Monday, January 14, 2013

A big hurdle in a long line of hurdles...

Great news!  I was approved for an insurance change last week.  After researching my new policy, I learned that I have open access for "diagnosis of infertility" and women's health care.  I also looked at the formulary for prescription drugs, and some of the meds I may need are covered, such as progesterone in oil injections.  My plan is to milk the maybe-you-have PCOS thing for as many tests and treatments as I can.   

So, I made an appointment with the MN Center for Reproductive Medicine.  The doctor that I am scheduled to meet with founded the clinic, and has a fairly decent reputation with the Choice Mom community.  The feedback about him is that he isn't very warm and fuzzy per se, but he does lay out the facts and gives you all the information you need.  I've heard some ladies on the SMC/CM boards saying that their doctors don't give them their lab values, follie size, etc; they just say that they are "good."  I need a doc that will give me facts, and answer my questions.  It sounds like this one will.  We shall see...

I want to put the question out there about what to expect for the RE.  I know that he will probably examine me, and maybe do another ultrasound.  He'll order day FSH/estrogen, maybe a TSH and probably hormone levels to check for PCOS.  I'm wondering what questions I should ask.  I started out with this last year thinking I would maybe need some progesterone to prevent miscarriage, and maybe a trigger shot.  Now, it looks like I may need to induce ovulation.  I'm wondering which is better: Clomid or Femara?  I've read about the benefits and risks of both, and it seems there are an equal amount for either drug.  And, what about synthroid or metformin?  Also, this is a big newbie question, but I know that my ovaries are already covered in follicles, so how can they use U/S to see when I ovulate?  The radiologist said the cysts were "small," but they looked pretty large to me, esp. when I compared them to other images I looked up online.  So, how can the doc tell which follies actually have eggs in them?  This may seem like a silly question, but will they put me on suppressors or BC to get rid of them, and then use meds to stimulate new growth?  And what are the benefits and risks of that?  I think I have a lot of research to do before that appointment....any feedback anyone can give me will be helpful.       

Some may not think this is as humorous as I do, but my dad is coming with me to the initial consult.  It's not exactly a Daddy/Daughter thing, but he's my biggest supporter at this point.  So cute; he actually put two pairs of knitted baby booties in with my Christmas present.  I think he's excited to be a grandpa.  I keep remembering how he told me he wanted to be a grandfather, but he wanted it to happen on my terms when I was ready.  I'm so thankful for that. 

So far, things seem to be falling into place the way I need them to.  I know that this is just one hurdle in a long line of hurdles that have to be jumped over, but I'm happy to be moving forward.          


  1. Just my two cents - I would definitely do Femara over Clomid. Worked like a charm for me, and zero side effects. From what I've heard Clomid can have pretty intense side effects.

    I may be totally wrong about this, but as to the cyst vs follicle thing, I don't think they can tell which will produce eggs. I remember doing an ultrasound and the nurse saying my ovaries were poly-cystic (but not PCOS related) but that they didn't know if they were all cysts or egg-producing follicles. They kept saying things like "but this could just be a cyst." My clinic was fairly limited in their diagnostic abilities though so maybe a real RE has better knowledge/technology...?

  2. Hopefully, you've already found answers to some of these questions, but I'll chime in with what I know. I used Clomid for four cycles, and while I didn't have as many side effects as some women, the Clomid was definitely affecting my mood by the last cycle. Gonal-f is crazy expensive (luckily my insurance covers drugs, but nothing else), but I felt much better on it, and my lining was decent (Clomid thins it -- not sure about Femara).

    Depending on how many cysts you have, you doctor/nurse might just be able to remember which ones are where. They'll be identifiable during a baseline scan, since you shouldn't have large follicles at/around CD3. They can also test your E2 early on, because if the cysts are producing estrogen, they can inhibit growth of egg-producing follicles. Later in your cycle, your E2 number can indicate how many eggs you might release (I think it's generally 100-200 per egg). Also, I know that when my cysts (remnants from a previous Clomid cycle) were deflating, or whatever, they were oddly-shaped, so the nurse could pick them out from anything that was new.

    I've found that it really helps to know what you want as part of your protocol (like taking progesterone, say) and push it even if your doctor doesn't initially suggest it. Taking progesterone supplements isn't going to hurt anything, and if it gives you peace of mind, it's really valuable. I haven't yet had my nurse disagree with anything I've suggested, but I don't know that she would have brought certain things up if I hadn't.

  3. Thanks both of you. I am very set on what I want to do. So far, I know which tests I want and I know that I want to use progesterone. I'm still not sure which ovulatory drug I want to use, but I'll discuss it with the RE. Day three labs are on Thursday.