Should I get a new doctor/clinic?

Regan

Sorry in advance for the long post, but I was hoping for some advice.

I've purchased donor sperm, and have been ttc through IUI over the last 6 months. This is my third round of attempts, earlier losses included an ectopic pregnancy and 2 miscarriages (through natural conception). IUI has never worked, I think this is attempt #5. I'm grateful to have excellent health coverage, including for IVF, with low copays. I have two vials left at the doctor's office.

I know it can take time, IUI isn't always successful, etc, but I'm having some difficulties feeling secure with my doctor. First round was drug-free, using OPK kits, negative. Then we tried the next month, and realized the OPK's were too late, through ultrasound and I had already ovulated. So, then we bumped up efforts and tried Clomid with an injection of Ovidrel. One follicle, but we went anyway, and had a difficult IUI procedure, she couldn't seem to "find" the right spot to thread the catheter, I think I've been told I had an inverted cervix before, but it didn't go well, and of course, didn't work.

Last month, she increased Clomid hoping for more follicules, and I ended up with cysts on both ovaries (not sure what large would be considered, but they are causing a lot of pain). I'm now on Provera for ten days, since I haven't started my period. The plan was to get a baseline ultrasound when my period started to make sure the cysts were gone, then increase the Clomid. I'm also on a regiment of Estrace with the Clomid, then I use the Ovidrel, then take Lovenox and Endometrin post insemenation (with a baby aspirin).

I'm using the local OB/GYN office for this, that is known as the "Area's leading treatment for infertility", but the MD following my care (the NP does the inseminations) is not a reproductive endocrinologist. When I expressed my frustration with all that is going wrong, I was reassured by the staff, who explained that they usually try locally for 3 months, then send me to Syracuse for the fertility "specialist", and possible IVF. I've been wanting to stick it out locally for convenience, and because I have 2 vials stored here for IUI (I haven't found an IVF donor, yet).

At what point do you insist on them "throwing everything at you", and insist on injectibles, are they really that much more effective than pills? I'm ok with injecting myself (I'm actually a nurse, but I obviously don't work anywhere near maternity!) and have the insurance coverage, I just feel the doctors are not being aggressive enough (perhaps because I am 35 and have insurance) and I want to be pregnant already!

That's my story, those are my concerns, and I would appreciate any advice, especially if anyone in the New York area has used Syracuse, I'm not even sure of the name of the clinic! Good luck with all these wonderful journeys...

~Regan (Really hoping the Provera works soon and I can begin another cycle this month)

Cmartin6706

This is what my wife told me to tell you when I read her your posting...

"You totally need to write her back right now! She needs to get right over to our clinic because they are amazing!!"

My wife is 28, male infertility, so we are using donor sperm. 5/26 was our first IUI. She did CD3-7 with Clomid, multiple ultrasounds to get a baseline and then to do a follicle check (we only needed one check as we had a 19mm and a 12mm), then we did the trigger shot that night, followed by the IUI the next morning. She is now on progesterone suppositories starting this past Sunday. We aren't sure yet, but we think we are pregnant as she is having symptoms and we tested last night and the trigger shot is out of her system already.

Our doctor told us "back when donor sperm cost $50 a vial (they) would do unmedicated cycles, but now that sperm costs $500 a vial (they) start right out with Clomid, the trigger shot and monitoring to maximize chances of pregnancy."

We see Dr. Massey at CNY Fertility Center in Syracuse.

tillie

I think your doctor's approach sounds right in line with what the normal protocols are and your experience sounds not at all uncommon. I go to Shady Grove and they have never said we go right to Clomid because donor sperm is so expensive. Your doctor probably will be as aggressive as you demand they be, but I think them proceeding in the way they have so far is right with the usual protocol for a 35 yr old. I think what we all do not want to deal with (including me very much so) is that this is not an exact science, that getting pregnant is not a one time and done guarantee with any approach, and that it often takes exploration and attempting differing approaches and trial and error and guesswork and $$ "wasting". Everyone wants to say hey do this it worked for me on the first time, but just a caution that everyone is different and luck is involved here. If we followed here's what worked for me, we'd all still be going in 100 million different directions and those methods would not be more likely to work for us. Personally, I find it very challenging/frustrating deciding how aggressive to be. I want to do the least invasive/expensive and get pregnant using natural IUI but when several of those don't work and that cost a pretty penny I'm thinking damn that was the wrong decision. But, then again, had it worked it would have been the perfect decision. That being said, I wouldn't judge another doctor or patient (like Chris and his wife) going right to meds or injectibles or IVF, and I think it is 50/50 on whether doctors will start you there. Though I think it is rare for a 35 and under to be started there! And some doctors would refuse to do this, especially where there have been no isolated female issue that would necessitate the use of Clomid etc.

Even though I think your protocol so far sounds exactly like what Shady Grove does, I think you may be better going to an RE nonetheless.

Good luck Chris and wife! If I've learned anything - and everyone on this board can attest - do not go reading into any "signs" during the 2WW and certainly not in the first 8 days. However, if you get a positive pregnancy test, well, that's different and wonderful and big congrats to you!

tillie

tillie wrote:

I think your doctor's approach sounds right in line with what the normal protocols are and your experience sounds not at all uncommon. I go to Shady Grove and they have never said we go right to Clomid because donor sperm is so expensive. Your doctor probably will be as aggressive as you demand they be, but I think them proceeding in the way they have so far is right with the usual protocol for a 35 yr old. I think what we all do not want to deal with (including me very much so) is that this is not an exact science, that getting pregnant is not a one time and done guarantee with any approach, and that it often takes exploration and attempting differing approaches and trial and error and guesswork and $$ "wasting". Everyone wants to say hey do this it worked for me on the first time, but just a caution that everyone is different and luck is involved here. If we followed here's what worked for me, we'd all still be going in 100 million different directions and those methods would not be more likely to work for us. Personally, I find it very challenging/frustrating deciding how aggressive to be. I want to do the least invasive/expensive and get pregnant using natural IUI but when several of those don't work and that cost a pretty penny I'm thinking damn that was the wrong decision. But, then again, had it worked it would have been the perfect decision. That being said, I wouldn't judge another doctor or patient (like Chris and his wife) going right to meds or injectibles or IVF, and I think it is 50/50 on whether doctors will start you there. Though I think it is rare for a 35 and under to be started there! And some doctors would refuse to do this, especially where there have been no isolated female issue that would necessitate the use of Clomid etc.

Even though I think your protocol so far sounds exactly like what Shady Grove does, I think you may be better going to an RE nonetheless.

Good luck Chris and wife! If I've learned anything - and everyone on this board can attest - do not go reading into any "signs" during the 2WW and certainly not in the first 8 days. However, if you get a positive pregnancy test, well, that's different and wonderful and big congrats to you!

By the way, to confirm what I said before about the frustration, I am currently second-guessing my approach of several natural IUIs and wondering not if I should have started with Clomid but if I should have started with monitoring (at a great added cost). But I'm just 2nd guessing because I was unsuccessful. My friend who got prego on the first natural cycle IUI with no bells and whistles beyond donor sperm and an OPK is not 2nd guessing taking the same approach! I think how good people think their RE is, how good your sperm bank is, etc. is sometimes dependent upon if there is success. But not always. Sounds like Chris and his wife just have a winner of a clinic for them success or not. I hope I feel the same about my clinic but I am sure I'll be colored by how long it takes for me to have success and how much $ I spent getting there!

Regan

Thank you so much for the replys, and it's so great to hear something positive about CNY. I can't say I'm any less frustrated, ten days on Provera, and still no cycle due to these cysts from Clomid. I guess now I'm looking at either another ten days on Provera, or a month on birth control pills, which I've never taken before. We'll see what the doctor says tomorrow.
I think I'm pretty much stuck finishing up my last two IUI cycles here, and will just continue to hope. Hope for a less painful IUI procedure, hope for the "right" doses of hormones and the perfect mix of timing for those follicules. Every day I am reminded what a miracle having a child is, I hope I never lose that gratitude and feeling, no matter what the challenges of motherhood brings me.
Best wishes to all,
~Regan

Angel&Deb

Hi. I think that you would feel much more secure at CNY Fertility in Syracuse. I just started going there (first IUI will be next month) and have been very happy thus far. I have found them very aggressive in their treatment with a focus on getting us pregnant ASAP. For example, I am 30 years old and have no known fertility issues except for the lack of sperm (we're lesbians) and they recommended me for Clomid and trigger shot straight out of the gate. They also did a full battery of tests including HSG just to be sure. I feel that they have a lot riding on getting people pregnant as soon as possible because their reputation depends on it rather than a regular GYN that might not be so focused. Also ,everything that I have read on hormones and what I know about people receiving hormone treatments makes me think that only an endocrinologist should be prescribing and monitoring this stuff. I really hope that things work out for you and hope that if you find your way to CNY Fertility you will have a positive experience as I have.

Regan

Just wanted to say that all these positive replies about CNY swayed me to make a decision, I have an intake appointment on August 1. I still have the two specimens locally, although still seem to be "on hold" due to the cysts and no cycle, but will keep going this route, if I do happen to get a cycle and have follicles. Otherwise, it hopefully won't be a difficult task to transfer the specimens remaining here to Syracuse.
Thanks again so much for the positive words, and advice, this is such a long and frustrating journey!
~Regan

tinymouthwash

Thanks for bringing this up, it was exactly what I was going to ask! Just did our first IUI with only a trigger shot and got a BFN this morning. I've cried my eyes out, but now I'm absolutely resolved to starting Clomid. The only problem is that I'm a medical student getting ready to start rotations and I'm nervous as heck about being on Clomid! Good luck, everyone!

moewhit

tinymouthwash wrote:

Thanks for bringing this up, it was exactly what I was going to ask! Just did our first IUI with only a trigger shot and got a BFN this morning. I've cried my eyes out, but now I'm absolutely resolved to starting Clomid. The only problem is that I'm a medical student getting ready to start rotations and I'm nervous as heck about being on Clomid! Good luck, everyone!

Depending on the dose and how sensitive you are to getting PMS, will usually determine how you will be on Clomid. When I was on 100 mg I had wicked PMS symptoms, moody, bloated, gassy, forgetful, night sweats, and crampy. But on 50 mg I really only had night sweats, it really wasn't bad. So I'm not sure why you're thinking this will affect you being a student on rotations. If you have side effects they are gone pretty much a week or so after you take the last pill.

Good luck!

Regan

Just an update, while waiting for my appt at CNY, I am still moving forward at the local office. Up to 150mg of Clomid this month, and yesterday, my follicles were small. I'm going in on Monday to remeasure, but it looks like I have one on both sides.
Keeping fingers crossed, but debating not even trying at all, and holding on to the last two specimens we have.
Decisions, decisions....
Good luck to all!

Regan

And CNY had a cancellation! I'm heading up today, and maybe can get an opinion on thsi cycle, since I only have one follicle that is only 16mm. We were so torn with what to do, so I'm so grateful to be getting this consultation appointment!
Here's hoping for a lot of BFP today!
~Regan

Cmartin6706

So exciting that they had a cancellation and you got in! GL!!

Regan

I am now in love with CNY! After the initial visit, I wasn't so sure, but I met Dr. Kilz today for an Hsg, and he was amazing! Unfortunately, I have both tubes blocked, but we were going to do IVF now, anyway! I do have a small pollup, so need a hysteroscopy first, but I can have that next Wednesday, and still try for my first IVF next month. The drugs are on order, and we are very excited.

I don't know if I would have been more aggressive personally if I hadn't read this forum, all the topics and stories, and asked the questions and received such great feedback. Not that I received any level of poor care, but I did have 5 cycles of IUI (didn't always get inseminated, but used medications and TRIED for 5 months), used two specimens, etc, without any hope of getting pregnant.

But we are moving forward! I did have another questions (well, about a billion), but has anyone ever heard of using a "scraping" of a sample? I got a cooler of dry ice and drove the IUI specimens stored locally at my MD office up to CNY, and they said they could unthaw them. Due to the preparation and the small number of sperm used for IVF, they mentioned thawing one of the specimens entirely, or only using a "scraping". Just wondering if anyone has ever come across this procedure.

Thanks again for the words of encouragement, and wisdom, not to mention experience! And I am so thrilled to see all the happy BFP's being posted lately, congratulations everyone! I hope I have the same good news in 6 weeks... 8-)

~Regan