1st appointment with Reproductive Endocrinologist

[starkyld]

What should I expect from my first appointment with a Reproductive Endocrinologist? I suspect that I may have a borderline luteal phase defect and want to be specifically evaluated for that in the least invasive ways possible, definitely starting off with appropriately timed bloodwork panels and maybe a diagnostic ultrasound. I'd really like to delay getting an endometrial biopsy until it seems truly necessary. I'm also inclined to want to treat this dietarily rather than through progesterone or hcg injections.

Am I opening myself up for lots of pushy interventions by even pursuing this avenue?

[avocada]

I don't have an answer, starkyld, but I'm jumping in because I would like to know the answers to this, too. We've been TTC about 2 yrs and I've had the occasional random hormone test, but no "full work-up," whatever that is. I'm finally going to sched an RE appt, but I'd like to get whatever diagnostic things done that I can first, without going directly to meds. (Several yrs ago w/ ex-H, I saw an RE who immediately prescribed clomid without many (or any? can't remember) testing!!! So it negatively colored my experience and these years later it's taken me a while of ttc to come around to the RE idea again.

[starkyld]

avocada, I think that it would definitely be a good idea for you to see a reproductive endocrinologist soon. You've been trying to conceive for a good bit longer than I have. Have you been charting?

Along with being uncomfortable about the possibility of pushy interventions, I'm simultaneously worried about getting scoffed out of the doctor's office, because I don't fit a typical infertility pattern at all. But still I'm concerned about my past cycle history and really want someone knowledgeable to review it with me before trying to conceive again. It broke my and my husband's hearts to go through our miscarriage and I don't feel secure in trying again without getting my hormone levels checked out. My midwife is great, but I'd really like someone more experienced in looking at cycle irregularities and hormone panels to work with me on this.

I just set up an appointment for 2 weeks from today and I'm already nervous that I picked the wrong place. It's stressy.

[dachshund mom]

I asked this last month and am happy I can now post an answer for you.

We got a packet in the mail with forms for our medical history. Mine was 3 pages, DH's was 1 page. Last Thursday DH and I went in for the first consultation. We met the dr in an office and she went over the histories with us and brought out a chart of common infertility problems and we talked about where I fit into that (no ovulation obviously). Then we went into an exam room and she did an exam and vaginal ultrasound. DH and I both had appts today for SA for him (allowed to bring in from home) and blood work for me. She wanted fasting, so we didn't do it at the first appt. It didn't matter what CD I was on as she only wanted to know why I wasn't ovulating for now, not how to get me to ovulate (her words). DH is being tested so we don't waste a lot of money if he isn't working, and because it's so easy.

We go in again in two weeks to talk about the results and get a plan of action.

[kdcraig]

Prior to going to my RE my regular OB/GYN had already done a base line day 21 progesterone test (low) and my hsg (normal) and my husband had already had his SA (low volume) and a full workup by his urologist (blockage on one side).

My doc and my husband's doc both sent our records to the RE BEFORE my first visit.

Now this is what happened at my first RE visits.
We went through the long evaluation form I filled out before coming in. Then we discussed what he felt like my issues where and gave me my options (Clomid IUI, Injectable IUI or IVF) and told me what he felt my chances where but he did point out that after some test he may have to alter our plans and it could change our chances of success. Then I had about 3 vials of blood drawn for testing and they did a vaginal swab for more testing. I was told to call them on the first day of my next cycle and they would schedule my day 3 blood work and ultra-sound.

[wantbaby]

I think it depends on the RE. If yours happens to be pushy, probably he might not be the one for you. Mine was not. He was very understanding. But they seem to be enthralled w/ statistics . Sometimes I wanted some questions answered and all that I would get is numbers after numbers which I do not care about at all.

[mischievium]

Originally Posted by avocada

I don't have an answer, starkyld, but I'm jumping in because I would like to know the answers to this, too. We've been TTC about 2 yrs and I've had the occasional random hormone test, but no "full work-up," whatever that is. I'm finally going to sched an RE appt, but I'd like to get whatever diagnostic things done that I can first, without going directly to meds.

What my pre-RE workup has/ will include is:
1. CD3 bloodwork (should include Estradiol, FSH, LH, Prolactin, DHEA, and testosterone (free and total)).

2. 7DPO Progesterone-- also called "cycle day 21 Progesterone"-- but you should only do it on CD21 if you actually ovulate on CD14, for me, the first cycle I did it, I didn't ovulate until CD23 so a CD21 Progesterone would have been useless.

3. Semen Analysis

4. Baseline ultrasound-- to look at ovaries and uterus.

5. Hysterosalpingogram (HSG)-- to check for patentcy of the fallopian tubes and the uterus. Some women also end of up getting a hysteroscopy.


Now, obviously, the results of these tests can lead to other tests-- for me, I was referred to a regular endocrinologist from the results of my CD3 bloodwork and my husband was referred to a reproductive urologist (RU) from the results of the SA. Only after getting the results from the RU were we sent to an RE, all of the above tests and referrals were done by my regular OB. I actually haven't had the HSG yet, but when we had a phone consult with an RE, she said I would need to have one done before starting IUI or IVF.

[avocada]

Thanks, everyone. I now know a lot I could possibly get done at the OB, (we have two in my small town), before making the drive to the big city (3 hrs away) for an RE. So I'll make an appt here first. (I've only been going to a NP for my annual exams-- I don't have a rel'p with an OB here yet.)

I guess I might ought to have gone to a regular doc sooner; I've just had a confusing history, plus those early negative experiences.... But if I get scolded I'm going to have to employ some radical patience to not quit the process. I guess I'm dreading the scolding ("you're 38?! what a moron, I won't give you very good odds...") before it even happens. Rrrrr. Calm, calm, calm.

[starkyld]

Calmness is good.

I have an appointment with my local midwives a week from today and my first appointment with the reproductive endocrinologist a few days later. Her office sent me a lot of paperwork that isn't relevant to my needs. I did explain what I was looking for to the receptionist and did manage to get an appointment set up, so I'm hoping that she'll be able to help me. We'll see.

[avocada]

Good luck, Starkyld. I hope they do what you ask.
I'm waiting til my DH gets back from several weeks of field work-- he'd like us to go together to the first appt.

[starkyld]

The reproductive endocrinologist thinks I have PCOS. I'm having bloodwork next cycle to investigate further. I'm supposed to have serial ultrasounds too, but I'm going to be away travelling when they were supposed to start, so maybe that won't be possible.

Sigh.

[avocada]

starkyld, what led to the possible PCOS diagnosis? Something in your bloodwork or something else? Hang in there and just go with the process. I know the travel issue. DH and I have had to miss many important mid-month trysts in the last couple of years because of distance. It's really frustrating to watch that day go by. You might consider letting the powers that be know you have an important, time-sensitive medical thing....??? But I know that's a tough thing to do.

I've made my first appointment with RE for June 30, and if DH is not away at work, he'll be coming with me. And no med people in my little town know what I"m talking about with the list of labs that I could get pre-RE (thanks for the list, mischievium!), so I'm getting it all done there (RE). But, that took some frustration. I made the appt with the front desk for 1st available, then noticed it MIGHT be on my cd2 but could be on day 26 or so (depending on variable cycle length), so I called back to see if I could make another appt for a few days later (dep. on cycle), but NOT cancel the other one, and go closest to cd3 when I know.... Receptionist first informs, then insists, that the dr only does consultation on the first day, no labs, no tests (regardless of my situation of driving 3 hrs there and 3 hrs home) ...:... But finally I spoke with a nurse and she scheduled the two appts, and bloodwork and even an U/S for my first appt, AND told me the cd3 BW has a 5-day window, tho they don't tell people that, and they can do the US when bleeding too, tho I certainly won't want to take a day trip on cd1. She was so nice and accommodating, I wondered later (after the warm fuzzies dissipated a little) if they do the good cop/ bad cop thing on purpose.

I, too, am hoping for some real answers, and not just statistics and standard-issue invasive options. So I'm excited about the first appointment, but guarded and waiting to see how it goes. My old TCM had been wanting me to get some western-med-style testing done to help him in my treatment because he felt he was hitting a wall... He said "western medicine excels at diagnosis, and eastern medicine excels at treatment." But I didn't get any then. Now here I am. Good luck to both of us!

[starkyld]

avocada, she diagnosed me based on my history and appearance. That hurt my feelings a little bit, because I had felt like my chin hair and weight distribution were within healthy variation, but I have to admit that the constellation of characteristics fits. By the same token, though, she and I both seem to think that it's a good thing that I ovulate on my own, so that's a start.

Based on where my cycle is now, it looks like I'll be able to get my cd3 bloodwork before I leave for my trip and my 7dpo bloodwork when I get back. She wanted to start serial ultrasounds on cd13 and I'll be gone until cd19, so I don't know that it will be possible for me.

There's not really a way for me to change my trip. I'm going to Japan to present at a conference and then to Thailand for a couple of days afterwards. I'm not thrilled about delaying the ultrasounds until the following month, especially given that my insurance situation is a little twisty, but I can accept it. I'm really glad that it looks like it'll work out for me to have my bloodwork done.

[avocada]

At least your cd3 and 7dpo bloodwork is a good start! But waiting sucks. Have a good trip. I'll let you know how my appointment goes.

What have your midwives said?

[starkyld]

My midwife in NY is supportive of whatever I choose to do and can see that I could maybe use some medical help in the first trimester. I'm still hoping for a smooth pregnancy and homebirth after that, fates willing.

I don't know if you saw my other post, but I'm having spotting at 7 & 8dpo right now. My husband and I were going to skip trying to conceive this cycle but had a moment of deciding to just go with it and then I had my temp rise the next day. I got in touch with the reproductive endocrinologist and I'm going in on Wednesday for a beta hcg, progesterone, and ultrasound. It might not be implantation bleeding--it could just be things still being all wonky for me because this is my first cycle after my miscarriage--but I've never spotted a week past ovulation before and I'd want to find out what my options are early on if I am actually pregnant.

[avocada]

That's odd, I spotted my last cycle on 7or8dpo too. First time that had ever happened, so of course I got ~tentatively~ excited about implantation spotting.... And then AF came. Good luck with YOUR 2ww! I'm at the beginning of mine (meaning I'm driving 4 hours tonight to meet DH, and probably will again on Thursday... And at the same time I'm gathering information packets from adoption agencies--- DH and I decided what is most important to us is nurturing and raising some kiddos, not necessarily making our own--- and I just HAVE to take some of this pressure off!!!

[starkyld]

I am officially Not Pregnant this cycle. I'm okay with that; it gives me more time to get healthy before trying again. I've been massively limiting my refined carbohydrates and am really hoping that this helps.

I hope you enjoyed your evening with your husband!