She Says… Trial and Error

The most frustrating thing about struggling with infertility for me is not knowing what’s going on in my body or how to make it do what I want it to. As a self-proclaimed control freak, this constant state of not knowing drives me batty. When I knew something wasn’t right when I didn’t get my period after going off birth control, I looked to doctors to use their magic to decipher the truth. But in the end, it’s really just a game of trial and error. The bottom line is that they don’t always know either, even though they are supposed to be “the experts”.

So, in an effort to gather as much information as possible, I turned to the internet, Googling the heck out of every search term I could think of. And I started this blog. And I joined Rubyfeather, a group of women in the Boston area going through some of the same issues. And I read other peoples’ blogs. Lots and lots of blogs. As I read them, there is this little ticker running in my mind all the time: She’s doing this, should I be doing that?… Her doctor said this, but my doctor says that… And on and on. And as more people have started reading this blog, I’ve started getting emails from readers doing the same thing. Comparing stories, asking for advice, offering advice, suggestions, comforting words. I love hearing from each and every one of you.

Over time I have received a few emails/comments that address the same issue: they question the level of care I am receiving from Dr. P. They asked why I wasn’t more closely monitored with bloodwork and follicle counts/measurements every few days throughout my cycle. They countered Dr. P’s decision to not give extra progesterone supplements with the Clomid. They expressed disapproval of the order of tests that he ran.

At first when I read these emails and comments, they made me angry. I trust Dr. P; I chose him because he is a well-respected doctor at one of the best infertility clinics in the country. I’m putting my body and my future in his hands. So I ignored them. But then I started questioning why I blindly put so much trust in him just because he is a doctor. Maybe I was wrong to just do what I was told and not question him? Maybe I should be pushing for more aggressive treatment or certain medicine?

So today I called Dr. P’s nurse coordinator (the one who knows me and answers all of my questions), and I told her I had been talking with some other people going through this process and that they were being monitored more carefully (bloodwork and ultrasound prior to each Clomid cycle, more bloodwork and ultrasound once the Clomid was finished, still more bloodwork and ultrasound around the expected date of ovulation, hcg injections, post-injection check-ups, etc.), and I asked her why I wasn’t getting these daily check-ups. She said that Dr. P was following normal protocol. That he is an extremely cautious doctor who doesn’t like to disrupt his patient’s lives with daily doctor’s appointments. Given my young age (26), overall health (excellent), fertility history (only been off birth control since March, borderline “Lean PCOS” diagnosis), and timeline (only on second cycle of Clomid, still having “relations”, as they call it, not IUI or IVF), he likes to take things slowly. And since I am starting with the lowest dosage of Clomid and working my way up, there is only a very small chance that I’ll be overstimulated. Given the fact that there’s no evidence that I have even ovulated at all yet, and my almost-normal antral follicle count from my previous ultrasound, he does not see a reason to overwhelm me with monitoring appointments and bills at this point. And for that, I thank him.

The nurse’s answer assuaged my fears, but still leaves me with that icky not knowing feeling. I don’t know what the right course of action is. Why aren’t there hard and fast rules about these things? The answer, of course, is that no two bodies are exactly the same. What your doctor says about you may not be true about me, and vice versa. So I appreciate hearing from everyone, but please know that I am a firm believer in individualized care. What works for me may not work for you. And what your doctor recommends for you might not be good for me. And as much as we’re all searching for answers in each others’ stories, we have to realize that we have no idea. It’s all a game of trial and error.

What about you? For those of you on Clomid/IUI cycles, are you monitored every few days? Does it add stress to your life and schedule? How do you know if your doctor is taking the right course of action?

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23 responses to “She Says… Trial and Error

  1. I say whatever works for you and your hubs go for that. I do have the monitoring at the beginning of the cycle – to make sure there are no cysts – and then through out the cycle to see how I’m progressing even at the lowest dose of clomid.

    I sort of like having the extra scans because it means he knows exactly how many follicles I have, how big they are, and where I am in the cycle. Not everyone has a perfect cycle and ovulates on the same day. It gives you more information than just charting and hoping that you got the right day and have big enough follicles. I also heard that women who have pcos have issues with opk monitors and such because their elevated hormones can make the tests inacurate.

    It doesn’t really disrupt my life that much since I’m a house wife at the moment. I know it does disrupt other peoples schedules since they are working and such, but they work around it. It’s all up to you and what your comfortable with.

  2. Honestly, Kate, when I did my first cycle with Clomid last fall with Dr. Alper (my old RE) at BIVF, they did b/w and u/s every 3 days. I would think that would be standard protocol there, not so much to watch for overstimulation, but just to see how/if you’re responding. Even though it was a hassle (I live 45 minutes away from the clinic), I liked these checks — I, too, am Type A, and I wanted to know what was happening in there.

    From the message boards and blogs of which I partake, I seems like most everyone goes into their IUI or BDing knowing how many follies with which they are working, so I think u/s are standard protocol.

    However, it is entirely possible that because you are so young, Dr. P doesn’t feel the need to monitor you so closely at this point. I did like him alot when I met him, he did my IVF ET in June and I can definitely see why you trust him. My best advice would be to ask Dr. P himself about it — the nurses are great but they don’t always know the exact answers the doctor would give. My current RE at BIVF does phone consults, they’re much easier to schedule than in-person (and free!). If I were you, I’d call his assistant and ask for a 15 minute phone consult to discuss your concerns.

  3. i haven’t started anything yet. but: while i was offered an ultrasound during the clomid (just to make sure i wasn’t overstimulated), the doctor left it up to me, saying basically what the nurse you talked to said.

    and i think i agree with her and the rationale that your doctor is taking. even though it’s hard to wait, you’re still very young, have a diagnosis that generally has a great success rate (whether it ends up being clomid or injectable hormone therapy that gets you to ovulate), and there is no true rush.

    for me, i considered the u/s because i am terrified of twins! we’ll see what i end up doing when i finally start with the medications (i am putting things on hold because some job/location stuff with my husband is up in the air and the timing just doesn’t seem perfect).

  4. I haven’t been through what you’re going through (yet?) but I think I would actually like a doctor who is a bit slower and less overbearing. I think that taking things slowly is good. Like the nurse said, it’s important to not disrupt daily life with tons of appointments – this probably just puts more stress on you, which is not helpful :P Obviously I have no experience with this, but it seems like Dr. P is pretty cool.

  5. Hi. I did most of my rounds of Clomid through my regular OB/GYN. I had not been TTC for 1 year yet, so they had not referred me to an RE. They increased my Clomid and also did a couple IUIs; I was never monitored at all. I did have one u/s, and that was just to make sure I wasn’t overstimulated b/c I was having a TON of ovary pain at first.
    My RE’s office only did the every 3 days monitoring with injectibles. However, they did do a small amount of monitoring while I was on my last Clomid cycle and then my 2 Femara cycles. I think those cycles only got me 1 monitoring u/s though. Hope that helps!

  6. I think it’s super-smart to be aware of treatment options and what kinds of tests and meds other folks in our boat are getting (through message boards, email convos, blogs, etc). I have learned SO much on your blog, from your commentors, and from other places like this!!

    But at the end of the day, we are all different people with different bodies. Your doc is providing you with the treatment he thinks is best for you. And, as much as we Google and share stories, we are not REs with years of medical school and residencies under our belts. :) So I’d say you’re totally smart to trust him. With a healthy dose of “huh?/but../really?/then what?” for good measure.

    Easier said than done, I know! Part of me is worried I’m not scheduled for USs/trigger shots/etc. to make sure everything is okay this cycle, but the other part of me is taking Zen breaths and following the plan. :)

  7. Hi! I am starting my second round of clomid on Saturday….obviously the first one didn’t work, but I am in ok spirits….on to the next month! I jsut bought some preg tests on the inernet for pretty cheap so I can feed my urge to test all the time just for fun! haha! My doctor does not test me every few days, to be honest I did not know that was something that happened. He tests me on day 14 and then on day 19-21. Not only that, I don’t even know what you are talking about when you refer to follicles! I have been trying to stay away from Dr. Google as he has proven to be unreliable, but I may have to go and poke around a bit to make sure I am getting the right care. Hope things are going well for you guys and that you are in good spirits these days. Starting a new cycle seems to be the most hopeful time of the month! ;)

  8. Hey Kate, I just have to agree with you 100%! Individualized care is the most important and you need to trust your doctor 100%. I had 2 miscarriages – both times I got pregnant on Clomid and I had to have a D&C with the 2nd one. I could have switched Doctors at that point – thinking why is this happening, how come he is letting this happen, how come he didn’t monitor me or do this or do that. But I didn’t – I trusted him to help me get and stay pregnant. And he did – I was on Clomid for 3 months without a positive test so he asked me if I was ready to get more aggressive…and asked me if I was ready for him to monitor me more closely on the 4th month..ultrasounds, bloodwork, higher dosages, more drugs….I only had an hcg shot b/c on the day of my ultrasound I had 2 mature eggs – it was by luck and chance that I was there.

    Don’t ever be afraid to ask questions – or talk about your concerns…it is imperative to be informed about all the medicines going into your body. BUT I think we all have to let our doctors be the doctors and we be the patients with patience. It is long and frustrating and everyday day feels like an eternity…but, based on my 2 1/2 year experience, I can tell you – you quickly forget the time spent struggling when you get the positive test!

    I think you are in great hands with your doctor :) I am praying for you and your husband for your little miracle :)

  9. *HUGS* Although I have never been in your position, I do understand the predicament of not knowing. I was making various ER visits a couple years ago and none of my doctors were able to figure out what was wrong with me. I finally googled my symptoms and realized it was plain and simple allergies. I then insisted my doctors do rash and skin tests and that’s when we finally knew I was extremely allergic to a whole bunch of things. I was very, very mad at my doctors for not figuring it out on their own.
    Annnyway, the point is: don’t worry too much. We are all behind you if you need any support or if you need an ear to talk to :)

  10. While it’s great for all of us to discuss our different treatments, swimming in this big blue ocean sometimes seemingly without any direction of where the next island is going to be, you are right…you have to believe that your doctor is doing what is right for you. He knows your medical history and has discussed with you his protocol and a plan that you and your husband have most likely agreed on with him. You are unique and every doctor has to treat every patient as an individual and plan accordingly.

    I am an attorney and I work in the insurance defense area. Sometimes the insurance company I work for questions the treatment people may receive from various providers. But we can rarely show that the subject treatment isn’t what that patient needed. Why? Because we are not the doctor. To us, the patient is summed up by a bunch of medical records. But a treating provider is treating the patient, he/she knows first hand what the patient’s symptoms are and performs occasional exams to see if any improvement has occurred. Simply, the doctor knows what to do and who is anyone else to question that.

    As long as you are comfortable with Dr. P and believe in him then that’s all you need. He knows what is best and will provide you the best treatment he possibly can!

    You are young and you have so much going for you! We are lucky (I’m 28) that we started trying when we did and were proactive enough to put ourselves in the hands of specialists so that we could be diagnosed and treated at a time when we have the most potential for success! And you will have that success!! Before you know it, you will be rocking your own little miracle to bed! :)

  11. Hi again,
    It’s hard not to compare yourself to other people’s treatment plan. I am constantly googling everything under the sun about Infertility and PCOS and Clomid.
    If you are happy with the progress than that’s all that matters. It’s nice the nurse explained everything to you.
    I was under care of a OB doctor for one year who just gave me only dose of Provera and 6 months supply of Clomid without doing the proper testing. Every month, I would take the clomid without the Provera, not knowing that this was a crucial step. I feel like I wasted one whole year with that doctor. After one year, we stopped trying and I got pregnant Clomid free, but ended up miscarrying. Then I found out the a few months later that my Thryoid was bad.

    Now I am seeing a regular OB but he specializes in Infertility. I am VERY confident with him. I am getting monitered very closely and I did get the Trigger for the first time, but that is because we’ve been trying for so long. I really believe that out of the last 26 months, this is really the first cyle that may have a chance. This is the first time I’ve ovulated out of 7 cycles of Clomid.
    I do not mind going in to get monitored so much because I feel like at least I know a little bit whats going on in there. Before, I would just h ave to wait the whole month and not know. Now, I know if there is a chance or no chance.

    Bwt, when I was on 50mg Clomid, I had such bad hot flashes and mood swings. I was scared to move up to 100mg, but I haven’t had any side effects. Well, maybe a bit of headache, and lots of pressue in the ovary region, but that just mean it was working.
    I wish you the best cyle this coming month!!!

  12. The post above is from me. Sorry about that!

  13. Low Fat Lady, Thank you! I totally agree. While I do feel like I would appreciate having little check-ins along the way to track the progress of my growing follicles, I also trust that the doc knows what he’s doing. So for right now, that’s working for me. Even if I get a positive OPK again this month, I am thinking I will ask for an elective appointment for bloodwork and ultrasound to make sure I really did ovulate (since last month I got a false positive). That will put my mind at ease.

    Lara, Great advice! Thank you. Yes, I love Dr. P, and I feel very comfortable with his treatment plan, given my young age and the relatively short amount of time we’ve been “trying”. That said, the Type A part of my brain would REALLY like some cold, hard facts throughout the cycle. As I said to Low Fat Lady, I am thinking of taking a middle-of-the-road response by going along with his plan but asking for an addition ultrasound after supposed ovulation to see where things stand. Even though I’m young and healthy, I’d still like to get preggo ASAP! I am not one to take things lying down (ermm, so to speak).

    sarah (ghost world), It’s so great to hear from you! I agree — there’s no TRUE rush for me, so I do appreciate the relatively relaxed approach Dr. P is taking with me. I, on the other hand, am NOT afraid of twins (I pine for them, in fact), so I’m definitely not scared of overstimulation. Although Kate Gosselin was on Clomid when she got preggo with the sextuplets, so, one just never knows.

    Maggie, Very true :) Thanks for weighing in!

    Jen, That DOES help! It is helpful to see how very different everyone’s treatment plans are. While some people would say, “Oh, you’re not being monitored at all!? How DANGEROUS!”, I think it just goes to show that every patient is different, and every doctor is different.

    LizardRuns, Yes! Ditto.

    Cathy P, Good luck with this next round of Clomid! Don’t worry about not knowing terms… every day I learn new things Googling. Not that I recommend using Dr. Google as your main source of info (it’s dangerous!), but it can be helpful getting up to speed with the lingo.

    Joanna, Right on, sister! I love that: “We all have to let our doctors be the doctors and we be the patients with patience.” Couldn’t have said it better myself. And I’m SURE you are right about forgetting all this nonsense once we reach the end. Can’t wait for that day.

    Nabeela, You are so smart to research and diagnose yourself! I guess it just goes to show that although doctors are experts, they may miss something. So it’s important to be educated and prepared to challenge those docs once in awhile.

    Michelle, Great points! I totally agree. I DO trust Dr. P, and now that I know that I can stop letting these little comments frustrate me. It is great to consider another opinion, though, so they are helpful in making me feel in control of what’s happening to me.

    Kristen, Oh, how FRUSTRATING to not have gotten enough information from your doctor to make those cycles worthwhile. That is awful. Congratulations on your most recent cycle, though! Now that you have a doc who is looking out for you, I’m sure you’re well on your way to beating that thyroid. Good luck!

  14. As you know I’m on Clomid round 4 (2 @ 50mg and now 2 on 100mg). My first round I went in for day 11 u/s and was good to go and given my hcg shot. Next round I went in on day 10 (day 11 was a saturday of labor day wknd) and follices were too small; they said they’d usually have me back two days later, but from where they were and the holiday, they had me come on day 14 for u/s, not quite big enough, so went next day for shot only. 3rd round they had me come in day 13 for u/s and all was ready, so shot given. I will go in day 13 for this round too. Also, when I had my BFP, they had me come that day for blood work and then again three days later.

    My insurance does not cover any infertility treatments, so I have to pay for each appointment. So I appreciate that my dr takes that into effect at this stage in the game. I think if we were further into treatments (IUI, IVF, etc) that more monitoring is necessitated.

    At this point though, it is very much a trial and error and learning what and how your body responds to different stimulants/treatments. So even though we’d love to know all the answers today, the dr.s are doing their very best to try and help the discovery process, but they can’t move faster than our bodies.

    Great post. I read way too much and although I love it, I’m trying to limit myself to just a couple of my favorite (yours <3 ) blogs a day. I find (for me) that I get more worked up reading everything else and trying to compare it to myself. And ready so many people's stories of such long stuggles and multiple disappoints only makes me wonder how long and crazy our journey will be and I just can't go there yet. So despite loving the information, I've decided my heart can't take it!

    Hang in there and trust you judgement. Don't let the haters get you down =)

  15. It sounds like you have a good doctor so maybe you’re okay, i had really really bad doctors who I put my faith in the first year of my journey and it really put me behind. Though I now have two excellent doctors I continue to do my own googling and ask any and all questions. If you are still feeling antsy ask some more until you feel 100% confident. You have hired them for a service and they should make you feel comfortable with the service they provide.

    thanks for stopping by and leaving a comment on my blog- I’m adding you to my google reader!

  16. I love being left alone by my RE. It saves me money and time. When I’ve been on clomid, he’s done an u/s on day 13 with b/w, but that’s it. When we did IUI, he had me do OPT’s at home and come in for U/S when it was positive. So I don’t see anything wrong with your care. And we are ALL different!!!

  17. I totally get this… I question my interaction with my doc/nurses all the time and I’m only at the beginning of this process. When a nurse tells me that something was normal, I hang up the phone and immediately call back to get the exact number of whatever tests have been run. Drives me nuts, but I have to know.

    Just like PP’s said, I’d ask your doctor directly– maybe there’s a reason or maybe he just was trying to make things easier on you. Either way, I’m quite certain he wants to give you the care that you expect and would feel most comfortable with.

  18. I’ve not done any bloodwork tests. The only thing that my gynae did was u/s and my husband went for a sperm check recently. I trust my gynae, who also treated my sister with pcos and my sis has a baby now. It’s a bit stressful sometimes when we need to take time off from work to do those checkups.

    I’m in my 2nd round of metformin (100mg) + clomid (100 mg) — same dosage as first round which made me ovulate.

    At day 10 – u/s check. One of the follicles was about 11 mm.

    At day 12 – u/s check. My follicle grew to about 18.5 mm. So I was given the hcg to induce ovulation and my gynae asked whether I wanted to try naturally again like in 1st round or go for IUI. I chose IUI. My IUI is scheduled tomorrow (day 14).

  19. kwally, I totally agree! Reading too much can be a blessing and a curse. I, too, begin to feel like, “Look at how long x has been trying, what makes me think it’s going to happen next month?“. And recently I’ve been reading about so many miscarriages that I feel like I might even be scared to get a BFP. Not the right attitude! I appreciate that you read mine, though :)

    Katie, Thanks for the input! You’re totally right. I will continue to ask questions and do my own research. It seems like it’s one of the only things I can do to feel in control recently.

    Amber, That’s good to hear — that sounds very similar to my treatment plan. It’s true, the more he leaves me alone, the more I feel like a normal person, and I appreciate that.

    Stef, Good point. I have a phone consult set up with the doc later in this cycle and I will ask him more about it then. As it stands, I think I am going to call and ask for an ultrasound on day 14 or 15, regardless of my OPK reading, to see what’s going on in there. I’m anxious and ready to start now!

    CA, Those sound like great numbers! GOOD LUCK THIS CYCLE!

  20. With my first Clomid cycle I too worried about my Dr. not monitoring me like so many other Dr. do. I questioned her and felt comfortable with her answer. I think the biggest thing to remember is that it is ok to question your Dr., but if you feel comfortable and ok with the care they are providing then it doesn’t really matter what everyone else thinks you should be doing or are doing themselves. This journey has so many similarities between us, but it is also so personal.

  21. you poor thing! I agree that the not knowing part is the hardest – not knowing if there’s more to be done or if you’re making the right choices. I feel that way with a lot of the things I’m going through now. Just today I was signing up for classes and trying to figure out if I’m taking the wrong ones or if I’m going to miss some key information. But what I realize is that everyone is going to have an opinion and I may or may not find the “perfect” class. But I’ll learn through the process which is exactly what you’re doing. :)

  22. I am starting my first round of Clomid within the next few weeks (on Provera right now to induce a period first), and my doctor isn’t monitoring me, either. I’m still at my OB/GYN, as she wants to give it three cycles with her and Clomid before referring me to a specialist. She mentioned I’d have to come in once a cycle to check for cysts, but that’s it. I, too, have been reading about how you’re supposed to be “closely monitored” on Clomid, and it made me nervous. My doctor said that based on my history, this is the correct protocol for me right now. I just hope it works. Good luck to you!

  23. Baby Hungry, Great point. It IS ok to question your doctor. I am certainly glad I called. But, like you said, I was happy with the answer and I still feel very comfortable in his care.

    Tabitha, So true! Everyone does have an opinion. And we just have to remember that the only one that really matters is our own (ok, and maybe the husbands’). :)

    heatherkj11, Hi! Thanks for commenting. It’s good to hear that others have a similar setup with their docs.

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