Meeting with my RE to give him a piece of my mind! Need advice from you wonderful ladies!

[mommyof3andhopefully4]

Ok, so I am going to meet with my RE next Wednesday.  We went through the first cycle/treatment plan he had for us which was clomid and triggers.  First month with timed intercourse, second month with IUI and third month was suppose to be IUI but we couldn't due to DH's work schedule for that week.  Anyway, when AF came this past Sunday, I called them to discuss what to do next, and I told them since I didn't have that third IUI, maybe I should fulfill that treatment plan he had for me, and the nurse said, "Sure!  If you want to do that you can!"  So, we decided to do that...she called in the Rx for clomid and trigger, upped my dose to 150 mg.  Well, I had a change of heart over the weekend (this was last Friday, once I knew I had a BFN) and I decided that we needed to meet with our RE and discuss.  Here is my issue:

My RE started with testing DH because I have three children from a previous marriage.  We ALL thought it would be him.  When he came back normal, he directly put me on clomid, a trigger and ordered up the HSG.  HSG came back fine and that is ALL the tests he did.  I went for my regular yearly and my OB-GYN asked me some questions and then when I told him I hadn't had any bloodwork done, he checked my prolactin and checked my thyroid....all normal.  That is ALL the testing I have had done.  Basically my fertility issues are unexplained, but I don't think I can say that because not everything has been ruled out!  If ALL the tests that could be done had been done on me THEN I would call it unexplained...but right now I just feel like my RE has the same treatment plan/protocol for everyone that walks through his door...why don't they check you for everything before they start you on meds?  Why wasn't my bloodwork done?  I didn't even have my blood pressure taken, my weight written down.....nothing.....I just feel like I may be going to a baby mill type RE.  I just want to know if this is normal treatment that you all have received....good or bad, I want the feed back.  Next question:

What tests do I need ran on me......I have thought of a few, but if I have left something out please let me know.

1) HSG (had this done, all good)
2) Prolactin and Thyroid ( all done, all good)
3) FSH test (I think this is the 3-day test to check ovarian reserve...am I right?)
4) U/S or B/W to check if I indeed ovulated (never had this done after O and never had u/s done before my next cycle  to make sure all follies ruptured)
5) Laparoscopy (this is evasive, I know that, but it may be getting to the point that it needs discussed)

Well, this is all I know of as far as tests go....can someone out there PLEASE tell me what else I need to discuss with them or if there are any more tests that should be done on me?  

Thank you so much, I just want to be well prepared on Wednesday and do my googling homework before I go!

Heather

[maybebaby29]

Wish I read this sooner. I totally agree with those saying that this quack should have done all blood tests first, then HSG (which you did), then a gradual protocal of clomid and IUI w/ or without monitoring and trigger 3-4 times (clomid doesn't work if it's after 4 times. The "rule is" 3xs and it doesn't work means it just won't work). Then discussion of IVF.
I hope you got some answers and kind of lead the discussion. I, in a way, did this with my RE and he caved on a dime and gave me what I want (monitored with trigger).

Let me know how it went.

[SHP]

Today was your appointment.  How did it go?  

[sarah9010]

soooooooooooo any news yet?????? i hope no one else butts in with thier dumb *** comments. i think if people dont want to answere the questions we ask they shouldnt answere and maybe keep some OPINIONS to themselves. and by the way trust me i know a lot of docs and alot of them dont really know **** and sometimes they need to be put in thier places why you go get a second opinion. we are allowed to do that RIGHT

[ALT76]

Hey Heather!  Sorry I've been MIA - as I told you, this month has been NUTS!!!  I just read this post today.  I will tell you that I'm on my FOURTH Obgyn in a year and a half because I've had to fight every step of the way for each diagnosis I've received.  One says definitely not this, then the next one tests for it and sure enough it IS that, then they say definitely not something else, then the next one tests for that and sure enough I've got that too....and so on and so on...   At least I found a great RE, but I'm sure the same things could be said for many of them.  I hope your RE either steps up to the plate today or you find someone good to move on to.  Good luck!  Let us know how it went!

[tina1111]

Thanks Angie, I see it now.

[4Angie]

bump for Tina1111.

[4Angie]

What a hoot!  How do you like that????  They are now butting into our posts and not just sending messages!  What is going on?

[mommyof3andhopefully4]

I agree....it makes me frustrated just thinking about it.  The best was when I asked the nurse if I should try one more IUI and she said, "Yeah, I am sure he will let you."  Then when I called back a few days later to say I didn't want too and I felt  like we needed to speak with the Dr., she said, "Yeah, I think that is a good idea."  I was like, WHAT???!!!  LOL......

Anyway, thanks again, I will let you all know how it ends up.....

HUGS TO ALL!

Heather

[scienceteacher79]

Go get him girl! Stand up and be heard! I am proud of you. You did your research, you know something is off and if he isn't willing to help do more testing, then go get a new one :) Hugs to you and let us know how it goes! :) HUGS!

[sarah9010]

deffently i dont understand how he can call you unexplained when hes not even testing your E2 and progesterone. i would be so mad if all it was is that i wasnt ovulateing (which is eaisily fixable) and i was wasting all this money all because the doc wasnt doing his job.

[mommyof3andhopefully4]

Thank you so much for your answer to my post!  I have a good idea and plan for this appt on wednesday.  Basically if he doesn't say he wants to do a test to see if I am ovulating...I am out the door.  That test at the LEAST needs to be ran.  Do you agree?

[sarah9010]

i do think you should switch docs but only because he is not fitting into your scheduale correctly. a fertility doc should be very acomidating seeing as though AF dosent think of others when shes planning. but as for the protocal. everything that you had is what i had plus E2 and progesterone but that was done at almost every u/s, by those numbers alone they can tell if you are ovulating which you are probably not (at least on your own) your situation is then same as mine. i have two kids from a previous and when me and DH starting i would have bet my life the problem was with him (he has no kids). but after three rounds of cycles and watching my levels and u/s they changed my diagnosis from unexplained to nonovulatory or something like that meaning i dont ovulate on my own anymore. maybe because your doc has a hectic schedual they are not finding this. swich to a doc that is very accomodating for you and see how that goes. my first RE was like yours and i missed 3-4 cycles because of her then i swich to this RE and second try got my BFP

[SHP]

My dear that was no lecture.  Sorry that you took it that way.  Sometimes there is no answer for what is wrong with you.  That is all I am saying.  RE's are judged on their successes.  You can ask for their numbers and they will show you.  They desperately want for you to succeed.  

You don't seem harsh - just very upset with your lack of success.  I am glad that you have had children already.  You are in pain though - that shows.

We are all paying lots of money to our RE's.  Just remember that they just don't know everything yet.  So much is still a mystery to them.  

I never said that i am not upset over not being able to concieve.  My husband and i have been trying for years.  We have spent over 45K in the last 14 months trying and will be paying that off for years.  We are completely childless.  I have no child at all to call me mother.  I cry every day.  I keep remembering that God gives life - not man.  I cannot be upset with a man who has tried to help me.  Sometimes there just are no answers.

[mommyof3andhopefully4]

Well, thank you for posting your answer to my question.  I am not on this forum to receive a lecture from anyone....we are all on here to get the answers we are seeking and to get opinions from others that are going through the same thing.  I understand there are some posts that we just roll our eyes at, but I keep an open mind because everyone on here has come to seek the answers or maybe just the support that they need.....If I don't have anything productive or helpful to say to someones post, then I don't say anything at all.....no one deserves to be lectured.

I am a a god-fearing catholic, I go to church and pray everyday.  It seems that you are as well, but I also see that you have been consulting with an RE as well, which means that at some point in your trying to conceive journey you have realized that you need a little extra help.  I am so sorry for all that you have had to go through, but since you told me I need to leave this up to God, I could only WISH for your patience and understanding.  For you to never get upset over the fact that you haven't been able to conceive after after all the treatments you have been through, kudos to you!

I'm sorry if this seems harsh, it isn't meant to be, but I have questions for my RE...several questions...I am paying a lot of money to him to get answers and I am feeling like I am not getting any...but I am not going to go there again, I don't feel a need to explain myself again.  I understand he is human, I understand the RE is not God, but I am paying him to figure out what is wrong with me and I feel like that isn't getting done.  

Again, thank you for your response, but I could have done without the lecture.....

[skipili]

You might want to get another RE's opinion. See how things are done in a different office. You have to go with your gut feeling though. That's what I'm going to do.

I wonder how your RE does IVF in cycles. I would think every woman is on a different schedule so that wouldn't work. Who knows how that would work.  

[HeathJo]

You should have your blood sugar, testosterone, and FSH to LH ratio checked to see if you may have developed a mild form of PCOS (Polycycstic Ovarian Syndrome).

If you go to http://www.fertilityplus.org/faq/hormonelevels.html it shows all the different types of blood tests for fertility and waht they do, what the levels should be, and so on. The rest of the site is very informative as well. Good Luck!!!!

[4Angie]

It stands for Anti-Mullerian Hormone and it has to do with ovarian egg reserve.  There is a correlation between this and the onset of menopause.  They tested this on cd1 for me, but I have not heard the results.  I couldn't find anything that says what the normal range should be.

[4Angie]

UGGGHHHH!  The endometrial biopsy was worse than the HSG.  They go inside your cervix and take a chunk (very small) of your lining out for testing.  I was in pain during.  DH was able to be in the room with me.  However, I did better a couple hours later and I did not with the HSG.  HSG took me a day or 2.  I will check on the AMH and what it stands for.  It is to tell you how many eggs are in your reserve though.  I have not gotten my results on that so I am not sure what the numbers are supposed to be.  I will research on google when I get back from lunch to see what I can find for you.

[mommyof3andhopefully4]

4Angie- Thank you, I am going to write all this down, but what is the "AMH" level?  I know FSH is follicle stimulating hormone, but what is AMH?  I did have the HSG done as I mentioned, it was fine....but not the lining biopsy.  How did they do that?  Was in non-evasive?


Skipili-  Thanks for all the info....sounds like there are some RE's out there that just go through the motions.  I think I am at one of them.  I didn't mention that when I was in there last time, the nurse told me that he does his IVF's in cycles.  Now, that may not be abnormal or anything, but I just thought it was a little inhuman to go about it that way.  He starts all the women that are going to do IVF at the same time.  He also has 6 offices.  Hmmm, starting to think I may need to go to a different one the more I think about it.

Anyway, it sounds like you and I are on the same page as far as our thoughts on the RE situation!  

Any other comments are appreciated!

[skipili]

I also have the tag "Unexplained". I've had the normal b/w taken, HSG and DB's SA. All come back good. There are more blood tests that can be done but they normally don't do them until you've had a couple of m/c, at least that is what the nurse said in my RE's office. I asked her if I could have the b/w done anyway before I do another IUI because I don't want to spend another $2000 or have another m/c if there is something wrong with me that they haven't found yet. She said she would have to get approval from the RE and she never called me back like she said she would. I am going to another RE for a consultation just to see their plan of action. Infertility is a big business. There are plenty of women who need help to conceive. I would like to think that all RE's are on the up and up but when I think about it I get nervous that that's not always the case. Why should I spend anothr dime if I really can't have a baby. Women who seek help to conceive will stop at nothing if there's hope that they can. There's a lot of money to be had with "unexplained infertility". I wish that the RE's would be a little more consistant with the testing before they just start trial an error treatments. I wish I was more knowlegable before my IUI. I would have done things differently and asked more questions and had more tests run. I was under the impression that it was all I needed to get pg. This is just my opinion and my experience. I'm sure there are a lot of good RE's out there and many women have benifited from them and I feel that I will too. I just have to find an RE that I feel will be a good fit. Every women needs to feel like they are getting the best possable care and be 100% happy with their RE. My goodness, we have enough on our minds as it is.  

[4Angie]

Oh, by the way, I did clomid for 3 cycles with old RE.  I have done 1 cycle with Follistim with new RE.  I have not ever had an u/s after ovulation.  

[4Angie]

I had cd3 b/w done to check for certain levels, which the FSH is very important, especially the older you get.  If FSH is 10 or above, it is elevated.  However, 10 just being slightly elevated.  They start getting worried the closer it gets to 15.  
I had HSG on cd10 done to check for blocked tubes.
I had an endometrial biopsy done on cd21 to check for lining deficiencies.
That was all done with my OB/GYN
Old RE only did u/s on cd12 of each cycle-3 times.
New RE did b/w on cd1 for AMH.  This checks your ovarian egg reserve.
Then they did u/s AND b/w on me for cd3, cd6, cd8, cd9, and cd10.

I believe the 1st important thing you need to know is your FSH and AMH levels.

[SHP]

My uterus is perfect.  My labs are perfect.  4 IUI's and two invtros later and not baby - nothing.  

They take steps rulling differnt things out by the way.

Doctors are not God.  They do not understand it all.  They all want success - their numbers are reported and everytime you fail they have a strike against them.  Believe me - they need for you to succeed.  

Only God gives life.  There are thousands on this forum with unexplained infertility.  

Giving the doctor a piece of your mind won't give you a baby.  It is not like having your care worked on.  Sometimes the answers lie with God - not man.

[mommyof3andhopefully4]

Sasparilla-  Awesome, thank you....I am writing that down.  I think that is the day 7 test....I remember hearing something about that.  Thank you so much!

Baby Hope1-  I did do an HSG...it was awful!  Anyway, I stated above in my inital question that it was the ONLY thing he ordered up for me.  So I did have that done and it was all clear.  All tests were done in Jan. of 08....so it has been about four months.

Helen72- I forgot to say that they do do the u/s on day 12 to see when I need to trigger....that is the only u/s they do.  From what I read on here, a lot of women get one again after ovulation to make sure all the follies ruptured and there are any left behind.

Can anyone tell me if my RE is way off base?  Is this normal for an RE to follow this type of treatment?  Is he out of line or is this normal?  

Thank you so much for all your answers!  Keep them coming!

Heather