Monday, January 30, 2006

I think I hate my RE.

I know that you* are shocked--shocked!--to hear this.

Went for my baseline US this morning. I got there at 7:40 and was not taken to an exam room until 8:30. Now, my clinic is terminally running late, and I hate it, but I don't fault them for the morning rush--monitoring is first-come, first-serve, arrival anywhere between 7 and 8, so there is no way for them to control how long it takes someone to be seen. However, once in the exam room, I was left to cool my heels until 8:50. Twenty minutes is a long time to wait when you're not wearing pants.

US was fine--multiple follicles <10mm on each side--and then Dr. S. asked me if I had my presciption yet. Uh, yeah, the letrozole prescription you wrote for me at my last appointment, back in December. Well, he said, there is a new study out that links letrozole to an increased risk of birth defects (which I already knew about; I got suspicious when at our last appointment he suddenly started talking about birth defects and letrozole, so I googled and found the study). He said the data was weak and that it was mainly women who got pregnant while taking Letrozole long-term, such as for breast cancer, and thus were taking the drug while actually pregnant--as opposed to for fertility treatment, when you take it just before you get pregnant. (Now, the reports I read didn't say, but since the doctor who authored the study is the director of the Montreal Fertility Centre, I assume he focused on women who used letrozole as a fertility treatment. Here's where I get suspicious of how well-informed Dr. S. really is.)

At any rate, Dr. S. said he was now giving patients the choice: letrozole, or Clomid. I asked him about the risk of multiples--pretty sure he'd told me before that letrozole had a lower risk of multiples (along with not having the risk of cervical mucus and lining issues as Clomid has). No, he says now, not enough data to know, but probably the same risk of multiples (my main concern with UU). "Well..." I hesitated, leaning toward Clomid, and he said, "I think you should take Clomid." "All other things being equal, yes, I think I'd prefer that," I replied. Now, I have NO problem with a doctor having an opinion as to the best course of my care--in fact, that is what I pay him for. So if there is an option that you feel is clearly better, don't give me this bullshit about giving me a choice. Tell me that one is a better option. I am enough of a grownup that if I disagree, I will tell you so. But I need your opinion to help me weigh the facts.

Okay, so we'll do Clomid. Fine. I get dressed and then go sit across the desk so he can explain the protocol--basically same as letrozole, I take 1 pill (50 mg) a day for 5 days, starting today, then go in next Tuesday for a followup US. Then I brought up something that had been on my mind: the risk of multiples, and his recommendation that if I did get pregnant with multiples, he would urge us to consider reduction. I told him that we'd discussed it, and that we were not comfortable with reduction and wanted to minimize the possibility. And I have to say, he was kind of a dick about it. He said, "Well, if you don't want any risk of multiples you really shouldn't be on fertility medications at all." He said that the only real option that would eliminate the risk would be to just "keep trying on your own, with the Glucophage." I got a little panicky--he was so abrupt, I almost thought I was going to get kicked out--and pointed out that I didn't seem to be ovulating normally on just the Glucophage. He said, "Look, on any fertility drugs, there's just no way to eliminate the risk of multiples." Fine, I get that--I'm not dumb. But, I said, "Can't you tell, during monitoring..." and then trailed off. (I am a very smart and articulate person who somehow gets completely tongue-tied around doctors, particularly jerky doctors.) "Well, but if you have a large follicle and an intermediate follicle, there's a chance that both could take," Dr. S. said. "Of course, if there's only one follicle, then you're okay." What I SHOULD have said then was, "Okay, so can we just decide that, if there is more than one likely-looking follicle on the right side, we will cancel the IUI, but if there's only one, we can go ahead?" Instead, I just said, "Well, can we go ahead with the Clomid and see how it goes?"

So that's what we are doing--going ahead with the Clomid and seeing how it goes. When we get closer to trigger time, I will have to bring this up again. I hate how doctors, especially jerky doctors, especially male doctors, make me lose all coherence. (Do I have weird daddy issues? My dad is a doctor--albeit the nicest, non-jerkiest, most mild-mannered guy you could ever meet, of whom I have no trouble asking any kind of question.) So yes, I could have communicated what I was trying to say better. On the other hand, isn't it Dr. S.'s responsibility as a doctor to work with me to find the best treatment options within my limits? Wouldn't it have been an OBVIOUS thing for him to say, "Okay, well knowing that, I would recommend that IF you want to continue with Clomid, we monitor you very closely, and if you have more than one follicle, even if one is dominant, we should not trigger/do the IUI. We'll only do an IUI if there is one follicle." Doesn't that make sense? (Especially given the fact that IUI and associated costs are fully covered by my insurance, so there is no downside, apart from time wasted, to starting a medicated IUI cycle and then cancelling it.)

Ugh. Anyone know a fabulous, compassionate RE here in Big City? (I'm sure you can guess of which Big City I am speaking. I don't know why I insist on being so coy about it.)

Just to add a little fillip of hilarity to the day, I had lunch with my boss. It was a lovely lunch, delicious food, nice to get to know my boss a little better. Except that (a) she asked me, "So, are your parents on you about having kids?" which I think was her nicely sneaky way of asking, "When are you going to have kids?" (I said, no, not yet.) and (b) I was sitting right next to an adorably pregnant woman, who ordered two desserts! Because she was pregnant! AHAHAHAHAHAHAHA! Oh, how we laughed!

I thought all the stories of being "pregnanted" were just paranoia--you don't really get more comments/see more pregnant people/etc. when you're infertile. But it is TRUE!

*all 0? 1? 2? of you who are reading this. BTW, I forgot to mention that I got my first commenter a month or two ago. It was the classic anonymous comment: "Ever think you weren't meant to have kids?" Needless to say, you will not see that comment anywhere below, because I have moderated comments and deleted it instantly. As proud as I was to get the comment--hey, you're not a real blogger until you've been insulted by an anonymous troll!--it was a full body blow to read that in my email first thing in the morning. Not fun.

2 Comments:

Blogger Moxie said...

Hi there. I can ask around and see who people really liked. Probably 1/3 of the moms in my son's preschool class did ART, so I'm sure someone will know someone.

Also, about the risk of multiples with IUI and selective reducition, do you read Jody at Rasing WEG? She has IUI triplets, and get the same BS line from her RE you did. She's got some amazing barnburner posts about risk of multiples and also about SR. You definitely should read them. Go poke aorund in her archives--the posts are mostly in the first month or two she was writing.

Is your only problem irregular ovulation? If so, and please ignore this if this is assvice on the scale or "eat pineapple," have you done the whole Vitex/Dong Quai routine for a month or two? I had to jumpstart my ovulation after 9 months of not ovulating and it did the trick. I don't know if you ahve more complicated issues, though.

7:44 PM  
Blogger electriclady said...

Thanks, Moxie--any suggestions are welcome. and I'm flattered you're reading!

I'll check out Jody's info, definitely. For us, the issue is complicated by my having unicornuate uterus (basically half a uterus), which might make multiples excessively dangerous--I've been reading lovely picturesque phrases like "uterine rupture." (Of course, some women with UU do successfully carry multiples--unfortunately, not having been pregnant, I don't know if my uterus is one of the ones that will stretch successfully.) On the other hand, the UU also carries a very high miscarriage rate, and as I understand selective reduction also carries a slight MC risk? so putting the two together is probably not a great idea.

I actually haven't tried vitex/dong quai...since I recently learned only have one tube, it might or might not help, but if I don't get pregnant after one or two IUI attempts, we'll probably take a break from ART for a few months, and I think it's definitely worth trying.

8:08 PM  

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