Friday, August 23, 2013

Curiouser and Curiouser

So, I had a really interesting night last night. A few weeks ago, I saw something on Facebook, I don't remember if I was a friend who had liked the page, or one of those sponsored posts that come up, but I saw information about The Missouri Center for Reproductive Medicine. Being originally from Missouri, I of course Googled it, and learned that my hometown had its own reproductive facility! I don't know if its a new clinic, or I just never realized it was there because I never had a reason to look out for it, but I was excited to learn if we ever move back, I'll have somewhere to go.

I ended up "liking" their page, and saw that they were having a free webinar last night. I signed up for it because duh, it was free, and I thought it would be nice to see what opinions another clinic has.

I get into the "meeting room" the webinar was using and learned I was the only one who signed up. What was supposed to be a general webinar about fertility all of a sudden became a one on one about my treatment. Unfortunately I was too chicken to talk to a random doctor via microphone, so I did a lot of fast typing and he responded vocally. He asked my age (24), if I had a diagnosis, (PCOS,) and what treatments we had done so far (Metformin, SA, HSG, timed intercourse for 8 cycles.)

When I mentioned that I thought our next step in treatment was IUI, he was surprised by that. He said that IUI was normally reserved for couples with male factor infertility, it wouldn't really help us if ovulation was our problem. Now, if we coupled ovulation drugs like Clomid or injectables with an IUI, he said that would make more sense. He went on to say that a Clomid or injectable cycle had about a 15% chance of conception as long as PCOS was our only problem. Adding on an IUI would increase our chances to about 16 or 17%, and some doctors argue if would increase the chances at all.

The doctor then asked about Keegan's SA numbers. Thankfully I have them written on my handy dandy blog, so I was able to give them to him quickly. He said that a total count of 23.5 million was on the low side of normal which might suggest male factor IF, but also might not, since counts vary from day to day. He said that the thing that would point to male factor infertility would be the fragmentation and morphology of the sperm. Since Keegan's morphology came back at 99%, I'm not worried, but it might be worth our time to get another SA done to see if the total count increases any.

The doctor continued to say that knowing what little he knows about us, he wouldn't suggest doing an IUI without ovulation enhancing drugs. He also suggested that if we do decide to do ovulation drugs, to get monitoring with ultrasounds because the only way to truly know if ovulation occurs is via ultrasound. OPKs and BBT can tell you if you have an LH surge, but only an ultrasound can show if ovulation actually happened.

The doctor also mentioned that all of those supplements and vitamins we take to try and increase our fertility don't really do anything, so they're not worth our time. I don't know if I fully agree with this, and I'm pretty sure a bunch of ladies who have benefited from using vitamins and supplements wouldn't either, but it was interesting to hear a doctor say that.

So, what do I do with this information? As I've stated before, my current doctor in Mississippi is wary about using ovulation enhancing drugs because with the help of Metformin, I seem to be ovulating on my own, and he is worried adding Clomid would increase our chances of multiples. Of course, I haven't gotten ultrasounds around ovulation, so I'm only going off of OPKs and my BBT as proof that I'm ovulating. The reason I suspect we'll move onto IUI next is because, from what I understand, the treatment ladder looks something like this:
  • Try naturally
  • Use ovulation drugs  
  • IUI (either naturally or with ovulation drugs) 
  • IVF
Am I missing a treatment somewhere that would naturally be our next step?

At my next appointment, do I bring up the idea that I "cheated" on my current doctor by getting a second opinion? I know I need to take the information I got last night with a grain of salt since the doctor I talked to doesn't know our medical history or all of our stats, but is it worth pressing my current doctor to use ovulation drugs?

While what the doctor tonight was saying made sense, it's only his opinion, just like not using ovulation drugs is my current doctor's opinion. I know that ultimately I need to do what I feel is the best treatment for Keegan and I, but having two conflicting opinions is super confusing.

Have any of you lovely ladies ever had two doctors give opposite treatment plans? If so, what did you do?  


  1. I think you progression of treatments is are not missing anything. I did two months of ovulation drugs (letrozole) with no IUIs just hoping it might happen...then we added 4 IUIs on top of the drugs. The risk of multiples is higher than average but still pretty low...8% I think? If you end up producing too many follicles they will actually cancel your IUI and tell you to use a barrier method while BDing because of the higher multiple risk. For me the drugs and IUIs were a headache for scheduling reasons but relatively painless and overall worth giving it a shot! Good luck deciding! And just tell your Dr. you came across a FREE web seminar...why not?

  2. I do not agree with the seminar doc that the only reason to do IUI’s is if you have MFI. I don’t ovulate on my own, so we immediately were thrown onto clomid with OPK’s. Well, it was so damn hard to read those things. I thought I was ovulating, but came across a website that mentioned u/s monitoring. On our 4th round of clomid with the OB I asked for an u/s, which is when I learned that I wasn’t growing anything on clomid. Off to the RE we went. We tried clomid, we tried femara. With each of these, we were given an u/s on CD11 to see if I was growing anything (follicles and lining). I was so thankful not to have to rely on those stupid OPK’s. I didn’t respond to either drug, so off we went to follistim. I grew three really good-looking follicles and decided to do TI to avoid multiples---BFN. Our next cycle, we grew 4 follicles, but RE said the follicles from the previous cycle looked better, so we opted for IUI. It was during that first IUI that we found out that my cervix is off-center. We asked if this could be why we didn’t get pregnant the previous cycle, and were told that it could be. We proceeded with the IUI’s—BFP! After that pregnancy ended too early, and we were ready to try again, we did follistim and IUI’s and conceived the first try. My personal thought is that if you want to give the sperm a shorter trip, you’re concerned about your cervix or CM, or hubby’s numbers are on the low-side, then you should go for the IUI. Another thing to consider is that once the sperm are in your uterus, they have to split (left tube or right tube). Since you’ve been ovulating and TI isn’t working, why not increase your odds a little bit by giving the sperm 2 targets (hopefully one on each side).

    1. Thank you for this! I thought saying IUIs were only for MFI was so strange. I totally agree with giving the sperm a shorter trip, especially since Keegan's numbers might be on the low side. I'll bring all of this up at my next doctor's appointment, assuming this cycle doesn't work.

  3. Good luck with whatever you decide to do. I don't have infertility, and we are using donor sperm (so basically no infertility issues on either side) but I am still using Letrozole and HcG and I am monitored by ultrasounds. I like to increase my chance of pregnancy as much as possible!

  4. That's interesting. Did he say at what point in the cycle you'd be getting an u/s to see if you've ovulated?

    1. I'm assuming once before ovulation (cycle days 11-17ish? you know, depending on when my body wants to get its butt in gear and pop out an egg...) and then once after an OPK/BBT said I had ovulated.

  5. Hope you are able to make a decision!!! I've never gotten more then one opinion so I don't have much to offer on this topic ;)

  6. My first RE wouldn't even discuss ovulation drugs with me. The one I saw today said that the chance of multiples is 10%, but he likes to use them because it's like getting two tries per month instead of (maybe) one, and so you have a better chance of a pregnancy. He said when he uses them they do the u/s and give a trigger shot if necessary, and that way couples know when to have sex right on the money.

    It all made a LOT of sense to me, and my next step if metformin alone doesn't cause ovulation, is letrozole and good old fashioned doin' it with the husband :)

    Good luck! And if you don't want to admit to "cheating"? Say you have a friend or goggled it ;)

  7. I've had two doctors give me different diagnosis before. It's confusing and can sometimes lead to catastrophes if you're not careful.

    I will say this: If you're not comfortable with directly speaking to a doctor, you don't trust him enough to follow his orders. It's as simple as that.

  8. I think it's great you got a second opinion, even though it's left you a little confused. There's nothing wrong with taking the information to your doctor. Tell him you attended a seminar and want to know if ovulation drugs would help. At the very least, you should clarify what your doctor thinks your next step should be and why. Not everyone goes through the same steps; it all depends on your situation.

  9. Hi from ICLW! I also think it might be a good idea to share the other opinion with your doctor. Maybe then he would also motivate his recommendations better.

  10. did new doctor mention which drugs?! drugs worked for us before switching to IUI!
    ah i dont know dear - its all such a crazy blur.
    i hope an answer finds its way to you!