Going to my OB/GYN on Monday (Jan 3rd)

iVillage Member
Registered: 06-27-2006
Going to my OB/GYN on Monday (Jan 3rd)
15
Thu, 12-30-2010 - 9:13am

I need to start formulating my list of questions.

I want to ask about progesterone supplements (because of my low progesterone levels from my blood draw two cycles ago). I also want to bring up Clomid, since he mentioned it in passing at my appointment with him back in August.

Do any of you think there might be a connection with poor ovulation (making Clomid more of a viable option) and my OPKs that I tend to get a "very close to +" result for about 2 or 3 hours and then it goes back to negative? This cycle, I had my fade in and the day that it got darker, I took an OPK every few hours to see what would happen and I only got one "very close to the control line darkness" and then a couple hours later, I tested again to see if it would darken even more and it actually was an almost non-existant test line. So, should I bring THAT up to the doctor? He didn't ask me to do OPK's, but I figure that they can't hurt anything and if it's additional knowledge, it might help, right?

I also want to bring up the possibility of endometriosis again. We briefly discussed that back in August, too. I have had history of unexplained abdominal pain, but it's not every single month.

The nurse I've been working with also told me that I should be reiterating my D&C story about my uterus not shrinking back to size, the bleeding that continued for weeks, and the "blood clots" they saw on the ultrasound, along with the meds I was given that caused horrible side effects.

Is there anything else I should be asking about? A friend of mine suggested that I ask about MTHFR. I don't even know whether that's something even worth asking about? I have had blood testing for all sorts of clotting disorders, thyroid, and auto-immune disorders which all have come back negative. So, I'm not sure whether MTHFR would be worth checking out?

What else should I ask about?

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iVillage Member
Registered: 05-04-2006
Thu, 12-30-2010 - 9:39am

Hey Tee!

iVillage Member
Registered: 07-28-2009
Thu, 12-30-2010 - 10:00am

Okay, here are my thoughts.

First of all, I like what Aubre said. He needs to treat you as a new patient and look at all your information as if it's the first time he's ever seen it. I am going to have to ask my RE to do the same with me next week. I have been his patient for years and I feel like we have been tweaking the same plan, but at this point I would like to wipe the slate clean and start from scratch.

Secondly, don't feel like there are questions worth and not worth asking. If you have a question and you want to know the answer, ASK!!! Don't worry about feeling dumb - that is what they are paid (and a LOT) to do!

So about your OPK question. I don't think that is anything to worry about. OPK's cannot be read as a whole series. They just don't work like that. You have to look at each one individually. Your LH fluctuates a lot during the course of a day so it's very common to take one now and have it be almost + and then take one two hours from now and see no line at all. That is not indicative of a problem at all BUT like I said, if it makes you feel better to ask, then by all means! Ask!

As far as the MTHFR goes, I would mention it. It sounds like they probably already tested you for it while doing all the other clotting type tests but I would make sure if I were you.

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iVillage Member
Registered: 05-12-2008
Thu, 12-30-2010 - 12:23pm

Looks like Aubre and Michelle covered all the things I would suggest and more, so I just wanted to say good luck!

iVillage Member
Registered: 06-27-2006
Thu, 12-30-2010 - 12:40pm
Thanks, Aubre! This is only the 2nd time I'll be seeing this doctor (I switched doctors after my miscarriage), so most of what he'll be seeing is "new" to him. He's only seen my records from the previous doctor once before. When I saw him in August, he did put me on baby aspirin just to see if it would help.

Should I be asking for a glucose test? Is that what they use to test for insulin resistance? I don't seem to have polycystic ovaries, but could that be a test that might be helpful, despite that? I have seen other women here talking about other symptoms of PCOS being acne and facial hair and I DO have that. Of course, I don't grow like a beard, but I know I have to pluck them from my chin and neck almost constantly. My Testosterone levels were "normal", which is what I was thinking could have been out of whack with those symptoms, but maybe it's not that? Maybe it's something else? Should I be asking about those? I didn't know those could be a factor to some hormone imbalance? I thought those were just hereditary, since my mom is the same way.

I'll definitely ask what tests we should start with and what we should do to give a better picture than the previous doctor's office had.

Thanks!
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iVillage Member
Registered: 06-27-2006
Thu, 12-30-2010 - 12:50pm
Thanks, Michelle! I appreciate your input. I don't think that MTHFR was tested for before with my clotting bloodwork. I know I was tested for Anti-Cardiolipin Antibodies, Anti-Phospholipid Antibodies, Thrombo-something-or-other, and Factor V Leiden, I didn't see anything in the lab script that specifically said anything that looked like it could have stood for MTHFR, but maybe that's what that Thrombo-thing was for?

Also, I know that you've been through the financial aspect of things. How would I approach the doctor about coding things so that when they go to insurance, I don't have to go through this whole rigamarole with insurance not wanting to cover it until they get office notes and reasoning WHY the appointment or tests are done and then having to resubmit things. I feel like I spend my days on the phone between a billing office and insurance with regard to anything infertility testing or consult-wise. Insurance will cover consults and testing, but not treatment. But, I know I went through this last January with insurance not wanting to cover a consult visit because the doctor didn't specifically put in the notes that it was a TESTING consult. They assumed it was a TREATMENT session. I felt like knocking someone over the head and saying that it would be a freaking MIRACLE if we went into a doctor's office and had a sit-down discussion with a doctor and that magically made my fertility problems go away and made me pregnant. LOL! Is there any way to approach that with the doctor? Best things to say to him?

As for the OPK's, you're saying that it CAN be perfectly normal to only hit a surge on one day and if you miss the surge by a couple hours, you might never get your +OPK? After that almost + test, I never got another one. Later that day and the next two days, I had negative OPK's and my CM dried up (not that there's much there to begin with)

I know I have a million and one questions. I just am so lost and asking the questions helps me feel less anxious about what I should be discussing going in. I'm a planner and I need to know what I need to talk about before I go in somewhere. Otherwise I freeze up and don't know what to say. LOL!

Thanks for your input!
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iVillage Member
Registered: 06-27-2006
Thu, 12-30-2010 - 12:50pm
Thanks Dustie!!! I'll take all the luck I can get!
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iVillage Member
Registered: 07-28-2009
Thu, 12-30-2010 - 1:03pm

It is possible to have a surge less than 24 hours long so if you test only once a day you could miss it. But if you’re testing twice a day and you still never get a true + I would be concerned that you aren’t surging at all and therefore probably not O’ing.

That is also a pretty good sign of PCOS. An insulin resistance test is basically the same thing as a glucose test. It’s pretty nasty so prepare yourself. It was all I could do not to hurl all over God’s creation when I had to do it. I would def bring up PCOS though.

As far as the insurance goes, that’s

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iVillage Member
Registered: 05-12-2008
Thu, 12-30-2010 - 1:06pm

Tee, I hope you don't mind me jumping in here.

iVillage Member
Registered: 06-27-2006
Thu, 12-30-2010 - 7:24pm
Thanks Michelle! So, you're saying that I could have several of the symptoms of PCOS, but not the cysts? I've had u/s's and none of them show any cysts. So, I really don't even know. I know that one cycle I had horrible pain in one side that was causing nausea, had a CT scan and an u/s and they showed a follicular cyst, but when those were done, it was O time, so they just said that it was follicles getting ready to ovulate. Then, again when I had my follicle study, they only saw the follicles. I guess I really haven't had any u/s's any other times, except when I was pg and after my m/c, but they didn't note any cysts. But, then again, would those cysts have not been there because I had actually ovulated when I got pg with my angel, and then maybe not been there after my m/c because I was not back to my regular cycle yet?
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iVillage Member
Registered: 06-27-2006
Thu, 12-30-2010 - 7:25pm
Thanks Dustie! Definitely jump in! Thanks for sharing. I will ask the doctor and see what they can code it as so that it's not so much of a hassle. We'll see what happens. :) I appreciate your input!
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