RE Confusion and Questions (loss mentioned)

brij2006 · November 2013

So Monday after our Dr's appointment and discussion about H only wanting to go as far as using Clomid to get pregnant, I told him that I was going to call an RE and get our info transferred over. If Clomid is our only chance at having children, then I'm going to make it our best chance possible. He agreed, and I called the RE on Monday. This RE office is based out of a city 3 hours from us, but they have a satellite campus that is a little over an hour away. When I called in, I explained to them what was going on, what we had tried, and about our 2 losses. The receptionist said that she would set up a phone consultation with the RE to discuss things and the next steps.

This morning we had the phone call with the RE, and I am so confused. He had looked over my charts, blood work, ultrasounds, betas, etc. He agreed with the OB that the cysts on my ovaries are barely there now, and that he would like us to begin TTC immediately after this miscarriage passes. Then he went on to look at the testing that I had done through my OB's office (just the bloodwork & u/s). He mentioned that I hadn't had an HSG and H hadn't had an SA, but he isn't concerned about doing either one of those because he knows we can get pregnant. So he feels those tests aren't necessary at this point. Huh? I questioned this again, and he said my OB had noted in my chart regarding my first pregnancy/loss, and that's why the OB didn't have us do either one of those tests before proceeding with Clomid. Um, why didn't I know about this and why wasn't this explained to us?

So moving on, H asked him about what his protocol is for the next round of Clomid. The RE said he would prefer that we do the next round in 3 months if my cycles do not regulate after this m/c. If they do regulate, then we can try naturally for as long as we would like. But that he is okay with us doing the next round of Clomid through our OB since it is covered under insurance there. He mentioned that the 50mg worked, and as long as we're using the 50mg then he's okay with us sticking with the OB. Once we move up to a higher dose, then he wants us to transfer fully to him. I questioned about the lack of monitoring with the OB, and he said that he would send over orders for different testing throughout to make sure that I'm being properly monitored. But that he works with this OB on mulitple occasions and he trusts his work.

Yeah, so now we're both confused. We were fine with switching to the RE, paying out of pocket for everything and more testing, and he is recommending we stay where we are till the Clomid dose is increased. He said by looking at my charts and how my body responded to the Clomid so quickly, he's hopeful we will only need the 50mg to conceive again.

Would you girls stick with the OB and have the RE's orders, or push more to move to the RE? This is the closest RE to us or else we will have to drive 2 hours each direction to the next one.

seahorse01 · November 2013

I would be concerned about nobody mentioning a RLP, and the laissez-faire attitude about monitoring. But if this is what you have access to, I guess you have to make a decision on if you are comfortable with this. It doesn't sound like you will gain much moving to this RE.

seahorse01 · November 2013

Dup

Aimothy · November 2013

Can you just tell the RE you would like to transfer your care to him at this time and you realize this means you'll be paying out of pocket?

brij2006 · November 2013

@aimothy The hours that he is at this satellite office are once every other Tuesday. So he actually works with local OB's to do a lot of the monitoring and testing when he or his office aren't able to do so. That's why he told us that we could stick with our current OB because he is one of the ones he outsources to.

@seahorse01 Not to sound dumb, but what is a RLP. Obviously this hasn't been mentioned to me.

seahorse01 · November 2013

No problem. It's a repeat loss panel for recurrent pregnancy loss. Just some extra tests that might help figure out if there is a problem that can be addressed upfront before moving ahead with further tries/testing.

BruinsBabe33 · November 2013

I agree with seahorse about the RLP. I wish there was someone closer to you. That seems like a pain.

ecinereb · November 2013

seahorse01 said:

I would be concerned about nobody mentioning a RLP, and the laissez-faire attitude about monitoring. But if this is what you have access to, I guess you have to make a decision on if you are comfortable with this. It doesn't sound like you will gain much moving to this RE.

This for me as well. We pushed for this even after our first loss and then had some more testing done after our CP. There is no point in wasting clomid cycles if there is something else that can be addressed. I'd suggest pushing for an SHG because maybe there is a problem with your ute (like a polyp or fibroid) that is causing your losses as well as the bloodwork.

brij2006 · November 2013

@seahorse01 Thank you for that information. I will definitely be asking about that.

tdmd09 · November 2013

We got similar advice from our RE (no HSG or SA because I'd been pregnant before) which did kind of take us by surprise. I think if you get additional monitoring from your OB on Clomid, I'd be fine staying there. I'd also definitely ask about blood work for repeat losses. Some places don't test until after 3 losses, but I know I and several others have gotten the tests done after two. I hope you guys come up with a plan that you are both comfortable with.

Uptowngirl2009 · November 2013

I think your RE sounds like he has a good plan but I agree with seahorse about the RLP. I didn't really know what it was either until she explained it but since you've had more than one loss you definitely want to check into it. In the end, you have to do what you feel comfortable with so if you want to push for treatment with the RE then I'm sure you could. Good luck!

brij2006 · November 2013

I e-mailed the RE about the RLP, and he said he does that after 3 losses.

These responses make me feel a bit better about how he's wanting to move forward. After we got off the phone with him this morning I told H that I really wasn't sure how I felt about it. I understand he utilizes the local Dr's to do a lot of the legwork, and it's great that he makes it possible for people in our area and so we don't have to drive the 2 hours. But it still makes me a little leary.

seahorse01 · November 2013

brij2006 said:

I e-mailed the RE about the RLP, and he said he does that after 3 losses.
These responses make me feel a bit better about how he's wanting to move forward. After we got off the phone with him this morning I told H that I really wasn't sure how I felt about it. I understand he utilizes the local Dr's to do a lot of the legwork, and it's great that he makes it possible for people in our area and so we don't have to drive the 2 hours. But it still makes me a little leary.

This is a great time to be an advocate for yourself. Why wait for another heartbreaking loss to so some simple blood tests? Especially if you are willing to pay OOP.

Maybe your OB can order them?

Since you are afforded a finite amount of times to take Clomid, why not give arm yourself with all of the knowledge you can, right?

brij2006 · November 2013

@seahorse01 I text H about the RLP, and he said he would feel more comfortable if we pushed it with our OB at the appointment on Monday. So hopefully he will run the test if we push for it.

seahorse01 · November 2013

I am glad to hear it, at least you will have tried, you know? Best of luck!

DangerMuffin23 · November 2013

I agree with @seahorse01. I would chose this time to be adamant about what care I wanted/needed. Two is two too many for me. I'd want the b/w done now. I think waiting for a potential third m/c is cruel and unnecessary. I would just want what's best for you. Answers always make me more confident whether it's good or bad news because then I can move in the right direction.

CincodeMayoLove · November 2013

Am happy that you have decided to advocate for yourself Brij. You are strong and you do what makes you and H most comfortable. Don't let a doc make your situation feel "not urgent enough" GL with getting Ob/Gyn to get blood work for you.

brij2006 · November 2013

seahorse01 said:

I am glad to hear it, at least you will have tried, you know? Best of luck!

That's a good way to put it. If he feels that 3 times is the magic number and won't do it, then I guess it doesn't happen.

But I think for H he just knows he can't emotionally handle a 3rd time.

ecinereb · November 2013

brij2006 said:

seahorse01 said:

I am glad to hear it, at least you will have tried, you know? Best of luck!

That's a good way to put it. If he feels that 3 times is the magic number and won't do it, then I guess it doesn't happen.
But I think for H he just knows he can't emotionally handle a 3rd time.

The whole waiting for a third one irks me so much, I really hope your OB will do it for you. Why should you have to go through it 3 times to get a blood test. Like I said my GP ran it after 1 (at that point we'd been TTC for 18 months and done 4 round of Clomid) because I wasn't comfortable taking and paying for more fertility treatments without at least looking in to it.

RE Confusion and Questions (loss mentioned)

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