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Do I need a new RE? (long)From: anonymous (anonymous@obgyn.net)Wed, 18 Dec 2002 13:50:25 -0600 (CST)
Any advice will be appreciated. Here are the highlights of my story: PCOS diagnosis made about 10 years ago, started metformin 1000 mg BID several years ago, with great results in terms of "cosmetic" issues such as acne and hirsutism. Continued birth control pills until I could afford to TTC, which maintained my "cycles" of withdrawal bleeding and helped to keep the testosterone levels down. Stopped the birth control pills last year, with a slight flare of PCOS symptoms such as acne, scalp hair loss, facial/body hair excess as the testosterone levels climbed back up. The IR-related symptoms have remained controlled with metformin (that is to say, no problems with hypoglycemic episodes or carb cravings.) BMI is in the overweight range, (not ideal, but also below "obese" range,) and my RE does not feel my weight will be a significant barrier to achieving a pregnancy. Cycles fell back into the typical anovulatory pattern I had before BCP (35-45 days) but some seemed ovulatory based on BBTs and progesterone levels--even some of the 45 day ones. The BBTs and progesterone levels also have seemed to imply that I do not have a luteal phase defect, since I start AF 14 days after the presumed ovulation during those cycles, like clockwork. We have been TTC for over a year, with the first 6 months using just metformin, guaifenesin (OK, it may not actually thin the CM in any significant way, but what the heck? worth a try...) BBTs and scheduled intercourse. No known issues with clotting abnormalities, but I also began baby aspirin given the hypercoaguability all of us with PCOS may indeed have. No other health problems. Due to our ages (late 30's) we went to the RE after 6 months of TTC to begin IF treatment. HSG was perfectly normal. DH's semen analysis was great, he was actually complemented on his numbers and quality when the RN called with his results. First round of clomid was very successful in terms of ovulation (confirmed by progesterone level and U/S; yes, I realize the only "true" proof of ovulation is a confirmed pregnancy, but you have to start somewhere.) CM was hostile, however, on the post-coital test. No pregnancy on a subsequent cycle of Clomid combined with IUI to bypass the hostile CM (U/S showed good follicles, progesterone was ovulatory level on cd 21.) My concern is this: My RE's office is only open 5 days per week (it seems some women on this board have clinics that are open 7 days, including 1/2 days on Sundays and holidays) and the scheduling of certain procedures is even more limited. They refuse to let patients administer their own HCG injections prior to IUI, so the timing of the HCG with respect to the procedure is not always optimal. I realize I have only been TTC for a year, with only two "treatment" cycles, and many women have been TTC for years without success, but I am starting to wonder if I will end up wasting all my allowed Clomid cycles at a clinic where the timing of the procedures is suboptimal. My RE is highly respected in the field, and I don't want to "jump ship" without good reason. Any thoughts? Cassandra
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