First Gyn Appointment for TTC-Obese

[Ursaula]

Hello gals!

History- Started bcp 6 years ago and I haven't had af since I started bcp. Off bcp Nov. 2013, still no af. Diagnosed PCOS Jan. 2014. Started using ff June 2015, currently on cd315. Started Metformin Nov. 2015. Healthy ovaries/uterus, no cysts, perfect bloods as of Jan. 2016.

I have my first appointment with a gynaecologist this Tuesday to discuss fertility issues. I'm super nervous! I am considered "morbidly obese". I guess I have a few questions with what to expect...

Questions:
-What will happen at the first appointment?
-Will she turn me away because I am "morbidly obese"?
-Will she turn me away because I don't have a job? (Long story.)

I have waited since June 2015 for this appointment so I want to make the most of it! If anyone can answer my questions, or has any advice, that would be awesome! (I live in Canada)

 

[Aayla]

I am in Canada too. I am in BC. I am also morbidly obese.

Your doc may say no to you. Some docs and all fertility clinics have a bmi limit. Mine has a limit of 45 but even that one has my doc was pushing it. Ideally they want a bmi under 40 for basic stuff like clomid or letrozole. Under 35 for IUI and under 30 for IVF. The College of doctors has stated that IVF cannot be performed on a patient with a bmi greater than 30 outside of a hospital. The shitty thing is that hospitals don't do IVF, only private clinics do.

You not having a job shouldn't mean anything. If you don't have extra medical and you can pay for any additional things not covered by our basic medical all is good.

Back to the weight issue. I highly suggest you go on a low carb diet. Get rid of all wheat and gluten products. It really goes against PCOS and I can't believe how awesome I feel when I get rid of these things. I know how hard it is. Trust me. I love bread and carbs but you have to pick what is important to you. A baby or a hamburger. and to be totally, bluntly honest with you..there are days I have chosen the hamburger. Food addiction is hard.

but in the end you also need to understand why they may turn you away. Most fertility drugs are fat soluble. Meaning they get absorbed into our fat and don't do what they are supposed to do. Clomid is like this. Letrozole not as much and has a track record of being better for obese/overweight women.

if you need to go beyond just pills it can be more difficult to perform the procedures. Fat moves our organs from where they are supposed to be and it is an extra layer they have to get through. So if they have to harvest your eggs for IVF, not only is your uterus not quite in the right spot but they have this layer of fat they have to get through. It makes their job incredibly more difficult.

Some docs don't want to do anything with obese women because of the complications our weight can have on a pregnancy. some just don't want to deal with it. Mine is great in the fact that he knows I know gestational diabetes is very likely going to be a thing with me and we will deal with it if it happens.

But if your current doc says no then find someone who will say yes. Or at least will put you on letrozole while you lose weight (assuming you will try).

 

[Ursaula]

Aayla thank you so much for giving me some information!

I'm in the process of trying to get on clomid or something similar, no IUI or IVF (fx'd never!). With the information you gave me I'll have to lose about 100lbs before I will be able to start clomid, as I have a bmi of 58-59%.

I took your advice on the low-carb diet. I really have to focus on saying "Hamburger or baby?" to myself to get me to stop. It's working so far, I started it today. I've always been a food addict, so I find asking myself which I want more helps a lot. I also looked into physical trainers but will wait until tomorrow morning at my appointment before contacting any of them. Fx'd!! And thanks again!!

 

[Aayla]

My bmi is about 55 right now. I need to get it back down to 45 ideally. I have a prescription for letrozole with 2 more months left on my refill and one month with me right now. So right now they can't stop me but they may not give me a new prescription in 3 months. But our plan is to do 3 more months of timed sex and if that doesn't work go on to IUI. So I have some work to do in the weight loss area.

If you want to be buddies I will be more than happy to help out. Even if it is just someone to vent to. It can be nice to be able to vent to someone that understands the desire to eat.

Let me know how your doc appt goes. You never know what they will say. They may say yes. But I do advise to go for Letrozole. Less side effects.

 

[MrsBarrowman]

Hey ladies, sorry to butt into the conversation, but I too have struggled with my weight, until I found a diet that actually worked for me, its Low Carb, High Fat, I know it sounds silly having high fat seeing as that's what we are all trying to get rid of...

The link for the website to have a read is https://www.dietdoctor.com/low-carb#theory

While on this diet I lost 12KG within 2 months, also I now find myself 26 weeks pregnant with no complications and no medication intervention...

 

[Aayla]

Ursaula: how did your appt go?

 

[Ursaula]

Yay buddies! And thanks MrsBarrowman!

My gynaecologist appointment went super well! She said I need to lose weight but she said she will help me anyway because I probably already know that. So, with that said, I have been started on Provera 10mg, today was my first day taking it. On my third day of bleeding I will do some tests and I see her again on June 2. June 2 we will discuss our next move. She mentioned being sent to a fertility specialist for IUI or IVF but we will try a few options first. I'm hoping clomid, as I've heard Metformin and Clomid work well together, fx'd this all works!

What are you trying for your current cycle, Aayla?

 

[Aayla]

That is so great she is going to help you. Having a doc that will work with you as you try to lose weight is awesome.

a bit of backstory for myself: I had a condition called uterine hyperplasia with atypia. This is a thickening of the lining of the uterus and with it being atypical, causes abnormal cell clusters to grow, giving me a 30% chance of getting uterine cancer. It is treated with high progesterone. The issue with this is that progesterone makes me crazy and near bipolar. We were going to take a bit of a break from TTC and because of my past issue whenever I am not TTC I have to be on provera but it got to be too much this time and it started to affect my marriage. So I went off of it and had to get a biopsy done to be sure the hyperplasia hasn't come back. My original gyno said that as long as I was ovulating and ideally got pregnant (which I have but that ended in a mc at 5 weeks back in Aug), then it shouldn't come back.

So now I am on provera again to induce another cycle early. I am waiting to hear back from the doc about the biopsy I had. He expected good news. If it is I stop taking the provera and go back on Letrozole starting day 3 of my bleed. Then I use OPK's from day 10 and on we do it like bunnies! lol

 

[Ursaula]

How long do you find you take Provera before you start bleeding? I'm on my fourth pill today and feel like when I wipe I see a tinge.

Also, did you hear back from your doctor in regards to the biopsy?

 

[Ursaula]

I also purchased some OPKs from online and expect to get them April 29 (hoping). Then as soon as this bleed happens I can start counting and doing OPKs!

 

[Aayla]

Usually I have to take it 7 days and then about 2-3 days later I start to see spotting. but some people do get it before their pills are done. If you are seeing pink when you wipe, stop the pills, it's coming.

I did hear back, i can't believe I didn't update. Great news. It is all clear. I am good to go!! So I took my last pill on thursday. Now I am just waiting. it may or may not work for me so soon because I just had a bleed 17 days ago. So I am not sure if one will happen or it may take longer to get here. but I have had some cramping today so I think she is on her way.

I got the clear blue digi opk's with smiley face. I tried the cheapies and while they work just fine I hated trying to distinguish if the line was as dark or darker than. A smiley face is just so much more clear. lol

If af arrives within the next day or two then I will be ovulating around my birthday. Super excited about that!

 

[Ursaula]

Thanks for the info!

Yay! I bet you're so excited! Has af arrived yet??

 

[Aayla]

I had some spotting last night. I'm worried it won't come in full because i read if your lining is thin provera won't work and I did just have a bleed 20 days ago. But the spotting has got my hopes up. If it doesn't happen in the next couple of days I am just going to start my pills. I can't wait for my usual cycle end of 35 days and I refuse to go back on the provera. It makes me crazy and I am not a nice person on it.

 

[Ursaula]

I'm finding the provera is making me really lightheaded. I hope it's worth it though! Only 6 days left of it. Will progesterone once do the trick to get my cycles normal? Or will I need it every month?

 

[Aayla]

I have found that when I am on letrozole my cycles become normal and that is because I am ovulating. So once you start ovulating they should become normal. They may be long, mine are 35 days, but still like clockwork. It is only when I am not on letrozole that I don't have them on time.

The provera can have nasty side effects. My worst was my moods. I became bipolar and very nasty. Hubby and I had to devise a system where he was able to tell me that I was going too far or being unreasonable. It was a little anger emoji when typing. And I actually would catch myself and yell out Anger Emoji. then he would know to back off and that I am fighting for no reason and I know it.

Hopefully you don't see that side of it. It is rare though. I was unlucky

 

[Aayla]

Oh I started my letrozole today! I start opk's on Ma 5th. So excited to be starting.

 

[Ursaula]

Does your letrozole have any side effects?

I'm pretty sure I ovulated two days ago! I'll find out with my temperature tomorrow if ff pinpoints it. I also received my wondfo opk and hpt. S/o and I were alone the past few days so we managed 5 days prior to ovulation and the day of ovulation...fx'd!

 

[Aayla]

Thankfully no side effects at all! I did an experiment though. So with clomid you can't drink any alocohol while taking it. and I mean when you are going through cd 3-7 and actually taking the pills. My sister found out the hard way. She had 2 beer and felt hung over for 5 days.

Even though this isn't clomid I decided not to risk it and every month since last May never had any alcohol while taking the pills.

Well last night we had a bbq and I really wanted one drink. I'm long past the age of getting drunk on purpose. We googled to see if there were any warnings on drinking but nothing came up. But today..oh my god..I have a migraine so huge and I feel like I have been hit by a truck. So while there is no warning about it..don't drink while taking it. ugh. not worth this feeling.

Congrats on ovulating. It sounds like you timed bd pretty well. FX for you!! Will you be testing early or waiting for af to show up?


AFM: I am on cd 6. 2 more days of pills. and I'm excited to start peeing on a stick in 4 days. lol

 

[Ursaula]

Note to self: Don't drink! Your day sounds awful with that migraine though. I'm super excited for you! Hoping this works

Depending on my BBT temp tomorrow, ff should be putting up those ovulation markers. I read that provera progesterone can stop ovulation though. Is it possible to conceive while taking provera progesterone to bring on a cycle?

To answer you question, af can arrive anytime between this weekend and May 16/May 17. If I did ovulate, I would be 14dpo on May 13. I'll probably start testing with HPT on May 9 (10dpo), May 11 (12dpo), and then May 13 (14dpo). Unless I can't control myself and poas every day like usual. If I don't get a BFP or af by May 13, I'll hopefully be able to wait until May 17 for af. If no af, I'll test again and so on

I also plan to start using OPKs on cd10 if I end up having af. Fx'd for us!

 

[Aayla]

I haven't heard of anyone conceiving on it. The likelihood is that it is acting like BC but without all the estrogen. It doesn't always hinder ovulation but I am pretty sure that is the norm.

You should get an af bleed about 3 days after stopping it. So if your last pill is on wednesday you should get a period by Saturday. but it can take up to 2 weeks but I find that you haven't had one in awhile then it comes pretty quickly.

I would probably consider yourself out this cycle as you likely didn't ovulate while on provera. And if you did there likely won't be time for anything to attach as af will be starting around the time that implantation would happen. BUT if you don't get one in 2 weeks time, take a test.

My day did get better. After awhile from taking my letrozole first thing I took some pain meds and that made it all better. but I will never drink again while on it. One more day to go on the pills!