Meeting Dr. Puzzle

My first appointment with the RE (Dr.Puzzle) went pretty smoothly, well until the morning after when a had a mini-freakout. More on that later. So, I think I really like Dr.Puzzle, but he also seems to be a bit hard to read. I felt very relaxed with him, which is great. I'm the kind of gal that only goes to women doctors for her annual poking and prodding. I thought it kind of sucked that the majority (Like 95%) of REs out there are male doctors. I thought it would be a problem, but he was very relaxed and I felt really at ease with him.

The reason I call him Dr.Puzzle is because during our consultation he'd give me these looks, almost like he's giving me the evil eye. Kind of like if he looks at me a certain way I'll give up the key to my problem. It honestly was a little off-putting. That's when it dawned on me that he sees it as a puzzle, trying to look at it from different angles. He loves a puzzle, and a puzzle is what I gave him!

So, a bit of our history he wanted. We're both healthy, under 30 and unsuccessfully TTC for almost a year. I showed my charts which easily show that I ovulate, on average, between CD14 and CD16. No spotting, no difficult symptoms, no low or high temperatures and LP is normal. In fact, he wrote "Excellent Charts" in his notes. DH's numbers are a bit on the low side, but still normal. I got acquainted with Wandy rather quickly, and unexpectedly. Ultrasound showed everything was perfectly normal and he even showed where I had ovulated from my right ovary and pointed out the follicles that were still visible. The best looking ovaries he'd seen all day.

My case baffles him. I have mixed emotions about that. For me, the unknown is more scary and more frustrating that anything else. The diagnosis I would loathe to hear, "Unexplained Infertility". I know it could be worse, which is why I am comforted that it still looks like we're good to go, just that our number hasn't come up yet.

He asked me what I thought might be the problem, and I said I didn't know, that this is what is frustrating to us. I should have stated my position right there, that the reason I was there was to find a diagnosis and not just throw treatments at it. I was enamoured by the fact that I appeared to be fine (I was afraid I had cyst on my left ovary). Dr.Puzzle doesn't see the need to medically try to induce ovulation since I appear to be doing a capable job on my own. His recommendation was to head into an unmedicated IUI, and that he thinks the problem might like in the motility numbers and that IUI is all we'd need. At roughly $200 (!!!!!) a pop, not a bad deal at all.

We had a bit more conversation where we got to know Dr.Puzzle and his practice a little more. We met with someone from billing about insurance and fees and what not. That's where we learned that IUI is closer to $800 after all office visits, that the $200 was just the IUI procedure. IVF is $12,000-$14,000, which includes everything and cost depends on what stims are used. Insurance, of course, does not cover treatment at all. Then we waxed unpoetically about frustrations around the politics of it all.

I was instructed to call at CD1 IF it arrived (FX that it doesn't) and to call again the day I ovulate to get in for the IUI. It wasn't until after I left the office that I hadn't spoken about wanting a diagnosis and not just a treatment plan. Apparently it was bothering me more than I thought because when the cat woke me up the next morning I couldn't get back to sleep.

My biggest fear, that he had given an official diagnosis of infertility and that we'd go through with the IUI or several IUIs only to finally get an HSG scheduled and find out that I have blocked tubes. Almost $1000 a try, and then have to pay for the HSG out of pocket on top of it? It only makes sense to me to try the HSG first since insurance will cover diagnostic tests, plus HSG can help increase fertility by cleaning out the cobwebs.

So from 5am-8am I fretted about the fact that I'll probably not get the test done and that he's already flagged me for infertility. I left a message with the receptionist who called back a few hours later, and calmed me a bit. The visit was not coded for infertility and she'd pass the message to Dr.Puzzle after she got his dictated notes. Hopefully I'll hear something before CD1

RE Future

Last week I scheduled an appointment with an RE (Reproductive Endocrinologist) at a well reputable fertility group in town. I got a chance to talk to the receptionist that was very kind and helpful in answering all my questions.

I have to keep reminding myself that it is not too soon and that I am not moving too quickly. The appointment is in mid-May, and it's more of a "get to know you" appointment to figure out our options, what kind of treatment or testing we'd like to do, that kind of thing. Mostly, I'd like to get out of it the knowledge that we are doing everything right or what we could be doing to improve our chances before dealing with ARTs.

One of the recommendations on his website is taking a daily baby aspirin. I've heard of this treatment before, but I had heard its use in those with reoccurring miscarriages. It is also supposed to help with the thickness and quality of the uterine lining apparently. I've seriously considered adding it to my regime. Anyone had any experience with this?

New plan of attack

We had an interesting discussion today over breakfast. I mentioned a book I was reading, "How To Get Pregnant", and how informative it is. The title got a little chuckle from DH, of course. :)

Over breakfast, I think we came to an understanding about TTC and the future. I feel a bit bad because I feel I pushed DH into seeing a urologist. It had been 6 long months while I was regular, like clockwork, we still weren't pregnant. DH did some research and it really started to kick in how important it was for him to change his lifestyle a bit as well. I think I was afraid that if I didn't keep up the momentum for him, that he wouldn't get around to seeing anyone. I know it wasn't the easiest thing for him to do, but honestly it was going to be the easiest thing for US.

The urologist released him from care with borderline numbers but no diagnosis for male infertility. Lifestyle changes seem to be slowly improving and I'd like to try for a bit longer before dealing with ARTs (Assisted Reproductive Technology). Surprisingly, he seems to be on the same page. He was eager for me to get tested earlier, so I'm not sure what has changed.

So, now we have a new plan of attack. We're going to keep up what we are doing now until July and then seek out diagnostics. July will be 1 good solid year of trying, then we will learn if ovarian stimulation will help, or if it's suggested we go onto IUI/IVF. Of course, if its the latter then we'll have to wait until we've saved up some money. I love the health insurance that I have, but it sucks that it doesn't cover any infertility treatments. Of course, there's always the Medical Flex Spending account.

BTW, I just joined the 2ww club. Currently 1DPO *Fingers Crossed*

Hormonal Imbalance

That's all I can describe what I am going through right now. I don't know it's even an imbalance, its just affecting my mood. PMS, only it's Post Menstrual Syndrome. I am on CD9 as of today and on this cycle day for the past 3 months I have noted emotional on my chart.Its the same emotion too, just a sudden mood drop. Not a bad mood, just really feeling down and sorry for myself.

It looks as though my body is gearing up to O on CD14 again, like last month. DH's SA is tomorrow. I have second thoughts about having it right before O, for two reasons. First, it kind of cuts in a bit on our timing, and second for not doing it is that I don't want to feel hopeless before BDing. This SA will probably give us a solid diagnosis. If numbers go up, then the fever is the culprit but if they don't then it's male factor infertility (as far as we know, it could be me too but we haven't done the testing yet).

We haven't discussed yet, or thought much yet, about what we're going to do if we do need to see an RE and if we do decide to participate in ART. I think partially because we don't want to get ahead of ourselves, partially denial that we are having problems. It weighs on me, but it's something I will force myself to think about after this weekend.

I really feel the need for some time off to sort through some feelings. I've been so busy with work lately, I really need some time to decompress. It might just fit in with some plans before we decide to go through with ARTs, or perhaps a second babymoon (which might be a bad thing considering the first one delayed O, which we likely missed).

*sigh*
I just feel so stretched, so thinly spread. I'm so tired.

Happy Valentine's Day!

Me and my two loves

DH and I celebrated Valentine's Day yesterday since my sister was bring over her LO, who is 4. DH is so great with her, which left time for my sister and I to catch up (and for me to work on her computer). The 4 of us ate a heart shaped pizza for dinner.

The day before, DH and I did some shopping and had dinner with my parents. How romantic, yes I know. We've been celebrating all week really, just doing little things for each other. DH surprised me with flowers on Friday and I surprised him with an edible arrangement on Saturday.



Cycle Update
I'm currently on week 3, or 9DPO. My temps are sporadic, and never really established so its really hard to tell how the cycle is going. I'm maintaining cautious optimism. The Dr gave us a 15% chance of conceiving with DH's numbers and if my hormones are playing around with me this month, then I'm sure that's even lower. After all we're already at a bit of a disadvantage because of needing to watch our timing and getting a + OPK 2 days early.

I've been getting twitches in my lower abdomen lately, which is hopeful yet confusing. I'm trying really hard not to read too much into things. My bbs are starting to get a bit sore and I've been wanting to go to bed earlier every day, but other than that I've not felt anything special. No PMS even, but the week is still young.

To keep my days sane, I am attempting to not chart my temperature until the evening, before I go to bed. I'll take it in the morning still, but I won't check the thermometer until I go to bed. That way I can get out the emotion, get some sleep, and then feel hopeful in the morning. I'll report back my findings, and if I'll be doing it again. I'm going to do some research on my charts to determine would be the best time to start it. I'll have to check when my cycle temps start to get rocky. I'm thinking of starting it tomorrow, but since I have the day off I'm not sure that I can resist. :)

Ah yes, I also got the "are you" question today from my sister. We were talking about vitamins. I told her I was taking a prenatal at night and she interrupted me with a, "because you want to or because you have to" inquiry. LOL! Well, I've been taking them for a year now...

(Pro)state Of Mind: Anxiety

We met with my Urologist the other day to discuss the results of my "sample" and have my hormone levels checked. We didn't see the nurse we spoke to last time. The new nurse was kind but cold. The doctor met with us and though he answered our questions he also seemed distant and cold. We were both surprised by some of the information he gave us as it seemed to contradict thing that we had already "learned".

According to the doctor position is not a factor in pregnancy. His statement was, "As long as the man can ejaculate into the vagina that is all that matters". My wife has been in the habit of laying with her hips elevated for 15 to 20 minutes after ejaculation, a practice he suggested was unnecessary and a waste a time. He did say that hot baths can be an issue but that hot showers, sleeping under a heated blanket, or even sitting on a heating pad would not affect semen.

After answering some questions he moved into an explanation of the numbers and what they meant. For he most part my numbers are good. One number was a borderline and the other was a little low, all others were average or above. Apparently I have viable semen they are just sort of directionally challenged. If you know anything about me this extremely funny as I myself am directionally challenged. We had kind of hoped or expected that he would lay out at least some sort of preliminary plan or suggestion but he offered no advice on how to proceed.

In the meantime he wanted to do a physical checkup and blood draw. I'm not that fond of needles so I wasn't looking forward to the blood draw, but after the physical checkup it didn't matter quite as much. The check up was pretty much routine at first, stethoscope on the chest and back and listen to you breathe. I've never been sure exactly what it is they hope to get from that but I am used to going through motions.

After examining my chest he told me stand up and drop my pants! No one had mentioned this part before but what are you going to do? So I stand up and drop my pants and proceeds to examine my penis and testicles. A few turn your head and cough's later I assume were done and I can try and put my anxiety behind me. As it turned out my assumption was incorrect, as I started to pull up my pants he asked me to turn around and bend over. I can honestly say that the only thing worse than a prostate exam is a surprise prostate exam.

I have heard the funny stories from adults and comedians and their personal experiences and I honestly assumed they were subject of exaggeration. The whole thing never seemed like that big of a deal, but then I had never had one. I can share the details of the procedure if someone wants to hear them. I will say I was definitely not prepared for the experience and had they mentioned it I might have actually read a little more about the procedure and what to expect. I think the doctors execution of the procedure made it a little more uncomfortable than it needed to be. Immediately after he finished he got up and went to the door and started to leave. I am glad he had the presence of mind to push the door back closed and wait for me to at least pull up my pants. As it was he almost treated the staff to a nice image of my hairy butt bent over a table. Though honestly I don't think anyone there would care.

We have another appointment scheduled for next week. I am to give another "sample" and then in 1 hour we will meet to discuss the results of the blood work and the comparison of the two samples.

What Is Dignity For?

My wife and I decided before we got married that we want to wait for a while to have children. Our life was still hectic and uncertain and while you often hear, "If you wait until your ready you'll never have kids", we decided to trust our instincts. Years passed and time brought with it stability and finally we decided we were ready to start a family.

It was all fairly simple in my mind; we decide to have children, we "mate", 9 months later we have twins. I was fairly certain the entire ordeal would only take one shot. When our first attempt failed, I was playfully indignant but I figured next time for sure. After a few months next time's were beginning to seem tiresome. We were somewhat impatient and after all everyone else it seemed was expecting so why not us? For days after ovulation we would try to read signs from temperatures charts like fortune tellers with tea leaves. Neither of us wanted to get our hopes up but I think we were both secretly hopeful.

Time seemed to drag on for a while and finally my wife suggested perhaps we take an extra step and check our fertility. The common sense approach of course being to test me first because it is simpler and cheaper. I remember as a child secretly fearing I might be sterile. I don't know why I worried about and as I got older I eventually put it out of my mind. My thoughts wondered back to this but I eventually dismissed it. I agreed and it was settled, I would get tested. After some gentle reminders from my wife I finally decided to call my doctor.

The idea of being tested never really bothered me, perhaps it hadn't sunk in. In my mind I simply imagined it as a quick "pit stop" followed by a call a week or so later confirming everything was fine. I picked up the phone and called my Doctor's office and after navigating the voice menus a receptionist answered the phone. It was in this moment, of all times, that the reality sank in. Up until this moment I hadn't actually spoken the words to anyone. Apparently whatever I said came out as a mumble, because she kindly asked me to repeat what I had said. My thoughts strayed for a moment to her voice. The receptionists in my Doctor's office are all young attractive women roughly our age and I'm about to discuss with them about having my semen tested. I reminded myself that I'm not 5 and repeated myself, "I would like to schedule an appointment for a semen analysis for fertility." She was very kind and explained that I would need to see a Urologist but because of my insurance I could just call one in my network and schedule an appointment without a referral. I thanked her and told my wife the news who then pulled up a list of Urologists in our area that were supported by our insurance.

Everything seemed by going pretty smooth. The next day I chose a number from the list and called. I navigated through the voice menus until I reached a receptionist. I started to explain that I was calling to schedule an appointment when she cut me off and told me she needed my information before we could go any further. She seemed very irritated and after of 5 minutes of questions she finally asked me what the appointment was for. Having gotten over my initial cold feet, I simply stated, "I needed to schedule a semen analysis for fertility". Her reply was, "Umm, we don't even do that here", in a tone that suggested I should have already been aware of this fact. According to her, there was only one Doctor in the that group and they didn't have an office on my side of town. If I really wanted to see him I could schedule an appointment, but it would be a couple of months out. The whole ordeal was aggravating and her attitude was uncalled for.

After a while, I decided to call a different Doctor a little farther away. After speaking to the receptionist and explaining my problem I realized all the numbers on the list were from the same group. Even though they were all Urologists, only one specialized fertility issues. The woman explained, however, that if just wanted the analysis done all I would need to do was call my Doctor's office and ask for a "Script" and then call back to schedule an appointment at a lab. Now at least I knew what to do.

As it turns out our Doctor's office takes the last few days of the year off, so around the first week of January I called and explained the situation to yet another person (Fourth time's a charm?). At this point it feels as though I may as well being wearing a tee-shirt with some catchy way of saying, "My troopers don't march!", but I've come this far and dignity was never that useful anyway. She informed me she would write down the details and speak to the Doctor and later that day they would call and let me know if he would write the "script". Once we had picked up the "script" I called the Urologist's office once again and explained the situation to another receptionist.

This receptionist didn't have a bad attitude but it was apparent that speaking with me was a chore. After confirming I had the script, she read the next available appointment and asked me if I wanted it. I agreed and she simply said, "Okay, your appointment is at the lab, don't forget your script". It became immediately apparent that this was all the information she was going to provide so I injected before she could disconnect. Now I was feeling a little embarrassed. I had assumed they would give me at least a little more information when I made an appointment, but I was wrong. So I asked, in my awkwardness, if I needed to abstain from um... anything sexual... or something for some amount of time? She replied, "48 hours", but her tone of voice told me it was more of an opinion and that she really just grabbed a common sense number that would seem reasonable so I would just hang up. I obliged her and hung up with sense of disappointment.

The problem is awkward enough to absorb without adding to it the poor manners and service. I still have a lot of questions. What do I expect? Am I just going to show up at some office to be greeted by some grinning receptionist that sends me off to a little room to ... well you get the picture? Can my wife go with me? I've heard that sometimes you can "bring the sample from home", is that option available? It feels like the onus for knowing these processes lies solely on the patient. Questions are met with the attitude, "you have the Internet just look it up". As of yet, I'm not really that nervous, but perhaps at the clinic.

All in all, if it turns out I'm fine and my wife decides to get tested, I really hope they are nicer to her than they have been to me.