Frustrating first specialist appointment

[velo]

My DH and I have been TTC for almost a year now with no success. I've charted at least half of those cycles, which show I am ovulating, and our timing seems excellent the vast majority of the year. He's had a semen analysis which came back with good results. So I asked my GP for a referral and I have been waiting at least 3 months for it.

I went to see the specialist (male ob/gyn, I always feel they are less capable than women without self-experience, hehe) He suggested a day 21 progesterone test. I asked what this is for, and he said the only purpose is to confirm ovulation. I then showed him my charts but he still wanted to do the test. I don't see how you can get biphasic charts without ovulation unless the egg does not rupture, but you would still have blood progesterone. Meh whatever. I like tests so I'll play ball. (I also can usually feel ovulation now that I've been paying attention to it)

Next step he said is a HSG which has to be done after your period is over. Great, I want one of these. Except my next period will coincide with his vacation. So I'm waiting again. SIGH.

I asked what's next, and he said that's it! (unless I'm not ovulating) So frustrating. I asked about a few things and he either said that's not useful unless you are getting pg but m/c's or oh "that's now pooh-poohed". So apparently if there is good sperm, and I'm ovulating with open tubes it will be "unexplained". I asked about other hormone tests at day 3, but he said no unless I come back as not ovulating.

He said maybe after another 6 months he'd give me Clomid to which I had to refrain from rolling my eyes, because I do not want random drug experiments. If he tests something which clomid will help fix I will take it.

Anyway, any advice what to do next? I'm in Canada. All fertility testing is paid for by the health care system. I don't think there are any private testing options (not sure, maybe via a naturopath?) so my options would be trek to the US (WA state is closest) and pay someone to test what I want tested, pay a naturopath and/or TCM practitioner. I also wonder about asking for a referral to a RE. (after the HSG if its still unexplained) The nearest one I think is 2.5 hours drive. I have a reasonable amount of savings that I could use for getting pregnant but I want to use the money wisely as I'll probably also need it to live on while not working after (I hope) I give birth.

But if the RE will not do any further investigations and will just prescribe Clomid I think I'm best sticking with the ob/gyn.

Oh and he didn't do a pelvic exam since I had one at my GP three months ago. I still wonder about possibilities of cysts (which I forgot to ask about) - since maybe 5(?) years ago I had pelvic pain and had an ultrasound showing small cysts which went away. I mentioned my sister had problems conceiving and also had surgery for endometriosis (which I believe has a genetic component) but he didn't mention testing for that at all.

For those of you that have had problems diagnosed so far, which test found them?

 

[dachsundmom]

Velo, I have 'secondary unexplained infertility.' All that means is that I have had testing and no one can find anything wrong and since I had DD almost 15 years ago, the assumption is that I can get pregnant again. This is true, I just can't stay pregnant.

I had to do the CD21 tests as well, even though these should be called 7DPO tests, bc my doc said that temping can be misleading if the temper does not do it right...yeah, whatev!

I did an HSG as well, all clear...DH's last SA, good too.

I have been on Clomid and I am surprised that your doc doesn't want to rule out cysts first bc Clomid is a no-no if you have any cystic history.

I would take your tests results to the RE and see what they say; it's worth the one visit and you can decide from there.

 

[Ruth2307]

I'd ask for a scan to rule out PCO (doesn't sound as if you have the syndrome). An ultrasound one should do but an internal one is better.

 

[Indigo77]

Go to a RE....

 

[dachsundmom]

Like the new siggy!

 

[Indigo77]

Thanks!....likewise....

 

[Mon_n_john]

I would really recommend you see an RE. They are the best docs to deal with fertility issues.

 

[cupcake104]

Definitely consider seeing an RE. I saw a naturopath last year (Seattle area since you mentioned WA State) and she did several blood tests and recommended an HSG after a few months which showed that both tubes were blocked. So, even if I was ovulating (per temps), that egg and sperm would never "meet" since there was a big, fat fibroid in the way! I knew about the fibroid based on heavy cycles and annual exams with pelvic ultrasounds but didn't not the full extent of the impact. HSGs have also been known to clear any mucus or buildup that may be in the tubes, but isn't a for sure thing.

On the progesterone test, even if you ovulate, if you progesterone levels are low, implantation may not be supported and if it does, a healthy pregnancy may not be possible. So, the first approach for testing may be ok, but there are definitely other things to consider. Best of luck!

 

[StarSign]

You've gotten some great advice. I think I'd definitely ask for the referral to the RE so you can get this ball rolling sooner than later like with the HSG testing Definitely also bring up the cystic history when they start to mention Clomid.

Hope you have appointments soon!!

*SS*

 

[sarahincanada]

unfortunately unexplained infertility is just that....unexplained so rather than just have you continue unaided they usually prescribe clomid to try and boost your chances as on it you usually create more than one egg per cycle. I wouldnt call it 'random drug experiments'....many people on clomid take it as they are not ovulating but many are taking it as they are unexplained. it works for a lot of unexplained people so thats why most clinics all over the world prescribe this as a first step.

he said he would do clomid after another 6 months so assuming why he is not ruling out cysts now dachsundmom

everyone is saying go to a RA, but we dont call them that in canada so assuming this is a fertility specialist already? if you are not entirely happy perhaps you can asked to be referred to someone else? I was happy meeting my FS, although a little rushed I liked her protocol which was this:

• initial bloods tests (good), semen analysis (great), ultrasound (possible polyp)

• sono (like an hsg) to look more closely at ultrasound findings (then I had a polyp removal)

• continue trying naturally, then went onto clomid

• I sped up the process by starting IUIs as well, I figured if Im on clomid and doing monitoring already might as well spend $325 per cycle and try to boost my chances further. I want to try 3-6 IUIs before IVF. Im assuming they may try injectables for some of the IUIs depending on my lining.

My clinic doesnt do day 21 testing, they seem to rely on the bloods from the day of IUI and I do the trigger so they know I am going to ovulate. I do wonder about that as people talk about low progesterone, but its supposed to be one of the top clinics in Canada so I have to trust them (nurse said something about FS doesnt believe the progesterone talk). I will ask her about that when I see her in october (right now Im in the care of nurses for my IUIs), although she will probably roll her eyes as Im asking because Ive read it on the internet, just like your guy poo poohed some of your questions.

I just reread your post and saw you said there is a RE but a drive away, might be worth going and having a 2nd opinion...you want to be comfortable as time is not on our sides and you dont want to be messes around not doing tests etc.

good luck, hope you fall pregnant over the next few months while waiting so you dont have to deal with any of this nonsense!!

 

[sarahincanada]

Oh and he didn't do a pelvic exam since I had one at my GP three months ago. I still wonder about possibilities of cysts (which I forgot to ask about) - since maybe 5(?) years ago I had pelvic pain and had an ultrasound showing small cysts which went away. I mentioned my sister had problems conceiving and also had surgery for endometriosis (which I believe has a genetic component) but he didn't mention testing for that at all.

forgot to mention that small cysts are fairly common, I even have one now but they said its ok to go ahead with clomid and another cycle as they checked my bloods. so I assume if your bloods show something amiss he will check for cysts. same for the endo...I think they would see if you had signs of that during the hsg.

 

[velo]

forgot to mention that small cysts are fairly common, I even have one now but they said its ok to go ahead with clomid and another cycle as they checked my bloods. so I assume if your bloods show something amiss he will check for cysts. same for the endo...I think they would see if you had signs of that during the hsg.

Do you know what blood test checked that it was ok to go ahead with the clomid?

 

[velo]

Hi Sarah,
Thanks for your detailed response! As for the clomid, I was mostly upset that his testing was going to be so minimal before concluding unexplained. There are a lot more tests that could be done based on what I've read, and based on others experiences here! He didn't even want to do any day 3 bloods. The only blood test was the progesterone day 21 one. He also probably did not explain it very well either, he's like if you are already ovulating clomid can help produce a second egg. (but mentioned nothing about improving the quality of the egg)

This was an OB/GYN that my GP referred me to. No one has mentioned any other fertility specialists but googling I can find fertility clinics in the major cities. (Vancouver, Victoria) One looks like they mainly deal with IVF, the other one mentioned the full list of fertility testing they do (much more comprehensive than the ob/gyn's list!) Both mentioned paying for a consultation unless you have a referral. Hopefully if I explain to my GP that I want a more in depth opinion she could refer me.

Did the sono confirm the polyp? Can a sono confirm open tubes like a HSG can? Not sure if I should be asking for something more than the HSG. (such as ultrasound, sono, hysterscopy) I don't think the HSG can show endo.

I asked about low progesterone but the ob/gyn implied the only purpose of this test was a yes/no ovulation and couldn't really indicate that.

Yeah I'm hoping I don't have to muck around with this and will fall pg in the meantime!

unfortunately unexplained infertility is just that....unexplained so rather than just have you continue unaided they usually prescribe clomid to try and boost your chances as on it you usually create more than one egg per cycle. I wouldnt call it 'random drug experiments'....many people on clomid take it as they are not ovulating but many are taking it as they are unexplained. it works for a lot of unexplained people so thats why most clinics all over the world prescribe this as a first step.

he said he would do clomid after another 6 months so assuming why he is not ruling out cysts now dachsundmom

everyone is saying go to a RA, but we dont call them that in canada so assuming this is a fertility specialist already? if you are not entirely happy perhaps you can asked to be referred to someone else? I was happy meeting my FS, although a little rushed I liked her protocol which was this:

• initial bloods tests (good), semen analysis (great), ultrasound (possible polyp)

• sono (like an hsg) to look more closely at ultrasound findings (then I had a polyp removal)

• continue trying naturally, then went onto clomid

• I sped up the process by starting IUIs as well, I figured if Im on clomid and doing monitoring already might as well spend $325 per cycle and try to boost my chances further. I want to try 3-6 IUIs before IVF. Im assuming they may try injectables for some of the IUIs depending on my lining.

My clinic doesnt do day 21 testing, they seem to rely on the bloods from the day of IUI and I do the trigger so they know I am going to ovulate. I do wonder about that as people talk about low progesterone, but its supposed to be one of the top clinics in Canada so I have to trust them (nurse said something about FS doesnt believe the progesterone talk). I will ask her about that when I see her in october (right now Im in the care of nurses for my IUIs), although she will probably roll her eyes as Im asking because Ive read it on the internet, just like your guy poo poohed some of your questions.

I just reread your post and saw you said there is a RE but a drive away, might be worth going and having a 2nd opinion...you want to be comfortable as time is not on our sides and you dont want to be messes around not doing tests etc.

good luck, hope you fall pregnant over the next few months while waiting so you dont have to deal with any of this nonsense!!

 

[velo]

You've gotten some great advice. I think I'd definitely ask for the referral to the RE so you can get this ball rolling sooner than later like with the HSG testing Definitely also bring up the cystic history when they start to mention Clomid.

Hope you have appointments soon!!

*SS*

I'd love to get this ball rolling sooner, but I don't think there's any way I get an appt for a HSG this month with someone else - the wait for the RE is probably similar. Next cycle if I am not pregnant and job-wise it works out I am thinking of taking a 1-month honeymoon for our 1 year anniversary. (we never took a honeymoon originally) Heh maybe my brain has had that in mind before thinking to get pregnant (wouldn't want to do it while nauseous etc) and the relaxation of the trip may be what I need! But then of course that puts another month before the HSG.

 

[sarahincanada]

forgot to mention that small cysts are fairly common, I even have one now but they said its ok to go ahead with clomid and another cycle as they checked my bloods. so I assume if your bloods show something amiss he will check for cysts. same for the endo...I think they would see if you had signs of that during the hsg.

Do you know what blood test checked that it was ok to go ahead with the clomid?

she said she wanted to know my estrogen levels. I know I had about 2000 estrogen right around ovulation which is good as I had 4 follicles (they want a certain amount of estrogen per follicle). so Im assuming they wanted it low on the CD3 test as there are no mature follicles right now and if it was high perhaps the cyst was a concern and I would have to skip this cycle.

 

[sarahincanada]

Hi Sarah,
Thanks for your detailed response! As for the clomid, I was mostly upset that his testing was going to be so minimal before concluding unexplained. There are a lot more tests that could be done based on what I've read, and based on others experiences here! He didn't even want to do any day 3 bloods. The only blood test was the progesterone day 21 one. He also probably did not explain it very well either, he's like if you are already ovulating clomid can help produce a second egg. (but mentioned nothing about improving the quality of the egg)

This was an OB/GYN that my GP referred me to. No one has mentioned any other fertility specialists but googling I can find fertility clinics in the major cities. (Vancouver, Victoria) One looks like they mainly deal with IVF, the other one mentioned the full list of fertility testing they do (much more comprehensive than the ob/gyn's list!) Both mentioned paying for a consultation unless you have a referral. Hopefully if I explain to my GP that I want a more in depth opinion she could refer me.

Did the sono confirm the polyp? Can a sono confirm open tubes like a HSG can? Not sure if I should be asking for something more than the HSG. (such as ultrasound, sono, hysterscopy) I don't think the HSG can show endo.

I asked about low progesterone but the ob/gyn implied the only purpose of this test was a yes/no ovulation and couldn't really indicate that.

Yeah I'm hoping I don't have to muck around with this and will fall pg in the meantime!

hmmm day 3 bloods is important to test FSH, which is good to know at our age.

a sono and hsg is basically the same I think, one used ultrasound and one xray I think. they both have liquid inserted to check for blocked tubes. and yes they confirmed my polyp with the sono, it was like a round mass on the ultrasound.

my clinic has also told me clomid just produces more eggs, never said anything about quality but people on here seem to think it produces better quality. I have a feeling it just produces more and nothing on the quality....ive popped out 7 eggs in 2 months and they could have all been bad quality, I would have had to wait 7 months to pop those out, so I like the clomid speeds things up!

I would try and get to a clinic that has a large range of treatments and have fertility as their main priority. vancouver is bound to have a big hospital like Im going to in toronto that has a fertility section? your doctor should be able to refer you, we are at the age you dont want to wait around so why not go to the best.

 

[StarSign]

You've gotten some great advice. I think I'd definitely ask for the referral to the RE so you can get this ball rolling sooner than later like with the HSG testing Definitely also bring up the cystic history when they start to mention Clomid.

Hope you have appointments soon!!

*SS*

I'd love to get this ball rolling sooner, but I don't think there's any way I get an appt for a HSG this month with someone else - the wait for the RE is probably similar. Next cycle if I am not pregnant and job-wise it works out I am thinking of taking a 1-month honeymoon for our 1 year anniversary. (we never took a honeymoon originally) Heh maybe my brain has had that in mind before thinking to get pregnant (wouldn't want to do it while nauseous etc) and the relaxation of the trip may be what I need! But then of course that puts another month before the HSG.

Hmmm, so more waiting. Maybe you want to talk to them and find out what the appointment will entail and pose some questions beforehand so you get the most bang for the time/buck.

But, honestly, I hope you get a chance to take the trip. It'll be the perfect time to get all knocked-up. You'll be able to get relaxed and you can focus on you and DH. Take some good pre-natals along with you and leave them by your toothbrush.

*SS*

 

[asd963]

Thank you!

 

[crystal443]

I'm "unexplained" as well, we had the same testing and sadly if they all come back fine they will more then likely put you in the unexplained category and try clomid, and then its IUI or IVF. Definatley ask to have an ultrasound to rule out cysts etc. and good luck!!! I hope you get pregnant without having to worry about any diagnosis

 

[crystal443]

Hi Sarah,
Thanks for your detailed response! As for the clomid, I was mostly upset that his testing was going to be so minimal before concluding unexplained. There are a lot more tests that could be done based on what I've read, and based on others experiences here! He didn't even want to do any day 3 bloods. The only blood test was the progesterone day 21 one. He also probably did not explain it very well either, he's like if you are already ovulating clomid can help produce a second egg. (but mentioned nothing about improving the quality of the egg)

This was an OB/GYN that my GP referred me to. No one has mentioned any other fertility specialists but googling I can find fertility clinics in the major cities. (Vancouver, Victoria) One looks like they mainly deal with IVF, the other one mentioned the full list of fertility testing they do (much more comprehensive than the ob/gyn's list!) Both mentioned paying for a consultation unless you have a referral. Hopefully if I explain to my GP that I want a more in depth opinion she could refer me.

Did the sono confirm the polyp? Can a sono confirm open tubes like a HSG can? Not sure if I should be asking for something more than the HSG. (such as ultrasound, sono, hysterscopy) I don't think the HSG can show endo.

I asked about low progesterone but the ob/gyn implied the only purpose of this test was a yes/no ovulation and couldn't really indicate that.

Yeah I'm hoping I don't have to muck around with this and will fall pg in the meantime!

hmmm day 3 bloods is important to test FSH, which is good to know at our age.

a sono and hsg is basically the same I think, one used ultrasound and one xray I think. they both have liquid inserted to check for blocked tubes. and yes they confirmed my polyp with the sono, it was like a round mass on the ultrasound.

my clinic has also told me clomid just produces more eggs, never said anything about quality but people on here seem to think it produces better quality. I have a feeling it just produces more and nothing on the quality....ive popped out 7 eggs in 2 months and they could have all been bad quality, I would have had to wait 7 months to pop those out, so I like the clomid speeds things up!

I would try and get to a clinic that has a large range of treatments and have fertility as their main priority. vancouver is bound to have a big hospital like Im going to in toronto that has a fertility section? your doctor should be able to refer you, we are at the age you dont want to wait around so why not go to the best.

The only thing my doctor said about Clomid and unexplained infertility is that it would give us a boost I don't know what that means but that's what we were told. I think your right though it produces more eggs, not helps the quality