

That said, someone with more experience dealing with fertility doctors may be along shortly with a different perspective.

3

I’m sorry to hear that you’ve had a relatively poor first experience with this RE, but I can’t say that I am too surprised given the experiences that I have had to date. It seems to be common that they don’t really give any weight to all the data and information that the patient has themselves has collected (temp charts, fertility monitor info etc). In a way, I can see why. It is such an imprecise science that what they really want to see are test result levels in black and white - FSH levels, AMH levels, day 21 progesterone levels, semen analysis results etc. Even then, all these do is give them an indication as to what is **not **wrong with you.

Having just been through this whole palaver myself, I can totally sympathise. It took us a year and a half, almost, between first consultation with GP, through consultation with NHS fertility doctors (oh god, such a dismissive and depressing experience), to treatment at a private clinic. Even when we were paying thousands of pounds out of pocket for private treatment, I still got the impression that what we were saying to the doctor was really not of huge consequence, once they had our file and medical notes and had made a decision on treatment.

I used the fertility monitor as well, for months, and this information was never commented upon. I think the reason is that all these kits do is monitor your LH surge/oestrogen levels, and these ultimately indicate nothing more than the fact that you had an LH surge. It can’t definitively say that you’ve actually ovulated (good chances you did, but when you’re at 2+ yrs of unexplained infertility (like us), the issues you may be having are going to be really hard to detect by hormone tests alone. In fact, we were told that perhaps the only way of diagnosing an actual problem would be to go through IVF and see what happened).

I don’t think that you are wrong for being disappointed in the REs bedside manner, though. The private clinic we went to may have done things not much differently from the NHS one where I got the really bad feeling, but they treated me sooooo much better. I wouldn’t be afraid to ask to see the other RE next time you go in. This experience is stressful enough without having to feel like your doctor isn’t listening to you or being sympathetic. For them, it is a day at the office, for you, it’s all your hopes and dreams teetering on the brink.

As to your other question about jumping straight into an IUI, my feeling is that no, this isn’t jumping the gun. We went straight from timed intercourse to IVF, and I am really glad we did this. To my mind, actually, you may be wasting time trying clomid and IUIs, given your age. I don’t want to say this to worry you, but IUIs and clomid don’t have great success rates, and if they try to get you to try this approach for several cycles with no success, you may as well have jumped straight to IVF with its far superior success rate. Don’t underestimate the stress of going through treatment, either. I found our one round of IVF stressful enough, but fairly easy to deal with. If this had followed on from months and months of clomid, then IUIs, I think the overall total effect would have been far, far worse. It eats into so much of your life, that to go through that for that long has to have a big impact.

If you are completely unable to pay for IVF, though, then the paragraph above really isn’t much help, so sorry! It is just my experience that go after go after go at IUIs will eventually add up to the cost of one go at IVF, and I know many people feel that they have wasted time if they eventually get to that stage anyway. Can you take out a loan? Borrow from family? This may sound drastic, but if you really want to get pregnant then you may end up needing to find the money anyway. Again, at your age, time isn’t on your side. IVF rates drop off quite a lot, the older you get. I know I really sound like I’m scaremongering, but it is the reality we are all having to deal with and it’s not nice :frowning:

Also, it is totally normal to want to have conceived naturally, or with only a little ‘help’, but at the end of the day, the goal is to get pregnant without waiting years and years. We have, fingers crossed, achieved this goal, as of last week. Our (first) IVF cycle this month was successful, and I am currently 5 weeks pregnant. It still seems weird to type that! I will say this, though - I am not going to lie about the fact that I am really bitter that it came to this, and that we couldn’t do it the normal way. That is hard to deal with, so I totally get where you are coming from. I don’t feel like a ‘normal’ newly pregnant person, and I still look at the people who got pregnant easily and feel bitter and jealous. Can’t seem to help that!

So, I don’t know if any of the above helps. Our experience was in the UK, and I think IVF is slightly cheaper here (£5000 for us - about $8000), and we have the NHS to fall back on (totally free for those that qualify, and that live in an area that provides it).

It is completely understandable to feel deflated after seeing an RE for the first (and second, and third) time. It’s like any doctor, if things were going well, you wouldn’t be seeing them. Combine this with the nature of the problem, and all the emotions tied into it, and I would be surprised if you didn’t feel down.

Hopefully some of that was useful. It’s a strange, bizarre, surreal experience to go through fertility treatment, and for the most part, you just have to cling on to the hope that it is all worth it. We got free counselling at our clinic – is this something your clinic offers? If so, I would take it up. We found it really helpful as this was the more ‘human’ side of the process. Someone who actually understood the issues we were facing. Infertility is such an isolating experience. If you haven’t been through it, you just can’t get your head around the emotions it triggers. We didn’t have anyone close to us that had been through it, so it was good to get that help.

Gosh, that post turned out to be longer than I thought!

Good luck with everything. If I can answer any more questions, let me know.

4

No - it doesnt matter what the issue is, you need a doctor you are comfortable with, whether it is fertility or routine gyn or a gp for a cold …

5

But what if the gruff doctor with no bedside manner has the best success rates, and you only have limited funds? I’m not sure it’s always so cut and dried, unfortunately. I know I would have persisted with a doctor I wasn’t always comfortable with (within limits, of course), if I thought they were my best chance of achieving success. There is much about this process (fertility treatment) that invloves the gritting of teeth and just getting on with it.

That being said, success rates are usually given by clinic, so there is probably no reason not to switch doctors within a clinic and try another one if you have the option.

6

I can’t comment on the regime your doctor is recommending, although it does sound a little odd to me that he’s recommending chlomid when it appears you are already ovulating. It’s usually recommended when someone is either not ovulating at all, or is irregular.

However, what is important is that you do feel comfortable, and feel that you can trust the advice of the specialist. You seem to be taking it really hard that you can’t do this the ‘normal’ way - and that’s kind of par for the course when you take your initial steps into assisted conception. But, I also found it kind of a relief that when we saw our specialist, we had someone else on our team - someone who had seen a lot of couples in a similar situation. If this guy is not the guy you want on your team, find someone you do.

Tracking for us was fantastic up to a point - I was able to bring 10 months of records demonstrating that I was ovulating (my specialist never questioned the ‘quality’ of my ovulating!), and that we were correctly timing intercourse. I also stopped it at his direction since he felt it was making me more stressed than anything. However, it was also only useful after the fact - it could never predict when I would ovulate (I have polycystic ovaries and O would vary up to a week). I found checking cervical mucus a much more accurate predictor of when I would ovulate, and even once we stopped temping, I could tell where I was in my cycle.

We were lucky (I guess!) in that Boy from Mars had a dramatically low sperm count, which meant that basically from day 1 we were braced to do ICSI, and weren’t required to do any faffing about with other drugs. However, before getting to that point, the RS made sure to carry out some basic testing so he knew what he was dealing with - that included day 3 and 21 bloods, and an internal ultrasound (go the dildocam!). It was at that point that we discovered the sperm result - a previous test had indicated no problem, and it was only through the specialist lab that we found out what we were really dealing with. So I’d recommend proceeding with all of the testing at the very least, simply so you know what cards you are playing with.

From the time we started trying (Oct 07) we took around 10-11 months to see the FS, and had out first round of ICSI in Jan 09, followed by our positive test (Feb) - around 18 months. Our FS gave us a 5% chance of getting pregnant naturally, and given my age (33), was comfortable letting us try ourselves for a few more years - we were the ones that made the call to proceed to IVF.

I think that was important - besides making us feel in control of our situation, it made us have a lot of deep conversations about why we wanted kids, how we would handle things if it didn’t work out, etc. We know couples who went through 11 rounds of IVF, and we decided that that wasn’t us - luckily we needed just the one round, and I’m now 6 months pregnant.

Now, you might be different, but after the first month or two of feeling ‘fragile’ pregnant, the memory of the treatment has mostly faded away. The experience of carrying this child has overwritten the nature of its conception. That’s not to say that the infertility demons don’t occasionally strike fear into you. Up until week 24 (viability), every trip to the bathroom came with an expectation of seeing blood, which I don’t think would be the case for a natural pregnancy. But I’m also really proud of us for what we achieved - together as a couple. OK, not the normal way - but we have the rest of Peanut’s life to be normal.

So, final suggestions (although happy to answer any questions either here or through a PM) - take each day at at a time. You may be facing a marathon, but that doesn’t mean you have to run it all today. Use the power of the internet - I found a lot of support from infertility bloggers, who had either succeeded, or were in the same position as me. Ask questions of your FS. This is your life, so own it, be in control of it. If you’re not clear, keep asking until you are. He probably sees a lot of couples, and you are a statistic to him, but make him work for you. And stay strong as a couple. This will most probably work - but if it doesn’t, don’t have this be the year you tried unsuccessfully. Have lots of mini treats and goals to work towards, in case this doesn’t work out. It may be that you do end up in Cambodia at 7 weeks pregnant (you can tell we weren’t expecting the first time to work out!), but if it’s something you always wanted to do, it will make any unsuccessful attempts easier to bear.

And good luck! The technology is amazing, and geting better all the time. This is definitely doable.

7

Just wanted to say WOOT! Congratuations! I’ve been thinking about you and had my fingers crossed. Best of luck for a very uneventful next 8 months!

8

Not to derail the thread, but thanks! Just waiting on a scan to see how many have stuck. What a rollercoaster this has all been!

Also, getting back to the OP, having read your (Girl from Mars) account, I would say that everyone’s experiences are different. Maybe that helps Oni no Maggie, knowing that there’s no one right* way to do fertility treatment. Each clinic has their own way of doing things, and there is usually a method to their madness, even if it mostly seems madness!

*Although, like you, I would be surprised if the gave clomid to someone who was ovulating normally - maybe it is part of the IUI treatment?

9

If you feel uncomfortable with him, find another doctor.
I haven’t read it, (and didn’t have fertility issues) but there are scores of women out there that have read and swear by Taking Charge of Your Fertility.
I think the best way to get pregnant is to either Go Full Catholic or Lose Your Job.

Might be extreme, but it’s worked for alot of people I know.

Best of luck!
(Bonus points for the line *, if I have the choice I’d rather know my kid was created when her parents made sweet, sweet love than when her daddy spooged into a cup and then the doctor cleaned up the spooge and put it into mommy… of course, that may be the way it has to be but it just leaves a bit of a bad taste in my mouth.

  • A++ would read again.
10

To perhaps answer for the OP, it sounds like insurance issues might make this difficult.

It also sounds to me like Oni no Maggie has probably bought the book and tried all of this already. By the time you get through 2 years of trying, and charting, you are probably a little beyond the help a book can give you, unfortunately. I say this as someone who has this book!

Also, if I’m honest, telling someone with fertility problems about a great book you heard about that might help, or joking about turning Catholic (when you yourself have no fertility problems), can sometimes seem a little insensitive. I speak for myself, here, and maybe the OP doesn’t mind these sorts of comments. I am not trying to offend (as I know you are trying to be helpful), I just think that sometimes these things aren’t obvious to someone who doesn’t quite get the sheer heartache of infertility, and it is useful for them to know. You can tell this is a subject close to my heart!

11

My RE had me do Clomid when I was already ovulating. While they run tests, Clomid produces MORE eggs than normal. More eggs = more chances. Its a temporary shotgun sort of treatment.

We spent three months on Clomid while tests were run - with IUI (again, better chances) - three more on Fertinex (this was fifteen years ago now). Then we were already at the IVF stage. We chose to adopt. Our infertility was never diagnosed - all the tests came back ok - I had low hormone levels and my husband wasn’t exactly Captain Spermcount - but both were within the range of fertile. Three years after stopping treatment we had a surprise pregnancy. (My sister has two kids by IVF).

I wouldn’t worry about the fertility doctor. I think most of them are gruff and dismissive because otherwise their schedule goes to hell with the dealing with the tragedy of women trying to get pregnant. At least, that’s what my OB told me later…Mine had several nurses - she was the one who explained everything and listened and sat with you and was ready with the box of kleenex.

12

And I hated the book Taking Charge of your Fertility. Its a fine book for natural family planning. Its a LOUSY book on infertility.

13

I read TCOYF as well, although well written with a lot of food info I think it turned me into an obsessed baby making machine. Everything about sex felt so timed, robotic…meh…

Several years ago at the age of 27 my gyn sent me for all the fertility tests (hsg, hormones, dh sperm sample). Everything seemed to be good, and so he put me on clomid for 3-4 months. After about 6 months I was frustrated with timed intercourse and started looking for a fertility doctor in our area. I had been charting, and using OPKs (when I wasn’t on the clomid) for well over 2years.

I took all my paperwork and stuff into the RE and he told me he didn’t want to see it either. We did the same tests again, minus the HSG. He had a very very dry bedside manner and was extremely blunt about everything. I was scared that this guy could very well be the answer to our problems, but scared it wouldn’t end how we wanted.

Turns out I was full of cysts from being on the clomid. I cried in the exam room, and tried to compose myself before leaving everytime he told me - ‘sorry, come back next month!’. We had to wait 2-3 months before trying IUI, even then I still had a cyst he was worried about when we did a clomid + trigger/IUI cycle. We got pregnant that cycle - IUI was April Fool’s day of all days. It was kind of odd being in a room with my husband holding my hand, my legs up with a doc doing his thing, and a nurse there as well. I was to lay there for about 10 mins after and keep my legs up, and during that time my hub and I just remarked how many people can say there were 4 ppl in the room when you were conceived! I was SO scared, it was all on me at that point I felt.

A few years later we weren’t really preventing, and we weren’t obsessed with trying, but the first time I actually caught a positive on the OPK I thought ‘what the heck,’ and I find out - pretty shocked, that we were pregnant!

Good luck and happy thoughts!

14

Full disclosure: I work for a company that supports RE practices; providing business services to them. IANADoctor.

Based on what you are describing, Oni, it does sound like there are options you might look into. There are a number of websites that show where RE’s are located - I know some are not part of the KP staff of physicians but have contracts with them. By the same token, you might look into (if you haven’t already) various multi-cycle treatment plans, where you pay a fixed fee to qualify for more cycles - committing to a course of at least 3 cycles can up the success rates, say, of a woman under 35 with standard female-factor infertility from ~40% to upwards of ~78%.

Sorry you are stressed and down - it makes sense. But you can arm yourself with more data and options by doing research so you can either make a change or feel better-armed in sticking with your currect situation.

Books that our practices use include: Conceptions & Misconceptions by Wisot, The Infertility Survival Guide by Elizabeth Swire Falker and a couple of others - there are a few out there.

Hope this helps,

WordMan

15

I know the entire process feels very rushed and hectic. Our first meeting with the fertility doc was just as mind blowing as you described. Don’t dismiss this doctor just yet because of the unease you felt. You were in a highly charged situation, and it is possible his manner may suit you better after you get used to the stress and emotion surrounding situation.

IANADoctor, but I’m not surprised by the jump to IUI. Our doctor told us bluntly in our first meeting that his goal was to get us pregnant. So your doctor is probably taking the quickest route he knows of to your ultimate goal. Another consideration is that Clomid alone gives him very little control over the number of ova that are released and ultimately fertilized.

As far as knowing your child is created the old-fashioned way, all I can offer is that I’ve never considered it when I look at my daughter. She is my daughter, I love her and I don’t care where and how that moment of conception happened. I care about that huge smile I get when she sees me come into the room.

Finally, make sure you both continue to communicate well throughout this process. It’s a stressful process, full of emotions and feelings that you may or may not be aware of.

16

Oooof. I had a very, very different experience with my RE than you did Oni. I’m going to join the chorus and ask if there are any even marginally feasible other REs you could be seeing. It’s important to be comfortable with health care providers - doubly so, IMHO, when dildocams are involved.

It turns out that the fertility issues my husband and I have are all on my end (PCOS - and damn, am I glad to know that I have that - given the other symptoms), we’ve had one cycle of Clomid that failed to trigger an ovulation, but my doctor is letting my current cycle wind itself up before we look into other options (since on Monday’s dildocam images, it’s possible I might just be ovulating all on my own - tomorrow’s dildocam will tell us for sure :stuck_out_tongue: I spend an amazing amount of time with a camera in my cooter for someone who’s not a porn star)

17

If he’s putting it in your mouth, you **definitely **want to find a new doc.

Seriously, though, good luck. If you can, try to find out what this specific RE’s success rate is–it could be he’s a very good doctor who just has zero interpersonal skills.

18

I think you need to decide what you want…and what you are willing to go through to get there.

When I started infertility treatment, one of the best pieces of advice I got was to think hard about the process. How far are you willing to go. Infertility treatment is a roller coaster, and pretty soon you can be making decisions that you wouldn’t have made if you weren’t on the roller coaster.

As an adoptive mom, and a bio mom, I’ll assure you that it makes no difference at all how or where or even by whom you children were conceived - IF your goal is simply to parent children. But its never as simple as simply wanting to parent children - so determine where you are - what your goals are - and what you are willing to do to achieve them. Is it to parent an infant? Spread your genetic material? Experience pregnancy? Are you willing to drive crappy cars for the rest of your life and not eat out to get there. Are you willing to work second jobs now while you are childless? Are you willing to put your body through fertility treatments (for us, the answer was only yes to a point - at the IVF point it was no). Its a highly emotional and highly charged decision process - which is why its helpful to at least think about this before you are both feet in. Its even possible that at the end of this thought process, you’ll decide that its ok if you don’t conceive doing X and you aren’t comfortable with adoption that you’ll remain a fabulous childless couple.

As to “how to afford it” - yep, its expensive. I’ll be blunt however - its cheap compared to daycare (or giving up your income to be a SAHP), funding college, keeping them in diapers, being on bed rest for six months, buying the saxophone for band, paying extra airfare every time you want to go on vacation, paying for the neighbors broken window when the baseball goes through it, school supplies, milk and groceries for a growing near teenage boy… Going through infertility treatment wasn’t cheap. Adoption wasn’t cheap. My sister’s IVF wasn’t cheap. But in the end - kids aren’t cheap. If you can’t make the sacrifices now…how willing are you going to be to make them for the next - well, honestly, until you die because my mother is still making sacrifices for her adult children.

19

My wife and I did not like the first RE we went to see. We ended up switching to an entirely different clinic, where we were much more satisfied. Even then, it was a multi-year project was several periods of excitement and disappointment. Finally, things seem to be successful for us – she is 20 weeks pregnant now.

20

My first child was conceived on IVF #4, after about 2 solid years of infertility treatment. First of all, infertility treatment sucks. There’s just no way around it. I would ask at your doctor’s office if they know of any support groups you can join, because it helps to know other women that are going through the same thing. You can find message boards on the internet too. Women undergoing infertility treatment are also usually depressed, so you (and your husband) should be on the lookout for that. I know I certainly was. As for the RE, I would try the other RE next time and see if you like her better. You can still have good treatment without liking your RE too much, but it does help to have one you like. I think in general doing all the tests at once is OK, but if you feel they are too much, you can certainly ask that some be put off for next month or the month after. I think my fertility workup took a total of 5-6 months. I would be wary of an unmonitored IUI for the first cycle. If he monitors the follicle growth I think an IUI would be OK, although forgoing it the first cycle would not be a big deal.

One thing to remember is that REs don’t know everything, and there is still a ton about fertility that no one knows. For example, I had been told that I had “old eggs”. After kid #1 was about 1 year old, we went to a different RE. He did some more tests and said that I was fine and the problem was my husband. He said we had a 5% chance of conceiving on our own. The next month I was pregnant naturally.

Good Luck!!