Sunday, October 20, 2013

Under New Management - Part 1

I did it. I actually switched REs, switched hospital systems, converted to the dark side. It would probably be a big deal for most for people, but for me especially because a) I consider myself a pretty loyal person and this feels disloyalty (I know I shouldn't see it this way, but I do) and b) I am employed by the hospital that housed my former RE and the hospital system that houses the new RE is our city's biggest rival [and now that I think of it, maybe this is where the disloyalty is]. So here's how it all shook out:

Back in the spring, when I was originally referred to a reproductive specialist from my OBGN, I had consultations with two different people, at the two different hospital systems. I probably wouldn't have done this in the first place, but my OBGYN, who practices independently but is affiliated with my hospital system (we'll call it CC), strongly recommended against the fertility center at CC and gave me a few names of people at UH (the competing hospital). So I met with both of them within a week and my first impressions were that both were very knowledgable and both presented relatively similar options of plans from the start. However, Dr. P from UH generally had a better bedside manor and presented the plan as "your options are A, B, C, or D, depending on how conservative/aggressive you want to be," whereas Dr. F from CC was much more systematic and presented the plan as "First you would do A, if that didn't work we would move on to B, and I'm confident you won't need to get to D".

At that point, the idea of someone giving me a clear direction was reassuring and I felt like there would be a benefit to keeping all of my medical services in the same hospital system (e.g. shared medical record, potential for some special "colleague to colleague treatment") so I chose Dr. F/CC, even though I had a better overall impression with Dr. P/UH. I should say that my insurance doesn't pay for anything after the diagnostics, so everything would be out-of-pocket and insurance converage didn't really factor into my decision.

Fast forward 4 months... I've had really long cycles so I've only gone through three actual cycles. We re-did 100mg Clomid because my progesterone levels suggested I ovulated on the first try of this dose, but at my ultra-sound on Day 12, nothing was growing. They had me come back, just to make sure, and alas I was not responding. So I had a wait while, start Provera, get period, and move on to 150mg. Repeat. This time they only had come in once and they gave up after I showed minimal growth. On to 200mg, which they said would be the highest they would go. Repeat. This time (this past cycle), I went in for monitoring on Day 12 and just like all the other times, I had a crap-ton of little follicles, but none of them were very big. The nurse on that day mentioned that I might be able to move right onto a new drug without inducing my period (great news since it's now October and I haven't ovulated in 4 months and I have super long cycles). But then after consulting with Drs, they wanted me to come back again, "just to make sure" because they wanted to be positive before moving on to a different plan.

I should mention that I keep saying "they" because at CC they work in a team approach so all the Drs in the practice rotate during the afternoon meetings to review all the blood-work/ultra-sounds from the morning so it's not typically your Dr that's actually reviewing your data. So with this plan I called Dr. F directly to make sure this is really what he wanted, because a) this is not what they did last cycle, b) I'm paying for all of these visits out of pocket and would prefer not to have multiple visits just to be told repeatedly that nothing is happening, and c) I want to move on to the next thing already! I talked with his nurse who told me that he says "Sure, why not, it won't hurt" [I'm paraphrasing] and then also mentioned that I've gained some weight and should really work on this and see the endocrinologist and even suggested I take a 6-12 month break from trying to conceive to work on losing weight! (see this post for all my thoughts on this). So like a good little patient, I saw the endocrinologist, saw a nutritionist, and when in for a second ultra-sound a few days later.

Ultra-sound #2 was, surprise-surprise, also a bust. I was thinking, "great, now we can finally move on!"  BUT, then the nurse called me at the end of the day to say that the Drs wanted me to come back AGAIN because a) they want to "give me one last chance" and b) if I come on this certain day, Dr. F will actually we be there see the results. So do I get a refund for the other U/Ss that weren't reviewed by him and were basically just a waste? The emotional toll of being repeatedly told that nothing was happening is not cool. 

For this final ultra sound, I was over it. Things still weren't progressing. The nurse told me that my likely options were to try Femera for a couple rounds (which sounded eerily similar to my experiences with Clomid) or move directly on to injectables. I thought about these options all day, thinking that I am mostly over the whole oral medication thing. Then the nurse called in the afternoon as said that I didn't actually have two options, that Dr. F wanted to just start with the lowest dose of Femera (2.5mg, even though I've read that most people start with 5mg) and then try the other higher doses after this if I don't respond. Basically, the same thing we've been doing that's taken so long, only with a different medicine. I was not enthused.

I thought about this for a week or so while I took Provera and waiting for my period to arrive. Then, after it had been 10 days since finishing Provera and I started to get antsy because they said I should bleed within a week, I called the office. I again talked to the nurse and she said that for some people it can take much longer and I should continue to be patient. I explained all of my frustrations with this past cycle specifically, how much time and money has gone on without any progress, and how I'm mostly over oral medications. I said that I would like to try just one month of Femera, at 5mg not 2.5mg, and then move right along if it doesn't work. She relayed this frustration and my preferences for the plan to Dr. F. His response (she read it to me from the chart): "5mg isn't necessarily better than 2.5mg. The plan will be start with 2.5, then 5, then 7.5, and then we'll talk about the next plan." As in, completely ignoring/discounting my frustration and desires!

This was Wednesday evening, and the day I started seriously considering contacting UH be continued...


  1. Glad you made the move to a new RE if you weren't happy at the older one. I am currently awaiting the results of my last IUI at my RE before making a decision to move to another RE as well. Hopefully the new RE will have better insight and more to offer and ultimately give you guys the best shot towards TTC.

  2. I think changing RE's sounds like a good plan, especially since they are moving you up so slowly and you're having to pay so much out of pocket. My RE didn't see a lot of progress with Clomid and we immediately went into injectibles (fairly high levels at that). I think that they should allow you some say in the matter and if you want to be more aggressive, than they should let you, as long as you're being monitored.
    Happy ICLW!

  3. I'm glad you did what you felt what was best for you. I think I would've switched, too, especially considering all the extra visits. That's very frustrating if you're paying out-of-pocket. Best wishes!

  4. That's so frustrating. I am glad you are switching. When that much money is involved, you need the best that your money can buy. No bs :)