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Hmm, I don't know what to do. Warning: PG related.
**disclaimer** you may want to skip over this post if you don't have an interest in pg related issues!**
Today I meet with my OB.....well, I thought I would be meeting with my OB, but instead I meet with his new NP. She was nice, but dude, I am older than her. Not that that is an issue, but she seemed a little, how do I say this nicely, clueless about fertility issues.
My expectations were all wrong at this appointment. I thought I would be going in to get a prescription for Clomid and discuss when I should come back for monitoring. But I knew the appointment took a turn for the worse when the NP asked what "monitoring" meant. Puzzled, I told her to be monitored while taking the clomid, to make sure my ovaries don't overstimulate. She then asked me how that monitoring would be done. What? You're asking me? Umm, through ultrasounds. She then kinda laughed it off and said "no, you don't get ultrasounds until you are KU." Umm, wow. Every where I have read said that's it's recommended a patient is monitored WHILE on clomid. It was alarming that she was not aware of this.
Then, she writes me a prescription for clomid and says come back in 3 months if you are not KU. When I looked at the prescription it was for 150 mg!! OMG, at least start me on the lowest does of 50 mg! My goal is not to be the next Octomom! So she changed my prescription for 100 mg and she actually said "more is better".
Sigh. I doubt anyone really understands what any of this means or understands the risks of clomid, but this is not how I expected things to go today 
To make matters worse I just got off the phone with my insurance company and I just discovered that if I want to be monitored while on clomid, I would be responsible for the whole bill. Infertility treatments are not covered.
Blah. This sucks. I think I am going to call to reschedule an appointment with my OB, because I feel much more comfortable with him. Oh, maybe I should make the switch to an RE? Hmm.
If you made it this far thanks for reading 
Baby Macy is here!
12/09 - Macy (daughter) | 4/10 - Began TTC Baby #2 | 12/10 - Chemical Pregnancy | 1/12 - Miscarriage at 14 weeks | DX - PCOS & Hyperthyroidism
Re: Hmm, I don't know what to do. Warning: PG related.
Ok, I just got off the phone with my actual doctor and I spoke with him regarding my concerns.
I specifically asked him about the monitoring. I told him, everything I have read regarding Clomid recommended that I be monitored while on it. But I am curious to know more about why I need to be monitored. I understand the risks of Clomid, but I can't find any info about the statistics of the risks. Like, what is the % of people who actually suffered from the negative side effects. He didn't have a number, but he said in his 35 years experience, he has seen very few cases of hyper stimulation (well Clomid is a hyper stimulate, but YKWIM). He said they don't offer ultrasound monitoring because it is very costly and if I was interested in that I would need to see a RE. He then mentioned there is only one RE serving our area and the wait is 5+ months.
He also lowered my dosage to 50 mg, and he was also alarmed about the high dose. He then told me to come in on CD 21 for some blood tests and said that I need to see him either at the end of my next cycle or if I get pregnant.
So, I guess I have a decision to make. Stick with my OB (unmonitored) or wait to see the RE. Maybe this is a flameable question, but would it be super crazy to take clomid without being monitored via ultrasound?
Baby Macy is here!
12/09 - Macy (daughter) | 4/10 - Began TTC Baby #2 | 12/10 - Chemical Pregnancy | 1/12 - Miscarriage at 14 weeks | DX - PCOS & Hyperthyroidism
This. Also, everything I heard says you need to be monitored. Also talk with you OB and shop around for RE (sometimes, they can code these this for diagnostic instead of fertility and then they might be covered.)
Wow Kathy. She asked you how you should be monitored? Crazy.
Here is a little bit of my story, hopefully this will help you. Well, when I started clomid I did so unmonitored. When we first started TTC I went to my regular OB and had some discusssion. 6 months or so later with no AF I went back. He gave me prometrium to induce it, hoping to jump start it. The next month, still no AF. So again he gave me the prometrium. At this time he offered to send me to a RE or to try me on clomid for 3 rounds then I could go to a RE. I decided to stick with him for a bit longer. So we started at 50 mg, then went to 100 mg, then to 150. We might have done 200 mg also, but at this point I can't remember way back then. I have no clue why any DR. would start you out at the highest dose. Now, when I was seeing him I did not get monitored. I read a lot on-line and everything says that you should get monitored. Clomid could cause you to produce too many eggs, which can cause multiple problems. With clomid only it is fairly uncommon (like you said). But the biggest reason I like the monitoring is because without it I feel like it is a waste of time. With the RE (I am no longer taking clomind, we've moved onto other meds) they do a lot of U/S and B/W. Yes, it is very expensive to get all of that done, but I feel like it greatly increases our odds. My insurance (as most) doesn't cover anything. $150 an U/S and $200+ for B/W a few times a month adds up very quickly. But with the monitoring I know when I am ovulation. My OB told me to have sex (what is the abbreviation for that? I can't remember!) on day 14-16 (I think that is what I was told). Well with the monitoring I have found that I O at different days every month. Have they done any tests on you? There is BW that can be done to see if you are Oing, etc. I feel like I am rambling now...I am gonna go back and read your original post to see if you asked anything else...
So here is my advice to you. Because this is basically what I did. My H and I decided that while we want to get PG we want to start with the least medical treatment possible and work our way up. So I saw my OB for 3-5 months of treatment before switching to a RE. Seeing the OB cost much much less and was much much less invasive to my life. You need to decide in how much of a rush you are in and what is important to you. Do you want to get PG NOW and will do whatever that takes? If so, you may want to go to a RE now.
Also, I forgot to add in the last post- my OB did not monitor, but he did have me come in for an exam monthly before beginning the next round of clomid (at the time when the RE does the baseline U/S). He said he would be able to find any cysts. But an exam like that won't tell you if your follicles are growing, how many you have, what size they reach before you O, etc., like an U/S will.
Has your OB done any testing on you? (I think maybe I asked this in my last post). My OB did a bunch of stuff. My RE did more once I started with him. But my OB wasn't going in blind like yours seems to be.
Thanks for the response! I have had some blood work done a few times which was used to diagnose me with PCOS. I can't remember exactly what the results were. He said that a HSG wouldn't be needed since I got pregnant with Macy and I recently was pregnant in December when I miscarried. He also said because of those two pregnancies it wouldn't be necessary for a SA for my H. More than likely, based on my charts, my egg quality is bad due to late ovulation. He is thinking the clomid will improve quality and I will have a stronger O.
IDK, maybe I should request some of that testing to be done, especially if it is covered by insurance.
Ugh. I am not sure what my next step should be. I am an impatient person by nature, but something in my gut tells me I should go to an RE. IDK, I have some talking to do with my H when he gets home.
Baby Macy is here!
12/09 - Macy (daughter) | 4/10 - Began TTC Baby #2 | 12/10 - Chemical Pregnancy | 1/12 - Miscarriage at 14 weeks | DX - PCOS & Hyperthyroidism
Okay, that makes sense not to do the HSG or SA then. If I were you I would go to your OB (your real one, not that dumb girl) and ask him if he feels that it is poor egg quality, what tests can be done. I know there are some B/W's that can help with that, but I can't think of which ones right now. Good luck! And let us know what you decide.
Oh, also, I would call around for a RE, and not just listen to your OB saying that wait is that long.
After 3-5 months with the OB I switched to a RE. I was mad at myself for not going to a RE sooner. But now that's it's been much longer I got over it and feel like I did the right thing.