After talking to my RE, I may be coming around to hating my RE just like you do!

His "solution" to AF being late was--get this--to take prometrium to induce AF! I mean, I know Prometrium is okay to take with pregnancy, but what if I pulled a Lauren and was just showing a BFP really late. Wouldn't it be good to find that out now versus two weeks from now? Gah!

Annnnnd, when I mentioned only having one follie with my last cycle on low dose femara, I asked the nurse if I should increase my dose so I have more targets or something, and she said that femara doesn't work that way. I am already ticked, so who knows if she is right, but from what I have read online, that is not the case.

Maybe I am pissy from AF but I am all bothered by this. I knew I wasn't pregnant so it *shouldn't* bother me htat he didn't want to do a scan or blood. And I don't really need to be popping out multiple babies or anything either. But STILL!

[Garfieldbear]

I am still so stunned that they won't do an HCG blood test on you!!!!!! What is their explanation, really? It makes no sense! But thinking back on your RE's "style"....yeah, I just don't like it. I don't like how he kind of blamed you for having a hard time getting pregnant....that you weren't exercising enough, or building up enough muscle tone. I mean it's fine to exercise, but it sounded like he was blaming your habits. And I also never understood why he put you on 25 mg of Clomid after being on 50 mg of Clomid...aren't you supposed to increase the dosage, not decrease the dosage (I remember that was the cycle that you didn't produce any follicles). I also feel like he isn't giving you much of a say in your own treatment....I know that in my fertility clinic, they highly respect what you want to do.....I am very thankful that they let me switch from Clomid to injectables right away, instead of forcing me to try Clomid again and again if I didn't want to. If you want to increase the dosage of Femara, you should be able to, as long as you understand that they might have to cancel a cycle if you produce too many follicles. That's what they told me at my clinic....they could start me on injectables, but would have to cancel the cycle if I produced too many follicles (which wasn't an issue for me). In the end, nobody knows your body better than you do.........I knew that my body wouldn't respond to Clomid well (and it didn't....it messed up my lining even though I did only one cycle and had to take extra estrogen).

You should ask yourself what you really want, and then get them to see your reasoning. I mean, you and your insurance are giving them thousands of dollars....you deserve not only a say but more respect. They should have scheduled you for an HCG blood test even before your period, because you don't want to leave things up to chance (even women who have periods are sometimes pregnant!) Also, he might want to do a scan to see if you have any cysts....cysts sometimes cause AF to be late, from what I've read. And I have a question for you about the prometrium....my doctor had me start taking prometrium 3 days after I ovulated to decrease the chance of miscarriage (and I have to continue it until 10 weeks). Your RE didn't put you on prometrium or baby aspirin? Most women don't need this, but because women who suffer from PCOS are at increased risk of miscarriage prometrium and baby aspirin are often added for the first weeks of pregnancy (I began both soon after I ovulated). And of course, Glumetza is usually continued until 12 weeks of pregnancy (I know you said before that you stopped taking it....that your body wasn't absorbing it well). But maybe if you have a very mild case of PCOS, it won't be so bad not taking these medications. But I do hope that you push for what you want, and definately have a say in what direction you want your treatment to go.

[ShannonMVT]

Ugh, I'm sorry your RE is not listening to you. I would think they should give you an hcg blood test once AF was late. I'm surprised too, that they don't want to do a scan just to make sure you don't have any cysts.

I hope you can figure out a plan with your RE that is something that you are happy with. I know I wasn't thrilled to be on Clomid instead of Femara and I would have eventually pushed my RE to go on Femara if the Clomid hadn't worked. So I think it is reasonable for you to request going on a higher dose of Femara if the research shows that it can give you some extra follicles.

Thanks chickies. Jen, they do listen to me at the office. I think if I pushed it and asked the nurse to actually ask the doctor, he would go for it. Maybe though you are right in that I don't know exactly what I want here. Like, I feel fine not getting a scan or blood test since I have never had a cyst and I feel fine, but I was miffed that they weren't more concerned, kwim? But now I am thinking fertilization is occurring, but it will not stick, so that possibility worries me.


You know what else pisses me off, is how all these women (excluding you lovely ladies that I have nothing but happy warm fuzzy feelings for) with PCOS who take maybe 3 cycles to get pregnant. WTH! WTH is wrong with me? And they say lose weight to help with PCOS, well, you've seen my skinny butt on my blog! UGH! Why is it only my eggs seem to be craptastic and I can't get or stay pregnant. I am really wondering what to do here. Tell me what you would do in my situation because I need ideas or a different perspective or regimen or something. Should I go up to injectibles?

[Garfieldbear]

Michelle, have they been checking your progesterone levels? I think that your eggs might be fertilizing, but there is an issue either with your egg quality or hormone levels. I have read a lot about women with PCOS and their progesterone levels not being high enough to sustain a pregnancy.....I know that my doctor has always been checking my progesterone levels, and that is why he put me on a suppository three days after ovulation so that I would get that extra progesterone support.

PCOS messes with a number of hormones, but I read that LH and progesterone are the two hormones that often cause issues with fertility.....suppositories might help with the progesterone, and I read that LH agonists at the beginning of a cycle help with LH levels later on (for the first two weeks of my cycle I took Lupron injections----which is an LH agonist-----and they say that this helps with LH levels later on because too high levels can cause problems with fertility). So if this is the case, perhaps injections might work for you. Also, has your doctor been studying your lining? I just know Clomid tends to decrease your lining, which could prevent proper implantation. Maybe your doctor has been studying all your hormone levels and sees that everything is fine, just as long as he is doing it. Your egg quality is most likely okay because the eggs are allowed to grow to a proper level before they are released, and they respond well to treatment. So definately find out about your hormone levels, because there is support out there

Thanks for the info Jen You are one helpful pregnant lady

I finally decided that I would stop being so reluctant and that maybe I do need to take the injectable plunge. So I called my doc late this morning, but he was doing surgery all day. And since it is CD2, I need to start my protocol tomorrow, so no injectables this cycle. We will just be doing Femara again. But I will for sure bring up the Lupron with him at my scan for next cycle.

I am not having my progesterone monitored because my LP has always been 13-14 days. But maybe I will ask for that this cycle since it can't really hurt. And he does monitor my lining which is good. That's why I am on Femara now instead of Clomid.

Also, I talked to the lab embryologist and she suggested a medication that can be added to DH's sample before IUI to get it to liquefy more b/c he has been having viscosity problems. She said it is usually used for IVF, but it has been effective. Who knows, maybe that is a problem (but it doesn't explain the chemicals!)

There are just so many things that could be going on, I feel batty about all of it. Is it all related to DH's viscosity problem? Are my "bad" eggs still cycling through? Perhaps a clotting issue? Progesterone problem? LH still too high? Only thing is my ovaries have been looking good the last 2 months on ultrasound. Ugh! I am somewhat relieved that we will not be doing injectables next cycle, only because OHSS scares the bejeezus out of me and I don't want to feel like I am rushing it. But I think I will have to bite the bullet.


Jen, I have to tell you that your posts and rants about my RE have proven to be very insightful for me. I have been thinking about it a lot. Today when I told them I wanted to be more aggressive, they bent over backwards to try and contact the doctor between surgeries, even though I called them last minute. And then the lab was very helpful with their suggestions of what new things we can try even though we aren't IVF patients right now. And you know, he says a lot of stuff at my appts ("good job", "I am proud of you", "you have only been optimal for conception very recently even though for you this has been a 4 year process") and I think the only things I have been mentioning are the ones that sound critical or negative b/c I am critical and negative. think I really do blame myself for all these fertility issues, all on my own. And I do put pressure on myself because I really didn't want to go the injectable route. When he first mentioned injectables I squirmed and thought we could avoid it. When he suggested we go to 25mg Clomid or no Clomid b/c my ovaries overresponded to 50, I wa sall for it because I wanted to do what was minimally possible. Of course, he aien't perfect, but I have been sooo reluctant with meeting my treatment completely head on, which is very unlike how I usually am. And you are your best advocate. I think I am just afraid, and honestly, still a bit in denial that we have fertility problems. Which is kinda cuckoo.

Soooo, this cycle is Femara, baby aspirin, possible prometrium and IUI (we may be able to fit it in on Sunday), and next cycle is some injectable combination (maybe Femara + Follistim, and I will ask about the Lupron--I am still researching and we will see what he says at my scan), plus maybe prometrium and more baby aspirin.

Thank you so much Jen and Shannon. You girls rock! I am wondering, does anyone else find this stuff interesting besides us med assistance gals?

[ShannonMVT]

I am wondering, does anyone else find this stuff interesting besides us med assistance gals?[/b]

In all honesty, I think if you haven't undergone med assistance, it's hard to know what we are even talking about a lot of times!

Thinking about the progesterone, I guess it could be that a progesterone problem is keeping implantation from happening. My OB (I have no idea if she knows what she is talking about) didn't want to check my progesterone levels in the 2ww because she said the levels can vary so much throughout the day so it's not a useful test. She said if it was indicated (and she didn't think it was), I could have an endometrial biopsy done to see if my lining was good enough, which would then tell us if the progesterone was okay. Take that with a grain of salt because I have no idea how accurate that is.

I did take progestone in the 2ww for a couple of months. The reason I stopped was because it gave me pregnancy symptoms (hard to deal with emotionally) and AF would not show up until I stopped them. I was always afraid to stop the progesterone because I thought what if I was going to get a late BFP and I stopped too early? But in your case, it may be worth it to try progesterone in the 2ww.

If the problem is that your eggs are not good quality, I would think either Femara or injectibles would help with that. And like you have said before, it's only been a few cycles where you really had a good chance. Like maybe your chances were upped to that of a "normal fertile couple" but that is still only 20% each cycle. I know, still not a comforting thought when you are one the dealing with it. But I'm hoping that what you're doing right now WILL work for you, but it's just taking a few tries.