Need some advice on how to negotiate with my clinic

[FtMPapa]

Backstory is: I've had one appointment with the RE, last month, and then I called today. This my first cycle with this clinic, but I did 4 cycles with another clinic where I used to live, so I'm not new to this, and I've had all the baseline bloods done two years ago, and repeated this month.

Please, please, please don't tell me to switch clinics - I know I should, I know this clinic is all wrong for me, but it's the only one within reasonable driving, as I live in a rural area, so it means I'm motivated to try to make this work.

Today is CD 1. I called, and I found out that I am getting day 3 labs done on Thursday, but I am not supposed to meet with the RE to discuss my treatment plan, and I am thus not going to be able to get any meds this cycle, this is a "bloodwork only" cycle.

If I'm not wrong, virtually all fertility meds require starting on CD 3. In the past, I've had bloodwork on the early morning of CD 3 and then a phone conversation with a nurse in the PM to say "No meds" or "We'll call in a script for (whatever the doctor and I had previously discussed) if that doesn't sound reasonable, I can get the doc to call you in an hour or so..."

But this clinic says that they won't even get the CD 3 bloodwork back until Monday, which is CD 7 - at which point they'll call for me to book an appointment to talk about a treatment protocol. Which wouldn't start until next month.

Question: Are there protocols for injects that don't require starting anything until after CD 7?

Does this sound to anyone else like "Hey, go cool your heels for a month while we do nothing..." or am I just paranoid? Is this normal to do a blood work only cycle?

I am queer and I have a lot of friends who have dealt with fertility clinics, and I've never heard of anyone having to do a bloodwork only cycle, everyone I know has had ultrasounds, etc. I haven't even had a baseline ultrasound. For all they know, I don't even have a vagina, a uterus, or ovaries!

I already had "my go-away, come back next cycle," appointment last cycle.
Why can't I get one lousy ulrasound follicle count and a trigger shot and progesterone supplementation? (I ovulate on my own, just late in my cycle, CD 25 or so, lately.)

I'm worried this is going to turn into one "bloodwork only" cycle, then they'll say "oh, you didn't have ultrasounds" so then they'll want one "bloodwork and ultrasound" cycle, and then it will be three months from now before I start any sort of treatment, given that my cycles are 40 days long.

[Suka]

I am queer as well and in it alone, but it truly does sound like they are doing nothing but sitting on their hands with you. Im not sure if alot of "Phamily" folks visit that office or not and that may be the reason they are so hands off with you. My gut tells me that you should just go to the other clinic and not worry about them. I have always had my meds on cd3 with my ultrasound and bloodwork on cd2...its ridiculious that they wont have the bloodwork back until monday...my clinic had them back the same day...Run sister!!!

[crazyrunningmama]

Well, this does sound pretty crap. I think I did have a bloodwork only cycle, but I had no idea what I was doing and you do. I think you should heavily advocate to make sure that ALL the tests, ultrasounds etc you need get done this month, as well as an RE appointment to make a plan. That way at least you'll be ready to go next cycle. And tell them that you have 40 day cycles and don't want to diddle around wasting time. I really hope they are not being heterosexist on you, I'm sure that's the last thing you'd need during this difficult journey. Take care and good luck.

[AmyKT]

This would be making me crazy, too. I just had my first appt with a new clinic on CD 15, and they did an ultrasound to check everything out. I would worry there is some prejudice going on, but it may just be the way they roll -- very slowly. I understand just wanting to make it work, so you're probably just going to have to put their feet to the fire. As for starting meds after day 3, I just checked the fertility friend chart gallery, and many don't start until day 7. I even saw one starting on day 14. since you o late, anyway, it's probably ok to wait. Starting on CD3 would speed your cycle along, but it doesn't seem you'll miss your window.

[Suka]

I think the reason why some people start meds at different times is they are using a different medication. I was using Femara and started on cd3 for one cycle...I used Gonal f before and i started on cd7 for 2 cycles

[FtMPapa]

Suka - thanks for the info! I've done Clomid before, and I know like Femara, it's typically CD 3, but I didn't know injects started later...good to know for the future.

I'm still looking for alternate care - has anyone had an OBGYN monitor injectables adequately? I'm considering that option if the OBGYN I'm seeing next week will agree.

So, the bad news from the clinic....

Turns out, my CD 3 labs were in today, CD 4.

I'm still sitting this cycle out dealing with other stuff that absolutely is related to my gender and sexuality and parenting choices (particularly my known donor - that's been an issue too). They wouldn't even give me my lab #s today - they claimed the labs were in but they didn't have the numbers, which is fishy. And I have to go see the clinic's psychologist and seek approval from their advisory board - I'm not sure if that's about the known donor issue or about the gender issue...or both.

Now I have to get on board with just hoping it all works out, and if not, I'm driving 3 hours each way to the next closest clinic. . . assuming that clinic will even do anything for me.

[kristenok18]

I'm sorry, FtMPapa. I hope everything gets straightened out in your favor.

[lexbeach]

I'm sorry, Papa.

I will say that when we were first TTC, the OB practice I was using did make me do a "bloodwork" only cycle, followed by a "clomid only" cycle (no insem, just to see if clomid would work) before I could do an actual TTC cycle. I'm not sure if they made me wait longer than most people (because I was young or queer or had just had an intense medical, near-death experience (one of the OB's in the practice saved my life)), or if that was standard practice. It worked out OK with our timing plans, so it didn't irk me at the time, but I could see how it would have in a different context.

When we were TTC the last time--I think using the same clinic that you are now attempting to use--dw's process did sound similar to what you're now doing. At her initial appointment she told the RE that she had previously been diagnosed with PCOS and wasn't sure if she could get pregnant. The RE did an u/s at that appointment, checking out her ovaries (which she said were actually fine, in the range of normal). The following cycle was bloodwork only. The third cycle, the u/s was only offered after I questioned if there was anything else we could be doing to increase our chances since we only had the one vial of sperm from our kids' donor. So then dw had one u/s as we approached ovulation, to aid in the timing of the trigger shot (which was also a last-minute decision).

I hope you get some answers about what their plan is soon.



Lex

[Suka]

about the psychologist...My clinic(s) both required me to get an approval...They say its standard procedure, i was using an unknown donor.

[FtMPapa]

It continues to get uglier - Lex, it is the same clinic.

It turns out my "bloodwork only cycle" is only day 3 bloodwork. Day 3 bloodwork isn't particularly meaningful, because mine is amazing, except that my estradiol is low. But they aren't planning to follow up with CD 7 or 10 or 14 or 7 DPO bloodwork, just this.

I'm seeing my OBGYN tomorrow and continuing to jump through the clinic's hoops while simultaneously getting him to order Day 10 and 14 and 7 DPO labs. My insurance - and their policies - require a bunch of other tests, but they haven't actually ordered any of them for me, so I'm going to get him to order those, too.

Suka - I know all about the clinic shrink, I've done this before with anonymous sperm, but even then, that social worker made it clear to me that her role was not to evaluate, but to counsel and advise me. This meeting is clearly evaluative, they're putting my case before the ethics committee to see if they should even treat me.

I'm slightly overwhelmed and feeling quite picked on. At least my day 3 labs were good. I'm just holding on to that.

[crazyrunningmama]

FtMPapa I'm sorry they are making things so hard for you.

[Suka]

O M G....I had no idea...an evaluation to see if they will even treat you...Heck they are already treating you....Pllllzzzzz go somewhere else

[kristenok18]

That's outrageous!!!! I hope you're able to seek help someplace else. This place sounds ridiculous.

[Noelle C.]

Sometimes clinics will do these cycles to space out their clients. Because so much in reproductive medicine is day-by-day, they can't have so many people projected to need a certain procedure at a certain time that they end up unable to see everyone if everyone needs it done at the same time.

If you feel the clinic isn't right for you, then you do need to change. I understand driving distance and all, but the stress will work against you.

[Sasha299]

I've been to multiple clinics that all had b/w testing only cycles BUT this going before an ethics board to see if they will treat you? RUN somewhere else! I would rather TTC on my own than go to somewhere like this. After 4 prior cycles I would be concerned that the would not be aggressive enough for me. I commuted to my last clinic because they were one of the best. I would suggest that you look into cycling out of your area - you can have your OB/GYN do the monitoring and go into the clinic for the last 5/7 days before trigger. I forgot - were you doing IUI or IVF cycles? IVF is worth it but I don't know if IUIs would be worth it.

[FtMPapa]

Originally Posted by Sasha299

I've been to multiple clinics that all had b/w testing only cycles BUT this going before an ethics board to see if they will treat you? RUN somewhere else! I would rather TTC on my own than go to somewhere like this. After 4 prior cycles I would be concerned that the would not be aggressive enough for me. I commuted to my last clinic because they were one of the best. I would suggest that you look into cycling out of your area - you can have your OB/GYN do the monitoring and go into the clinic for the last 5/7 days before trigger. I forgot - were you doing IUI or IVF cycles? IVF is worth it but I don't know if IUIs would be worth it.

I've been TTC on my own for ::mumble, mumble:: cycles. A lot more than I care to count.

I'm doing IUI, but I wouldn't be surprised if an RE pushes for IVF because I have wicked awesome insurance.

So, can you tell me what a "bloodwork only" cycle looks like? In the past I've had bloodwork and ultrasound on CD 3, 7, 10, 12, 14...etc. until trigger, O, progesterone, and 7 DPO blood. I figured "bloodwork only" might mean CD 3, 10, 14, 21...no? My clinic is saying "bloodwork only" means only day 3. Which doesn't sound right to me. Like, what's the point? Nothing to confirm I oed?

[Sasha299]

You are correct that BW only cycles involve CD 3, 10, 14, 21 but on those cycles I also did HSG to see if my tubes were clear, Saline hystersonogram (sp) to ensure the structure of my uterus was good and an endometrial biopsy. That cycle I also did all immune testing, etc.