I Need a New Ob/Gyn

Hot damn, it really pisses me off when doctors get all doctorly on me. Below is a message thread between me and Dr. A.  When he didn’t respond within the given timeframe, I emailed him again and got a less than satisfactory response from a delegate, Dr. H.

The good news? Dr. H concurs that my FSH was not reliable.

The bad news is that for some reason (which still hasn’t been explained) Dr. A wished me to proceed with Clomid.  Annoyingly, my request to have new labs done on CD3 was ignored: I didn’t have enough character space in the message box to say this, but CD3 blood labs will be a couple hundred dollars, compared to my out-of-pocket costs of $1,200 for an HSG + $153 for semen analysis + $1,000 for Clomid.  Isn’t it prudent to go with the more cost-effective test that may even eliminate the need for unnecessary, invasive, embarrassing and expensive procedures?

When I was sitting with Dr. A last week, I felt like he was painting a picture of doom and gloom.  He gave a little Hmh. when I said I came off the Pill last August — I felt like he immediately drew a negative conclusion, so I pointed out that I conceived quickly, and that some of this past year was taken up with a pregnancy and then my cycle not returning, but maybe he wasn’t listening.  I also told him that my stage II endo was on my bladder and in the cul-de-sac and that at the time of my laparoscopy in 2001 my doctors said that my reproductive organs (specifically, my “fallopian tubes are open”) were “unaffected and that [I] shouldn’t have problems conceiving.”

Yet, Dr. A wants me to go on Clomid.  His concession was that I could try au naturel for a few months.  If, in his medical experience, he thinks that my age, endometriosis, and desire to have a baby makes putting me on Clomid worth it, then… well, okay.  I mean, I’ll do what it takes, of course!  I just feel like Dr. A wants me to pursue a more aggressive form of treatment that is based on skewed data and nothing more than a negative.  Not to mention, it will costs thousands of dollars because none of these tests are covered by my health insurance, not even the prescriptions.

NOT HAPPY.

I think I need to find a new ob/gyn.  One with whom I can have a conversation.  If you’re in San Diego and love yours, please let me know…

July 30th

Hello Dr. A,

I’ve been doing some reading on FSH levels and it seems most people have theirs tested on Cycle Day 3. My result of 11.7 was done post-miscarriage and before my cycle returned. There was no indication in the results that this is a concern. Is that figure reliable? Should we test again on CD3?

Thank you.

August 7th

Hi Dr. A,

I don’t know if you received my message from last Tuesday, but I would like to have my FSH and other hormone bloodwork done on the third day of my cycle. (The results you saw were from 5/20/13, about 2-3 days before I ovulated–surely my FSH would have been at its highest then?)

I’d be grateful if you would put the order in the system. If I don’t hear from you I will follow up by phone.

Thanks!

Lauren

August 8th

Good morning Lauren,

I apologize for the delay in replying. I had sworn that I had replied to you earlier, but I guess I had not. My name is Dr. H and I am Dr. A’s oncoming fellow.

I see your blood work and results. I do no believe that those labs actually need repeating. Even with those results, it appears that we will be proceeding with Clomid trials. Since this is the lowest form of stimulation, repeating your Day 3 labs would not change our management. You are correct that your cycle day ~26 or so [ed: CD26? more like CD12!] would not be the correct values, however in your case repeating them is not necessary.

Please let me know if you need anything else. This was the plan from Dr. A’s notes:

HSG and Semen analysis, AMH

The AMH and HSG have been ordered for you. Please call radiology for the HSG and go to any UCSD lab to have the AMH drawn and let us know when the analysis is complete.

Take Care,
Dr. H

August 8th

Hi Dr. H,

Thanks for your response. Unfortunately, I remain confused.

1) Since you confirm the results are “not . . . the correct values,” why do they not require repeating?

2) Given these incorrect FSH results, what else about my case leads you to continue with your proposed Clomid trials (i.e. on what other data are you basing your decision)?

3) Could you please put in an order for an FSH test anyway?

Thank you!

Lauren

UPDATE

Dr. H just called me.  He didn’t have the whole picture and had understood that I wished to proceed with fertility treatment. I explained to him how I thought Dr. A may have understandably assumed that my FSH test was done on CD3 and based his recommendation for Clomid purely on that. Furthermore, Dr. H was of the understanding that I had had trouble conceiving (no I didn’t, I told him, the first cycle we tried where I wasn’t sick and we timed intercourse perfectly, I got knocked up!) and had experienced infertility for 6 months (uh, no, I corrected, mine was a missed miscarriage that lasted 3 weeks, after which my cycle didn’t return for 3 months!).  I was glad to be able to set him straight.  Seems like proceeding with Clomid is not necessary at this time. Best news of all, he said that my FSH could only get better by testing on CD3. And, as I requested, there is an order in the system for me to have FSH, AMH, and estradiol tested on CD3.

That is, assuming I didn’t get pregnant this cycle ;) I’m hoping my brush with infertility is nothing more than a scary door I saw begin to open, and close again.

I think the moral of the story is: Stay on top of your medical records. Do your research.  Learn how to have a conversation with your doctor.  And self-advocate, self-advocate, self-advocate.