Diagnosis, Prognosis, Treatment

Going to the RE for your first consultation after reading all the infertility blogs that you can find is kind of like watching the remake of an old movie.  You know the basic plot, you have a feel for the twist at the end, but the actors and the exact details are new.  While I was at Dr.  …

Hmmm.  What to call him — as a starring role, he needs a descriptive name.  Dr. Looks-Like-He’s 25-But-Is-Really-40?  Dr. Are-You-Sure-You’ve-Never-Had-Thyroid-Issues? Dr. Really-Positive-I’ll-Just-Need-Drugs?  How about we just stay simple — Dr. Local.

… Local’s office, I was composing parts of this entry in my head as we went along.  Mentally, I was running a comparison of his office and his actions to what I knew other women had experienced.  It actually felt a little odd, almost like I was testing him without telling him what was happening.  In the end, it didn’t matter, because he passed.  He seems to know his stuff, is personable enough, and didn’t set off any of Manly’s asshole-alerts.  (I swear, Manly can tell whether someone is going to be an ass within 30 seconds of meeting them.  Manly is one of the most charismatic people I’ve ever met, and he charms people as an automatic reflex.  He’s a great judge of character because new people almost immediately let down their guard against the force of his personality when he meets them.)

To start with, we had a clothes-on consultation* and talked a little about family history and my personal history.  He showed us a few charts, and told me that given my and Manly’s age and overall health, he believes that adjusting my ovulation cycle with drugs and timed intercourse would get me pregnant.  He did mention that IUI might be an option after several cycles, but he made it clear that he did not think I’d need IVF.  I’m not sure I’m as positive as he is, but his proposed treatment was pretty much standard, so we’ll run with it for a while.  He did tell Manly to stop smoking, as smoking can contribute to DNA fracturization in sperm, but told us that caffeine and alcohol in moderation were not a problem.  I was also instructed to start taking my vitamins again, as I’ve been a rebel lately and refusing to do so.  At the end of the clothes-on portion, he asked where in my cycle I was.  When I said day 4, he thought for a second and then asked if I wanted to start treatment this cycle.  Of course, we said yes.

Then came the wanding, which is a standard part of his initial consult, but had a little different flavor since we knew we’d be doing something the cycle.  So Manly slipped out to the waiting room — I was kind of uncomfortable having him in there with me — and I got my first internal ultrasound.  Dr. Local did the deed himself and had Nurse Short-and-Sweet there to scribe for him.  He supposedly showed  me my uterus and ovaries, but it all looked like static to me with a few dark spots floating around.  I realized that something might be a little off when he counted 15 antral follicles on my left ovary and 17 on my right, and then looked up at me and said, “Are you sure you’ve never had any problems with your thyroid levels?” 

Um, no?

So after all that fun and excitement, the wrap-up was fairly straightforward.

  1. Diagnosis: mild PCOS, suspected insulin resistance and pre-diabetes. This is based off of my lovely follicle count, my family history of diabetes, and the fact that I have slightly “dysfunctional ovulation.”
  2. Prognosis: good. He expects that we will be able to get pregnant by manipulating my cycle with oral drugs and timed intercourse.
  3. Treatment: I started on 50 mg of clomid last night and will take it for the next 4 nights.  Next Friday, I go in for a) cycle monitoring to check my response to the clomid b) mid-cycle bloodwork and c) the oh-so-lovely fasting glucose tolerance test.  After the glucose tolerance test, I am to start taking metformin to regulate my insulin levels.  I will most likely do an O.vidrel trigger shot.  Manly gets to go in for the standard SA next Wednesday afternoon.

Looking forward, if I am not pregnant after a few cycles on clomid, he will switch me over to femara to see how I respond.  Also, after two medicated cycles with no pregnancy, he will also send me for a HSG.  Past that, we would move into clomid or femara – IUI, then into injectibles and down the path to IVF.  Like I said, it’s just a new remake of the standard storyline.

I’m actually kind of hopeful right now, based solely off of Dr. Local’s optimism.  It would be really, really nice if he’s right.  Plus, I feel like I’m in good hands — Dr. Local came with good reviews, and his staff is very pleasant.  Nurse S.A.S is apparently ‘my’ nurse, as I got her direct line for any questions and she handled all of my prescriptions and instructions after the ultrasound.

So we’re off on Clomid Cycle #2!  Everyone excited now?

*Thanks to LutC for that description

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8 thoughts on “Diagnosis, Prognosis, Treatment

  1. I’m so glad you’re appt. went well. Has he ordered the mass of bloodwork yet? I had to go in for bloodwork and have my HSG before he started me on treatment. I also started my treatment on the femara. It is interesting how I compare how different people’s visits were slightly different than mine. I’m sure it is all to do with individual histories leading to individual treatment plans. I like how they assign us nurses. That way your nurse is always familiar with your file. 🙂

    Anyway, enough rambling! I’m excited that you get to start treatment immediately. I’ll be looking forward to how this cycle works out for you!

  2. I’m excited too! I didn’t handle Clomid well at all. How is it for you? I’m with Jess, it is funny how different our three appointments were. He told me he doesn’t prescribe Clomid, and put me on Femara. I didn’t mind it, and I know Jess took it. However, Clomid is a much less expensive drug to take.

    Major bummer about the PCOS. Don’t I understand! Any questions on that front be sure to ask. PCOS and I are real good buddies. (Ok, so more like enemies, but you get the idea.)

    How exciting you get to start right away!

  3. Jess, yes, the mass bloodwork is next Friday with the glucose test and scan.

    Winks, the clomid is kind of a transition between my ob-gyn and him; I already had the prescription and seemed to respond to it last time, so we’re going to do these two rounds before switching to femara. That is of course assuming that I respond to it the way he wants to see — otherwise he’ll switch me next cycle.

  4. Hi there.

    I found your blog through “Worldofwinks”. She mentioned that we’re all from the same part of the world.

    I’m glad your first appointment with Dr. Looks-Like-He’s 25-But-Is-Really-40 went well. The first time a saw a photo of him (I assume we’re talking about the same RE) I thought, “He’s a BABY! I could be his mother!”

    Of course, I couldn’t, because I can’t seem to get pregnant, but I digress . . .

    I ended up seeing another RE, but have heard wonderful things about Dr. Looks-Like-He’s-25. I am wishing you lots of luck with your journey and will be checking back often hopng for good news.

  5. Sharah, sounds like this appointment was a great start! You sound optimistic, and that is fabulous. It is so easy to catch a doctor’s optimism when you feel really comfortable with him. I’m so happy to hear that you are on a tresatment path, and that with this Clomid cycle you are having some monitoring. That will definately help you see if Clomid is the right drug for you. I am wishing you so much luck with this cycle… It’s so great that you were able to start right away- what a bonus.
    PS-thanks for your comment on my blog about the mind reading of the husbands. Oh darling, I can SO relate!

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