First Clinic visit and a million questions

[TheGirls]

OK, so I went to the fertility clinic for the first time. My partner got to come, which was a pleasant surprise (work-related travel). They were very nice, very queer-friendly, upbeat, etc. It feels pretty good to have a plan, but now I have bunches of questions.

She suggested that I get some tests done, to make sure everything's ok. She wants to do one blood test 2-3 days after my next cycle starts, an ultrasound at that point, and a progesterone test 1 week after I get an OPK+. Is this common? I'm 26 and in good health with a good family reproductive history. I do think I'll end up getting them though, since the insurance pays for the tests, but not for the inseminations/sperm.

She also pretty much assumed we'd be doing an IUI, and suggested doing 2 per cycle. When I asked about ICI, she said something to the effect of "well, you're just much more likely to get pregnant with IUI". She struck me as a very "touchy-feely" kinda person, and I like facts. I want to know HOW MUCH IUI improves my odds, but I couldn't find this information (in healthy women) online anywhere. Anyone have data or a link?

Also, she gave us a list of 3 sperm banks. They are all nearly 2x as much per vial as Midwest Sperm Bank here in Chicago, and that's before shipping (Midwest has free shipping in Chicagoland, and is located about 10 miles from this clinic). Has anyone used Midwest Sperm Bank? What are the differences between more and less expensive banks? The list says we can use a different bank, as long as the lab is AATB accredited. What does this mean? Is there a list somewhere? We are not looking for any particularly hard to find traits in a donor, really we just want him healthy. It will be difficult for us to deal with shipping because of our apartment building (which is terrible about recieving packages) and the generally horrid state of the Chicago mail service.

OK, there are more, but that's enough silly questions for one post...

TIA!

Angela

[kands]

I can't answer a lot of your questions, but I can tell you that we had the sperm shipped directly to our clinic. So if you wanted to use a different bank (which might have more ID release donors or more donors to choose from), the shipping could go right to your doc and eliminate the concern about shipping directly to your apartment.

And as far as the tests go, I would have them done if only because sperm is so expensive. I have friends who did six cycles of ICI, two inseminations per cycle, only to find out that the one who was being inseminated has fertility issues. Our sperm cost ~400 per vial, so assuming theirs was similar, that means they were out 4800 and still had to go through all the testing and other procedures. So if your insurance covers them, I'd go for it! I would go for ICI for the same reason. It increases the chance of you getting pregnant and therefore is likely to mean you will save money by being able to do less cycles. Of course, there is never any guarantee, but having spent 14k on getting pregnant, I tend to think about the monetary aspect

Welcome and good luck!

[FtMPapa]

Just for comparison purposes, I had my first fertility clinic visit yesterday. Long story, but I've been seeing a low-tech, touchy-feely doctor, and did two at home ICI inseminations last month, and I'm moving on to IUIs in the clinic because they have all the fancy bells and whistles and they do inseminations 365 days a year, and my doctor is one person, who sometimes travels, etc.

At any rate, I had an HSG on Monday (CD 8), blood work, and an ultrasound yesterday (CD 10).

I've already had a huge battery of blood tests, so I don't need to go through that again. (Basically, HIV and various STDs, as well as titers for a variety of things from toxoplasmosis to rubella, blood typing, etc, etc.) On top of that, I've already had "Day 21" blood work - 7 DPO, really, but they call it CD 21, and "Day 3" blood work - to test FSH levels.)

That is all standard protocol at my clinic.

As mentioned above, go for every test possible that isn't overly invasive in order to save time and $$$. Even though the doctor I'm now seeing has almost all of her patients get HSGs, I would have gotten one anyway of my own volition - if I have a blocked fallopian tube, I want to know *now* and not after I've spent months trying. Plus, it's supposed to marginally increase fertility for the next three months or so. (And, it really wasn't bad, I've had PAP smears that were worse.)

Oh - and I'm also 26. I am genetically predisposed to fraternal twins, so I don't want to go near any fertility drugs at all. All I want is a bunch of tests and a well-timed IUI or two each month. My doctor said she wouldn't even consider any fertility drugs, given my age, unless it looked like I wasn't ovulating on my own.

[TheGirls]

Yeah, I do think I'll do all the tests. One of the other questions, which I think you may have answered, FtMPapa, was whether or not these tests need to be done on the same cycle. I'll be here for the beginning of this next cycle (due to start next week), but I may be in China (big trip, yay!) for "day 21".

If the ultrasound is supposed to increase fertility, perhaps I should wait until I'm actually ready to start trying, though...I won't actually be doing an insem until nearly 3 months from now.

[Lingmom]

I think the doctors who do IUI are often specialists who assume there must be fertility issues and have a full workup as their standard protocol. When, in reality, all you need is to know when to go in and have the insemination done. You might try just doing the OPK and charting and arranging for your regular gynecologist when you want to do the insemination. You might miss a month if you have the bad luck to ovulate on a weekend or holiday, but otherwise you'll probably save a lot of money. Definitely skip the at-home insemination if you want to be effective.

[FtMPapa]

Originally Posted by TheGirls

Yeah, I do think I'll do all the tests. One of the other questions, which I think you may have answered, FtMPapa, was whether or not these tests need to be done on the same cycle. I'll be here for the beginning of this next cycle (due to start next week), but I may be in China (big trip, yay!) for "day 21".

If the ultrasound is supposed to increase fertility, perhaps I should wait until I'm actually ready to start trying, though...I won't actually be doing an insem until nearly 3 months from now.

I have no idea. I think it's probably preferable, but not required - in my case, they're not all from the same cycle.

It's not the ultrasound that increases fertility - it's the HSG, and it's an x-ray, although apparently some doctors are doing HSGs via ultrasound these days. Anyway, it's thought to push out any minor blockages in the fallopian tubes, in addition to its diagnostic value.

[gamitzer]

Originally Posted by Dobiecka

I think the doctors who do IUI are often specialists who assume there must be fertility issues and have a full workup as their standard protocol. When, in reality, all you need is to know when to go in and have the insemination done.

I basically agree with this, but would say that if your insurance is willing to cover infertility tests, it's worth doing the tests. We did not have that option, so we just did a regular IUI without knowing if there were any fertility issues. My wife is 27 and has always had regular cycles, so we weren't all that concerned. A friend of ours has PCOS, so it's fantastic that she has all the tests covered by her insurance.

Also, in your case, since you aren't planning to try for 3 months, it's a good idea to get the tests done. If you wanted to start TTC really soon, I'd say skip the tests and just do an IUI or two before getting any tests done.

Good luck! Meredith

[MichelleW]

I agree with pps aout getting the tests done (blood, etc). They do not need to be the same cycle (as I had to have a couple re-done, which were obviously not the same cycle), it just makes them happen sooner if it can be the same (or subsequent) cycles.

The HSG definately doesn't have to be the same cycle. While our clinic suggested it at first, I refused til 2-3 cycles/inseminations had passed, cause I didn't feel it was necessary. (I had very regular cycles, was 27 starting all of this.) My experience with HSG was the worst of anyone I have heard of/from, and thus wouldn't do it again. It is supposed to not jsut check for blockages, but help to clear them, which is what helps with fertility in following cycles. I got pregnant 7-8 months/cycles later -- so don't think it had an effect on me.

I had IUIs done, and understand why they work well. Pretty much due to the life of frosen sperm, and the tight timing of everything, I get that the closer you put the sperms to where they need to be, the better. But I get why people would do ICIs, esp at home.

I had decided to drugs for me, and know there are clinics where they make you go on them right away. I only went on ovidrel to better time the insems, and started doing vaginal ultrasounds to check for follicles, 5 months in, as I was never able to get a + OPK at home. Two months later, I started on a low (50) dose of clomid, after having an anovulatory cycle. It was on my 2nd (maybe 3rd) cycle of clomid that stuff worked. I also believe heavily that going to the naturopath helped, and it was also my 2nd cycle seeing him. (And I was less stressed cause my thesis got handed in during the 2ww with the last cycle too.)

Now, I am 4 months pregnant, and know that it takes time. That time can be super frustrating, as lots of people are successful in that time, and cause there was no medical/physical reason for it not to have happened earlier. Incidently, we got pregnant the last time we'd try for another 2-3 years (cause of other life plans). We are still getting over the shock! ;-)

Good luck!

[egarcia76]

Hi! As I'm sure you can tell from the previous posts, these tests are pretty starndard. I was also 27 when I first visited a fertility clinic back in 8/04. Unfortunately, insurance didn't cover ANYTHING, but dw & I decided to go ahead & have all the tests administered anyhow. My HSG was absolutely HORRIBLE-- the doc couldn't insert the catheter, and I lay on the exam table for AN HOUR while he tried a bunch of stuff. Anyway, I survived the ordeal, had my first IUI the following November, and got pg that first attempt. DD arrived July '05.

We chose IUI because of our limited $; we figured we may as well bypass ICI and increase our chances of pg. We're planning to ttc again in the fall.

Good luck!

[mama2rey]

I can't answer too many questions because we ended up inseminating at home-but from what I can tell you is that most fertility places are going to have you do a full fertility workup. They are asuming you are infertile.....

As far as IUI vs ICI-I know that with ICI you have about a 10% chance of getting pregnant, and with IUI it's about 20 percent. I read this somewhere and I can't remember where.

For the Midwest Sperm Bank-I've heard wonderful things about them. I believe you can only get IUI ready sperm with them, and it is all anonymous-they don't have any yes donors.

Good luck to you! I hope it all works out!

[jentina]

Hi there,

We're in Chicago, as well. We use Midwest Sperm Bank and we love them. The director is excellent and offers kindness, support, and lots of information about the donors and sperm. I'd highly recommend them to anyone. We have picked up from them since delivery is tricky for us, too. No one is home during the day and I certainly don't want it delivered to work!!

We are on our second cycle using two vials at home. We're trying to minimize doctor intervention, although if I don't get pregnant within a few months, we'll definitely start exploring more. I didn't have any fancy tests, though I did have a full physical and all kinds of bloodwork before we started. It sounds like you're ahead of the game with doing the tests in advance.

Good luck and feel free to ask if you have any other MSB questions--or any other questions!

--Jen

[FtMPapa]

Hsg

The HSG is the big, nasty, invasive test that everyone is concerned about - to the point that when I asked my regular doctor about sending me for one prior to my first at-home insemination, he said that it was so invasive and had so many potential complications that he didn't feel it was a good idea. When I told him it was standard protocol at Ye Olde Fertility Clinic, he was unswayed and said "let them order it then."

So, a month or so later, I did, and it was fine. I've had PAP smears that were worse. At the time, it was super easy, not painful at all, and I had a few mild cramps for about three hours a few hours later. I didn't take anything, except some Tylenol once the cramps started, and I ran straight from the clinic to the health card office to fix some issues, then to the grocery store, then home, then I carried two big boxes of groceries up to my fourth floor walk-up apartment, then I walked my dog, then I ran (literally, ran, since I was late) to meet the little girl I manny for after school. Then the cramps started. (Uh, oops, maybe I overdid it a little?)

Anyway, my point being - it can be nasty, but it won't necessarily be so, and I felt the benefit of knowing my tubes are open, plus the potential benefit of any minor thing getting swooshed out was worth it, by far.

[Twylightdove]

As most of the others have said, the bloodwork suggested is pretty standard. I'm 32 and have great fertility signs and obvious ovulation. I have had the CD 21 (progesterone) test and an ultrasound but that is it.

My NP said the same thing your Dr said about not 'wasting money and time'. Of course she said this at the same appointment where she confirmed that I had gotten pregnant and had a very early miscarriage on try #2 doing at home ICI! She also couldn't tell me how much more effective. I've never seen a study that I felt was unbiased.

I'm in try #4 doing at home ICI. After a lot of considering and talking we've decided that this will be our last ICI. Maybe frozen sperm is just a little too beat up for me to continue trusing it to find isn't way through my cervix. Thankfully, I have a nurse-midwife friend who is going to teach my partner (who is a nurse) how to do IUI at home. Hopefully this last ICI will work and we won't have to worry about it!

Good luck on starting up ttc!
And here is some unsolicited advice...Keep in mind that often getting pregnant takes time even when everything is perfect. You can have great sperm and perfect timing and still not get pregant for months. Walk into this process expecting a long road. If you get pregnant fast then you can be pleasantly surprised!

[lexbeach]

I had the tests done (well, just blood tests, no u/s), and I was only 22. It turned out that I wasn't ovulating (I had been charting, and I didn't think I was ovulating from my chart either). I took clomid and did 2 IUIs, and I got pregnant--with twins. I definitely think the tests are worth it--at least a blood test which absolutely won't hurt you (some people debate about u/s).

IUI is statistically more successfull, especially if you do 2 IUIs per cycle. I don't know the statistics exactly, but I believe they are mentioned in "The Essential Guide to Lesbian Conception, Pregnancy, and Birth" (a book you should definitely have if you don't already!).

I do know people who have gotten pg at home doing ICI with frozen sperm, but they are definitely the exception among our friends. Most couples end up going to the clinic and doing IUI.

We used California Cryobank and were very happy with them. I'd want to know why the midwest bank was so much cheaper than the others. When we were looking into buying sperm the first time around, I just assumed we'd go with the cheapest option. I mentioned this to my mom, and she was like, "of all things to buy the cheaper version of, why do so for your future child's genetic material??" My parents ended up paying for us to buy the more expensive sperm. Kinda weird (that my parents bought our sperm!), and I'm not sure I agree with my mom's theorizing, but it's something to think about. Do they do less testing on the sperm? Is their screening process less intense? Do they have less information about the donors?

HTH!

Lex

[rosesarered]

Originally Posted by lexbeach

I'd want to know why the midwest bank was so much cheaper than the others. When we were looking into buying sperm the first time around, I just assumed we'd go with the cheapest option. I mentioned this to my mom, and she was like, "of all things to buy the cheaper version of, why do so for your future child's genetic material??" My parents ended up paying for us to buy the more expensive sperm. Kinda weird (that my parents bought our sperm!), and I'm not sure I agree with my mom's theorizing, but it's something to think about. Do they do less testing on the sperm? Is their screening process less intense? Do they have less information about the donors?

There isn't a difference in quality of the sperm at Midwest. And she does all the same standard tests. Some banks, like Fairfax, advertise extra special tests that no other banks use. At the clinic I work at, all the banks we use are accredited by AATB or equilivant agency, and Midwest is one of those banks. I think part of MSB low cost is low overhead, it is a small bank. And no "identity release" donors so no need to do extra paperwork following up on donors. Also the director is a very genereous person. Sperm is big business these days, but she doesn't seem to take advantage of that. And one more MSB tidbit, her vials have a lot more in them than other banks.

[TheGirls]

Thanks so much everyone!

I definitely will do all the tests, and probably will do the IUI at this point. Our major arguement for doing ICI at home was cost, but if it takes more sperm/time to do it that way, it's hardly a bargain. We have some scheduling constraints with my partner's work, so it would be much more convenient if I managed to get pregnant by Nov/Dec. (Starting in Aug.) That may not happen, I know, and if it doesn't we'll deal, of course. But I can hope!

As far as sperm, we had a long chat and looked at the banks again today, and I'm leaning toward Midwest. From rosesarered's post, it sounds like they are AATB certified, so I think the clinic will take them. I checked the tests and they all do the same one. California Cryobank looks like they're more stringent on the education levels, and might have more "Ivy League" donors, but that's not really important to us. I suspect a major reason for the price difference is the size of the catalog - Midwest has a pretty small one, but that's not a problem for us.

Thanks rosesarered for the inside info!

[FtMPapa]

Originally Posted by TheGirls

Thanks so much everyone!

As far as sperm, we had a long chat and looked at the banks again today, and I'm leaning toward Midwest. From rosesarered's post, it sounds like they are AATB certified, so I think the clinic will take them. I checked the tests and they all do the same one. California Cryobank looks like they're more stringent on the education levels, and might have more "Ivy League" donors, but that's not really important to us. I suspect a major reason for the price difference is the size of the catalog - Midwest has a pretty small one, but that's not a problem for us.

That's been my experience, too. I chose the "bargain basement" sperm bank I have access to (I'm in Canada, so it's a bit different) and I chose them based not on cost, though that didn't hurt, but because they're the only Canadian bank - the other banks import the sperm from the US.

I don't think you get what you pay for with sperm, the only time you might is if you want a "yes" or "identity release" or "open" donor - costs more, you get a little more. Other than that, sperm is sperm, right?

[TheGirls]

Well, I went in today (CD 3) for an ultrasound and bloodwork. The u/s and hormone levels are normal, yay! Now I'm going in next week for the HSG, does anyone know what that actually does? My doc is not terribly good at explaining things at an adult level. I hear a lot of "It's just to check that everything is ok, it'll be fine!" from her. It's not that I'm worried, just that I want to understand what all these things are! She also felt a need to repeat my 5th grade health class lecture on female anatomy... My partner commented that she must get a lot of really uninformed women if most of them need an explanation of the words "vagina", "uterus", and "ovary".

They're doing an STD panel, and a test for a cystic fibrosis gene, I won't get those for awhile, but I'm not worried about those too much, there's ZERO family history of CF, and I know I dont' have any STD's.

[FtMPapa]

Originally Posted by TheGirls

Now I'm going in next week for the HSG, does anyone know what that actually does? My doc is not terribly good at explaining things at an adult level. I hear a lot of "It's just to check that everything is ok, it'll be fine!" from her. It's not that I'm worried, just that I want to understand what all these things are!

The HSG gives the doc a good look at the uterine cavity, and it makes sure that the fallopian tubes are open. If there is a blockage, they'll see it, and minor blockages may be swept out by the dye/saline solution they inject.

My only minor freak out with the HSG was when I got the results from my doctor. The radiologist and technicians told me everything looked fine...but then....

Doc: (reading the report) So the tube fell out while you were having the HSG...interesting. So they didn't use the dye, just the saline for the test...Interesting.

Me: MY TUBE FELL OUT!?!?!?! WHICH ONE? How could it just fall out? That makes no sense.

Doc: Oh, no the tube they put the dye in with.

Me: Oh, the catheter, not my fallopian tube!

Doc: Um, yeah, the catheter. (looking at me like I'm crazy.)

Hey, it was a test to look at my fallopian tubes! When I hear "tube" I'm going to think fallopian, not catheter!

[sasshell]

I didn't go to a fertility clinic because I didn't feel like all the extra tests were needed. Short of a Pap Smear and regular annual type exam, we decided against everything else. I also found a regular doctor who was not associated with a fertility clinic; just a regulal OB/GYN practice who was happy to help out!

I let them tinker with my cycle the first month, including an u/s to check my ovaries, as well as a shot of something to ensure ovulation, and it was a huge waste of money. They did the IUI 2 days before I thought I was ovulating, the IUI was extrememly painful and I ended up not getting pregnant despite spending a ton of money.

My doc was okay with following my protocol the next month, which included nothing more then a OPK at home and back to back IUIs when I was ovulating. It worked like a charm, painless, and I prefered spending the extra money on a 2nd IUI instead of a worthless u/s/ And when I say worthless I mean in my situation, which was one of no fertility issues. No doubt they have a point, just not in my situation.

GL!