and the verdict is…

My appointment with the fertility specialist went perfectly. I had been so fucking nervous, scared that my mental diagnosis  (schizoaffective, bipolar type) would slam yet another door in my face. The doctor was unlike any doctor I’ve seen since I first sought a pre-conception appointment with my GP at thirty-five. And I’m a strong-willed, difficult patient, basically walking in off the street with an Interwebs researched plan and a list of demands. She took it all in stride. I think I love her.

My husband took off work to accompany me to the appointment. He really is a great guy and didn’t get frustrated when I started wailing at him for being unshaved and sporting his work clothes–since he is a screen printer and it is a hot day, he was sporting camo long shorts covered with ink and emulsion  (the emulsion stains his clothes blood red, so he basically looked like a transient who had just butchered a dead cow or something). The waiting room was devoid of patients; it was lunchtime, and I had anticipated encountering at least a couple preggos (ahem, trigger city).

So a medical assistant took my vitals, my normally treacherously low blood pressure was through the roof. “I’m not worried,” I told her, “it’s usually very low but I am extremely nervous.” She smiled at me, explained that the appointment would mostly be a lot of talking. “She might want to do a manual exam,” she advised, handing me a paper sheet. Great, a semi-naked convo about my last two years of tragedy.

I’ll be clear: this appointment was my last ditch effort. I realize the odds of having a healthy baby at this point are scant, and was not pinning all my hopes on the outcome. I am also a disabled Medicare patient and cannot afford aggressive treatments. I didn’t want a lot of testing, I’m fairly confident that I am a DOR  (diminished ovarian reserve) patient with shitty remaining eggs, and I can’t afford to deal with that with donor eggs or IVF with PGS testing. I have a single year left to conceive a healthy baby and I am hopeful yet realistic–all I want is to try oral medications to improve my chances of catching a golden egg.

The make-it-or-break-it point with this reproductive endocrinologist–revealing I am on multiple medications to control a psychotic disorder (my official diagnosis is “schizoaffective, bipolar type”). Start spitting out a word that starts with “schizo” abd even trained medical professionals’ eyes will fly open in alarm. This doctor did not flinch. She said she was unfamiliar with the diagnosis, so I explained what it meant and she took it at face value, even deferring a bit to my greater familiarity with my illness. She asked compassionate, thoughtful questions on how I was managing my symptoms and if I had a plan in place to take medication that would be safe during pregnancy. I didn’t feel like I was being judged, or that she was uncomfortable treating me (I once had a dermatologist refuse to prescribe me ointment for poison ivy because he was not comfortable with my psych meds). I felt really safe discussing this with her.

“Well,” she said, “I think your plan is perfectly reasonable.”

She agreed that CD3 bloodwork, AMH and AFC would likely reveal DOR. “With your history, I would probably end up recommending donor egg IVF, but I see you’re not interested in that.”

I can’t afford it, financially or emotionally, I told her. She didn’t make me feel shitty about being poor. 

“The oral medications we use are Clomid and Femara,” she said, “Did you have a preference?”

I explained I’d like to start with Femara, because of less side effects for a shorter duration. I’m terrified of mood changes–I am severely bipolar. We talked about this and she called in a script for me. 

I got exactly what I had wanted, plus compassion to boot. Doctors have in the past been terrified to medicate me. I’ve been dicked around a lot since my ttc (trying to conceive) journey started in 2013. It was finally time for me to catch a small break.

Now, where are those jeans I ordered from Free People?

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13 thoughts on “and the verdict is…

  1. Glad it went well. What do you mean though by you only have a year to conceive a healthy baby? BTW the side effects of Femara/Letrozole were shit for me – everyone has different responses to meds, and for me I was in massive full-body pain for several days on it. The reason why I took it instead of Clomid when we did our IUI the first time was because it was covered by insurance – because it’s normally used for breast cancer patients…the pharmacist made a judgy comment about “why would a doctor only put someone on it for a week” (btw the second IUI, I did Bravelle, which is the next level above Clomid & Femara, which ironically got recalled later in the year and I got my money back, but of course by then I was well into DEIVF…).

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    1. I’ve given myself until I’m 40 to keep trying. I know 40 isn’t a hard date after which conception is infeasible, but I have not been able to take adequate medication to control my illness since I first went to my GP at 35. I also now have ptsd from my tfmr, and I cannot keep going like this for much longer. I can’t afford to financially, either. Ugh.

      I’m very concerned with side effects from oral meds. Full body pain sounds horrible! I chose to start with letrazole because it isn’t in your system as long as Clomid, and I’m mainly concerned with mood changes, being bipolar. None of the OBs I’ve seen have been willing to prescribe anything, so trying this and will switch to Clomid after 3 months if it doesn’t work.

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      1. Glad you took the first step so at least you’ll know what your labs look like. Did you get your thyroid checked as well? (I didn’t learn until several cycles in that TSH needs to be below 2.0 to minimize miscarriage risk due to thyroid, so I always share this with folks who’ve gone through loss like I have).

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      2. I had TSH checked after my last miscarriage in April and it was normal. I’ve heard you should get a full thyroid panel though, and I haven’t done that…did you? Supposedly I should have free t3 ad free t4 checked? I’m not super worried about it since the last loss was due to Trisomy 4, but maybe I’ll ask more about it.

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      3. Yes along with my T4 and T3 I also had my thyroid antibodies checked. It took about a year to get the first two under control but I never was able to get the antibodies under control which were through the roof, and are what my naturopath believed might be contributing to my infertility issues (lack of implantation, etc). When I would go on estrogen to mimic pregnancy hormone levels in preparation for the embryo transfer, that’s when my thyroid levels would go through the roof and then they would calm down after I was off of the drugs. They said every pregnant woman’s TSH levels go up during the first trimester but mine was out of control.

        A lot of doctors will just tell you to have your T4 because none of the others count but there are others who say absolutely get a full panel – especially with repeat miscarriage. I always figured since it’s such an easy test and thyroid tests are covered by insurance that you might as well, right? There’s a really good website called Hypothyroid Mom that investigates and shows research on everything which is what I really relied on when I was trying to get mine under control (and my fertility doctor was apathetic… As he was about everything has he never wanted to change any protocols).

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      4. Hmmm…interesting about how estrogen made your thyroid go wacky. I’ll ask about a full thyroid panel…did you RE order it? I’m sorry, it sounds like he wasn’t receptive to your concerns.

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      5. No actually my naturopath ordered it but you can request really any doctor to do that (I had my gynecologist do it years ago and have had my fertility doctor order tests as well, since they just send them out to a lab either way). Yeah it seems like each fertility doctor thinks they are the only expert in their field so some can get pretty stubborn.

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      6. Have you done all your treatments in Portland? It’s great you’re working with a naturopath, I wish I could afford that. I’ll ask my re, but maybe Medicare would be more willing to cover it if I just have my GP do it. My ob/gyn and I seem to have a mutual loathing for each other.

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      7. Yes… We got a second opinion at another clinic but the guy running that clinic was the devil as far as I’m concerned, a real piece of shit human being. Holistic care like acupuncture and naturopathy are covered by my husband’s health insurance (I think they’re realizing that those types of providers actually bill for less than standard doctors, and you can still get a lot of medical care from them). Yes definitely have your general practitioner order those tests, they are traditionally the ones who would, I just have rarely found a GP that I don’t loathe haha… Nothing like waiting 8 weeks to get in for an appointment only to be given 10 or 12 minutes by most General Practitioners.

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