Wednesday, August 21, 2013

The Boulevard of Broken Dreams

Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”… (WHO-ICMART glossary1).

Infertility.  A disease that affects about 10% of the population.  A disease that nobody talks about.  

So after we hit the year mark, I made an appointment with my OB/GYN for my annual exam that I had been putting off for a few months (because I just knew I would get pregnant then I could combine my appointments) and to talk about our trouble conceiving.  So I print out my BBT charts and head to the doctor.  He's thoroughly impressed with my charting skills (thanks, but it's not rocket science doc) and definitely thinks it's time for some testing.  He orders a Semen Analysis for the hubs, 7 DPO progesterone blood work for me, and an HSG (x-ray with contrast dye to check to make sure my fallopian tubes are clear) for me.  I had to request CD 3 blood work since he usually only does it for women over 30 (I'm 29 at the time).  This should have been my first clue to move on to a Repeoductive Endocrinologist (RE a doctor who specializes in treating infertility), but I was convinced that my OB/GYN would be able to help me.

Let me preface this next part with the fact that while my doctor may be a good OB/GYN (although he has no business treating infertility), his office staff are pretty much all morons.  So I call on CD 1 to schedule my CD 3 blood work.  I ask the girl doing the scheduling if I need to schedule my HSG, or if I can schedule it when I come in 2 days later for my blood work.  She says I can take care of that when I come into the office.  Cool.  I come in two days later and let them know I am there for a blood draw they take me back and the nurse notes that they have the wrong doctor listed as my doctor (there are two doctors in the practice), she changes it and verifies with my doc which hormone levels he wants to check.  He wants TSH, FSH, and Prolactin.  This means he is missing LH and E2, which should be checked on day 3.  I made her double check the hormones, but my doc wouldn't order the other two.  This is another red flag I ignore.  So after poking around for a decent vein, she gets the blood she needs and I let her know that I need to schedule my HSG.  She turns to me and says that has to be scheduled on day 1 of your cycle, you should have called then.  Of course I reply with the fact that I did call on day 1 and the girl told me I could schedule it today.  The nurse says nope, it has to be scheduled on day 1, so you'll have to wait until next cycle.  Are you kidding me!  I start to respond that that was ridiculous, that I started my cycle two days ago, how can it be too late to schedule the damn test, when my doc who was standing nearby filling out a chart overheard our argument.  He told the nurse that we could still scheduled the HSG, since it couldn't be done until next week anyway.  Crisis averted.

So the HSG.  It's the most dreaded test amongst infertile women.  I won't lie mine hurt like hell, but the good part of the test is that it is over in just a few minutes.  My big issue with this test was again the doctor's office.  So I get a call from the lady that schedules outpatient procedures (HSG is done at the hospital imaging center) and she tells me that my insurance has lapsed.  I said no, I gave them my new insurance card when I had my annual a few weeks ago.  She said that she doesn't have any of my paperwork on my new insurance card.  Come to find out, the idiots in reception pulled the wrong chart!  All of my records, blood work and insurance info were in another patient's file who has the same name as me.  This is also why my blood work had the wrong doctor on it, they had pulled the wrong file then too.  They get it straightened out, but this is another red flag I ignore.

The hubs' SA was only a little bit of a headache.  The two hospitals that do SAs are both about 45 minutes away and do not allow collection on site (catholic hospitals).  So we were in a rush to get the sample from our house to the hospital lab with in the hour time frame.  Some how we managed.  The only other test I had was a progesterone blood test.  The dumbasses pulled the wrong chart yet again, but the nurse and I caught it and they got the right chart.  The other issue that I had with the office staff is they refused to consider recoding my blood tests.  I have no insurance coverage for infertility and I asked that at the very least that my TSH (thyroid blood work) be recoded since they were planning to run that test anyway due to family history.  They refused.  I asked again and the nurse said she would look into it, but she never did.  So on top of being idiots, they are also liars.

Once all of our testing was done, the doc calls to tell me he has a diagnosis.  Despite having a normal length LP (luteal phase, number of days after ovulation), I have low progesterone.  He diagnosis me with weak ovulation and wants me to try Clomid to strengthen my ovulation.  I tell him that it sounds good to me, but I insist on being monitored by ultrasound.  He agrees and I start my first treatment cycle in October of 2012.  I take Clomid days 5-9 and my mid cycle u/s shows a 27mm follicle and my lining is 6.7mm.  I worry that my follicle is too big and that my lining is too thin, but my doc says it is fine.  He doesn't use trigger shots so I have to wait 3 days to ovulate on my own before we have our first IUI.  My blood work shows that the Clomid improved my progesterone level, however the cycle is not successful.

After the cycle fails, I decide that it is time to move on to a RE.  I don't want to waist any more time with a doctor that doesn't want to monitor me and relies on OPKs to time IUIs.  Also we are OOP for all infertility testing and treatment, so I would rather spend my money on treatment with an expert.

I think this is enough rambling.  I'll discuss our adventures in RE land in the next post.

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