Q:For all the moms out there

fitzhughh

I know it has been a while since I posted... I spend most of my time on my local board so Hello again!

My wife and I are ready for a baby. She has started tracking and we would like to make an appointment with a doctor for tests/info. How do we know if we should see a Midwife, RE, FS, ect? We know that we want to do IUI.

I think she is considered high risk b/c of her BP.

Thank you for your help.

Fitz

Mrs._F

The choice of midwife vs RE vs FS comes down to personal preference, what you have in your area, and cost.

For example, I always saw midwives for my regular gyne care, and we knew we wanted to start ttc with unmedicated IUIs.  The midwife office that I went to did IUIs for a fraction of the cost of the local fertility clinic (the exact same procedure!).

Two*True

Ditto Mrs._F - it's a personal choice.  We chose to go with an RE because our insurance covered it 100%.  I was open to taking meds to up the odds of us conceiving quickly and thus spending less money on sperm.  But that's what we felt comfortable with and might not fit others.

2brides

Ditto Two (well, except my insurance paid for nothing.)  We did 2 unmedicated ICIs at home and then went to an RE.  We started meds pretty soon after since we were hoping to conceive quickly and like Two, I was willing to take meds (which I did.)

fitzhughh

Thank you. That gives me a starting point. I know that we do not want meds unless we need them so I will start calling about pricing. I will also contact the insurance company re. any possiable coverage.

Mrs._F I also posted a question on the bump for you regarding two of your book recommendations. Which would you recommend for us just starting out? The Ultimate Guide or the New Essential Guide? We have already started TCOYF.

Thanks again!

ctbride08

as the pps said, its all based on personal preference.  we knew we wanted to start unmedicated and we also knew we had minimal insurance coverage, so we stated with a midwife practice knowing that if that didnt work, we would always have the option of moving on to an RE down the line.

Mrs._F

fitzhughh:

Mrs._F I also posted a question on the bump for you regarding two of your book recommendations. Which would you recommend for us just starting out? The Ultimate Guide or the New Essential Guide? We have already started TCOYF.

Sorry, I didn't see your post!  I bought TCOYF as well - great resource, but I mostly took away the highlights.  I knew that tracking allll the things that the books recommend would have driven me bonkers.  But it is realy great to get an understanding of the ins and outs of ovulation and your cycles.

Personally, I like the New Essential Guide (Brill).  Ms. Brill can be a bit much (like saying we should give up all refined sugar while ttc...), but I think that the information about the specifics - timing, odds, procedures, is the most thorough in her book.  There is also lots of touchy-feely stuff that you may find yourself skipping over (she goes into all the different ways to build a family - and being married and ttc with your partner, you've already decided to how to build your family), but again I think it's worth it for the nuts and bolts info. 

The Ultimate Guide (Pepper) is not as in-depth (I feel), but also not as intense (for example, she doesn't tell you to give up all refined sugar, and doesn't push multiple insems per month, which Brill kind of does).  The thing to remember about Brill is that she is writing on behalf of her midwife practice (Maia Midwifery), so her book is based on their beliefs and their approach.  While their approach certainly has been successful for many women - it isn't the only approach (i.e. people [like me] get knocked up all the time without giving up refined sugar or doing more than one insem per month).

Hope that helps!  If you wanted to get both, half.com has some discounted copies

thiswillbe

I think the pps have it covered. Just wanted to add that *if* you end up in the position of needing/wanting to take a medicated route, you *can* do that with a regular gyn (at least first-level meds, like clomid). The key, though, is that you need to be monitored on medicated cycles, and some gyns don't do a sufficient job of monitoring people. That's one of the reasons many people go directly to a RE when they find they need meds. (We were going to start with my regular gyn for our IUIs, but then found out that she doesn't do any monitoring on clomid cycles, which was an absolute no-go for us.)

thefamilyway904

Like the Two & 2brides, my DW and I are open to meds to speed up the process if the first few unmedicated iuis aren't successful. This is what led us to working with an RE from the start. I see that you are local to me. Don't hesitate to PM me if you want the name of our RE here in MoCo. We've been really happy thus far. Best of luck in making your decision!

ssg73

I agree with pp but just wanted to chime in about the bp.  Kind of made my heart skip a beat a bit.  If you think that bp is going to be an issue I would strongly sugest that you see a mfm or high risk ob before trying to get pregnant.  I didn't have high bp before pregnancy but ended up developing severe pre-eclampsia and hellp syndrome which caused me to deliver at 30 weeks.  My regular ob has told me that she won't touch me if I wanted to get pregnant again.  There are several things that they can do to keep your bp down and it might be a good idea to see a mfm before starting just to get an idea of what they would reccomend.

fitzhughh

ssg73:

I agree with pp but just wanted to chime in about the bp.  Kind of made my heart skip a beat a bit.  If you think that bp is going to be an issue I would strongly sugest that you see a mfm or high risk ob before trying to get pregnant.  I didn't have high bp before pregnancy but ended up developing severe pre-eclampsia and hellp syndrome which caused me to deliver at 30 weeks.  My regular ob has told me that she won't touch me if I wanted to get pregnant again.  There are several things that they can do to keep your bp down and it might be a good idea to see a mfm before starting just to get an idea of what they would reccomend.

 What is an MFM?

Mrs._F

fitzhughh:

ssg73:

I agree with pp but just wanted to chime in about the bp.  Kind of made my heart skip a beat a bit.  If you think that bp is going to be an issue I would strongly sugest that you see a mfm or high risk ob before trying to get pregnant.  I didn't have high bp before pregnancy but ended up developing severe pre-eclampsia and hellp syndrome which caused me to deliver at 30 weeks.  My regular ob has told me that she won't touch me if I wanted to get pregnant again.  There are several things that they can do to keep your bp down and it might be a good idea to see a mfm before starting just to get an idea of what they would reccomend.

 What is an MFM?

Maternal fetal medicine.  They deal with higher risk patients. 

I actually used to work on a medical research study that was trying to find the cause of preeclampsia.  Your doc will definitely want to know beforehand that your wife has high bp, and an MFM might be necessary for her regular prenatal care to be on the safe side.  I saw many preeclamptic patients while I worked on the study - many of them were not severe enough to cause serious problems, others, like SSG, had much more serious situations and premature deliveries.  It's the kind of thing your doc will want to be proactive about.

fitzhughh

Thank you all! Its hard to believe that I am a nursing student graduating next year and we did not learn about any of these specialists in maternal child. Do you know if the MFM will do the IUI or are there several different professionals involved?

Sorry so many questions. I just realized that I do not know as much as I thought I did.

Mrs._F

fitzhughh:

Thank you all! Its hard to believe that I am a nursing student graduating next year and we did not learn about any of these specialists in maternal child. Do you know if the MFM will do the IUI or are there several different professionals involved?

Sorry so many questions. I just realized that I do not know as much as I thought I did.

It's possible that an ob/gyn office that had both regular ob's and mfm's would do inseminations.  Probably not likely that an acutal mfm doc would do the insems, as their time is devoted to the pregnant patients that need their care.  You could do your insems with the ob/gyn, RE, FS, or midwife of your choice - but when it came time to choose prenatal care, as soon as your wife says she has high bp, it may be recommended that she see an mfm rather than regular midwife/ob. (Though I am totally not an expert - she may be fine with a regular doc, as long as close attention is paid for preeclamptic symptoms.)

We all have tons of questions when we start

ssg73

I would guess that they would not do the iui but you never know.  Many times they will put you on blood thiners such as lovenox which you inject daily.  I think you start that right away so you would want to have all your ducks in a row before starting.  Brit is right most people do fine with bp and pregnancy with clode monitoring.  I am just a bit of a debbie downer on this as I happened to be that person who develops not only high bp but also the very rare form of pre-eclampsia called hellp.  I must say that the NICU was filled with severe pre-elampsia and hellp people.  Also I truly believe that my MFM saved both my life and my babies so I guess I like err on the side of caution.  Also I have a total crush on my mfm and want to go have a consult just to see her again!  Oh Dr E how I love thee.  I wonder if she is not as hot when I am not totally doped up and have bp of 180/110???