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Old Aug 24th, 2009, 02:05 AM   1
sonyabazonya
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First serious appt. with gyno, what to expect?


Hey ladies! So I've been trying for 12 months now, and now is the time the dr.s have deamed it time to "start getting serious" I have an appt. with my gyno on friday, where im going to tell him "Hellooooo its been a year now, can we please acknowledge the problemo??!!" I was just wondering what to expect from my first meeting?

Thanks in advance



 
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Old Aug 24th, 2009, 02:08 AM   2
susanneb1984
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I'm sorry hun I don't know about the appointments. When I went to see a gyno, it was for abnormal cells and the first appt was a lot of background questions, so might be similar??
Good Luck anyway hunni

xxx



 
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Old Aug 24th, 2009, 02:57 AM   3
Megg33k
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I'm assuming by your wording that you are already familiar with this gyno. If so, that's a plus. If not, it's not really that much worse.

I didn't have a regular gyno several months ago. I went to one whom I hated. Then I got referred to my GP's own gyno, and she's been mostly wonderful. My first appointment with her was very informal really. She asked me a few background questions. I explained that my husband and I would really like to conceive. She gave me Prometrium to give me a new cycle (long story) and PhenChrom for weight loss (because I definitely need to lose weight). She told me that we were going to try weight loss and natural TTC for 6 months, and then we'd talk about doing more. The next month, I had a chemical pregnancy, and she (not sure why, maybe out of pity?) gave me a prescription for Clomid. I giggled to myself that she said 6 months and waited all of 1 month.

Since you've already put in your year, I imagine that yours will go a little quicker even. Do you have an idea of what the problem is? Are you ovulating? Do you have a luteal phase defect? Any diagnosed conditions (ie: PCOS, Endometriosis, etc)?

I can give you a better idea of how it might go if I had a little more background on your situation. I'm willing to offer as much help as possible... I read so much that I can tell you how almost any problem is treated... even how "unexplained infertility" is usually treated. You can update in here or pm me for more info if you like!

Good luck, hun!

~*BABY DUST*~



 
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Old Aug 24th, 2009, 03:08 AM   4
sonyabazonya
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well, i did go to a private hormone specialist (i cheated) and he discovered that my testosterone levels are sky high, my dhea-s is too low, my estrogen is too high for my progesterone levels which are too normal lol. i take natural progesterone from cd 21 til af or bfp (which i havent gotten yet obviously). my gyno is a pri** (no pun intended) but thats life thank you very much for your help i really do appreciate it xxxx



 
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Old Aug 24th, 2009, 04:17 AM   5
SarahMelissa
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I went to a FS for the first time last week, i posted this on another similar thread, but here it is again for you this is everything that happened for me.


First thing the guy asked was both our past histories including age, occupation, any previous pregnancies, surgeries, allergies, medical conditions or family medical conditions.

We were also told when making the appointment that we had to bring in a sperm sample. He then took the sample and looked at it under the microscope (oh we said that we had done the DIY one too and he said he had never heard of such crap and wouldn’t trust them lol). Anyway he said that the count was good and that it looked high however he was a little concerned because there seemed to be a lot that were not moving. So he made us send the sample off to scientists that do the proper evaluation, we won’t get the results of that back for a little while yet though. Anyway after that he asked DH to drop his pants so he could “feel his balls” DH was so not expecting that one!!!! Anyway he said they felt fine.

Next step was that he wanted to examine me, he asked when I last had a pap smear and I had one in December last year but he did another one anyway. He then used his fingers to have a feel around inside and check that it didn’t feel like I could have Endo. He said it felt fine in there. He then went on to do a vaginal ultrasound where he got out a condom and filled it with some kind of lube type looking stuff and put it on this thing that kind of looked like a vibrator. Anyway he then stuck that up there and we watched the monitor to see what he was looking at. We could see my uterus and ovaries and everything and he said it all looked great and that he didn’t see anything that made him want to do a lapsectomy (sp????) something where they put you to sleep and insert something through your belly button to check out your insides.

Anyway after that he sent us both off for some blood tests, I told him about my day 21 test last week and he was happy with that result but suggested the spotting could be from estrogen (sp?) not progesterone so a blood test was done for that and some other things, but not entirely sure on what the other things were. Not too sure on what DH’s blood tests are checking on either but he said something about chromosome somethings??

Anyway he has put me on Clomid (called Letrozole but he said it was like Clomid but it’s the next generation of it which is better). He said you need to take it from CD2 – CD6, I told him I was on CD4 so would it be too late to take it this cycle, but he said no, just start today and take it for 5 days. He did say though that it could make me release more than 1 egg so could end in a multiple pregnancy…..eeeekkkk! Anyways that’s all good I don’t really mind. He also said that I could come back on CD12 and have a scan to make sure the eggs are maturing properly and then I could have a set of injections to make my egg release and then we but DH and I both think we will just try the Clomid for a cycle or two and see what happens. If we still don’t get any luck then we might try and scans and injection things. He said if that didn’t work then the next step would be IUI. Im hoping we wont have to go that far though.

What he does want us to do starting from today and everyday is that DH has to take 20ml of Aloe Vera juice a day, a tablespoon of Goji Berries, 10 pumpkin seeds, zinc and folic acid. And I have to take folic acid (this is on top of my pre natal vit) berocca, fish oil and zinc.



 
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Old Aug 24th, 2009, 04:22 AM   6
urchin
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Gosh SarahM - that's a lot more than happened to us!

We were just asked a load of background questions and referred through for tests and things........though I think getting as much done there and then is a fantastic idea.

Did they tell you what all the supplements were for? Am very interested in what the aloe juice and goji berries were for



 
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Old Aug 24th, 2009, 04:28 AM   7
SarahMelissa
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Quote:
Originally Posted by urchin View Post
Gosh SarahM - that's a lot more than happened to us!

We were just asked a load of background questions and referred through for tests and things........though I think getting as much done there and then is a fantastic idea.

Did they tell you what all the supplements were for? Am very interested in what the aloe juice and goji berries were for
Those supplements are supposed to increase sperm count, goji berries are very good for it apparently.



 
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Old Aug 24th, 2009, 04:39 AM   8
Megg33k
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You're very welcome! Lemme see what I can offer here!

At first blush, I definitely thought of PCOS because you mentioned the high testosterone levels, so I looked up hormone levels associated with PCOS. Some of yours seem to fit and others don't. It appears that PCOS usually makes DHEA-S too high, rather than too low.

Other than that, PCOS doesn't technically cause high levels of estrogen... but, it kind of can indirectly. I don't want to sound rude or anything, but are you overweight? I am, so I'm totally not in any position to judge you... LOL... but it would possibly help me answer your question. If you are, and if by even a reasonably significant amount, the extra estrogen can be produced by an excess of fat cells. Fat produces estrogen and often causes women with PCOS to have high estrogen levels. The extra weight is commonly caused by insulin resistance, which is very commonly associated with PCOS. It's slightly akin to diabetes, but instead of the body not producing insulin, it just doesn't process it correctly. The symptoms are similar to that of diabetes in some cases, and it is treated orally with diabetic medication (not injections).

The level of your progesterone really doesn't say much, because it should be taken at certain specific times throughout your menstrual cycle to make the correct determinations. The major reason would be to confirm or deny ovulation. Do you know if you ovulate regularly?

Were I a medical professional and your gyno, I would do bloodwork to determine your reproductive-related hormone levels throughout your cycle to get a full picture of what you have going on, rather than a snapshot of your levels at this one specific moment in time but unrelated to your levels at other times. I would also ask that you not eat for at least 8 hours before your appt with me so that I could perform a fasting blood glucose test to check for insulin resistance.

If you are suspected to have PCOS (the high testosterone is so commonly indicative of PCOS that your doctor might just to it like I did), you will likely be put on Avandia (less common) or Metformin/Glucophage (much more common). The dosage will probably be low to start with... maybe 500mg/day for the first month, and then slowly working your way up to 1000mg/day or even 1500mg/day. Clinical studies have not found it to be effective in dosages less than 1500mg/day, but there are some unfortunate gastro-intestinal side effects that accompany taking too much of it too quickly. The issues do tend to subside after about a week if you can stick it out, but it can be fairly unpleasant especially in the first few days... think deep stomach groaning noises with gastro-intestinal cramping and (no good way to say this) liquid bowel movements... not just loose, but LIQUID! You likely won't have trouble making it to a bathroom, but you might have to find one pretty quickly. This is intensified with the consumption of complex carbohydrates, sugars, and sometimes vigorous exercise. The side effects are generally more common when you begin taking a higher dose rather than working up to it... ya know, starting with 1500mg/day like I did wasn't the best idea, but mine was un-prescribed when I started taking it.

If he suspects that you have PCOS, he will also possibly send you for a trans-vaginal ultrasound of your uterus and ovaries. Poly-cystic ovaries are pretty easy to pick out on an ultrasound. They kind of look spider-webbed, like this. The appearance is caused by follicles that begin to mature each month and then fail to burst at ovulation, so they have MANY follicular cysts that shouldn't be there anymore but remain anyway. The Metformin will help to control the possible insulin resistance, which will help to relieve other symptoms, such as aiding in weight loss when the glucose is being controlled, which leads to less estrogen-producing fat, which leads to less estrogen... which is GOOD!

He likely won't prescribe much more than that initially. The tests should really come first. But, Metformin will NOT hurt you to take it even if you do not have PCOS or insulin resistance (also called "metabolic disorder").

You will likely be asked to try for another couple of months with only the Metformin. That is sometimes enough to allow conception within a few months for women with PCOS.

The next step is almost always Clomid for 3-6 months (or until if that comes before the 3 or 6 month mark) depending on your doctor. It's best to be monitored while taking it (cd12 ultrasound to check for follicle # and size, cd21 bloodwork to confirm or deny ovulation, end of cycle ultrasound to verify that there are no ovarian cysts before the next cycle). Most reproductive specialists do this monitoring and many ob/gyn's do not... though some do. Clomid is a mixed bag... it slightly increases your chances of multiples but not ridiculously so. It can have some nasty side effects, but many women don't experience any side effects or only VERY mild ones.

I'm sorry that your gyno is a pr*ck. Hopefully he's pretty familiar with infertility and the treatment thereof? If not, you should probably push for a referral to a fertility specialist if you have insurance that covers it or can afford it.

I hope that helps? Good luck, hun!

~*BABY DUST*~



 
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Old Aug 24th, 2009, 05:49 AM   9
sonyabazonya
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wow! ur like a walking medical encyclopedia!!!! thank you ladies for all your replies! so meg, something you said got me thinking... im not overwheight but i do have a problem with my adrenal glands. and my motabalism is too quick bla bla bla... but my adrenal gland problem causes my body to send out too much insulin... i guess i should bring all that info with me to the gyno lol



 
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Old Aug 24th, 2009, 11:54 AM   10
Megg33k
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I would definitely take all that with you. If you make too much insulin, your body might not be able to process it quickly enough. You actually might end up with Metformin anyway to help you reduce your insulin. I don't know much about the adrenal glands' effect on other parts of the body, especially the baby making bits ... but I'm sure that it can all be sorted out when you get your appt. I would make it a point to take all info related to any current medical conditions and as much info as you can about your cycles currently. A good look at your cycles (if you know O dates and LP length) might be able to help your doc hash out what's going haywire and how to fix it. I'm not sure what the overproduction of insulin would cause on it's own... but with it being so common in women with trouble TTC... maybe there's something to it? I always just thought it was just secondary to the PCOS and wasn't technically part of the problem.. but I have never looked into it! Hmmm...

I hope you get all the answers you are seeking! I bet I spend a good bit of time scouring the internet tonight. Huge to you, hun!

~*BABY DUST*~



 
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