At what point should I get a RE?

JustinsMama · 07-01-2008, 09:28 AM

Hi ladies,
I was recently dx'd with PCOS when I had problems conceiving my second child. My OB/GYN dx'd me, but I'm not completely happy with him since he wanted to put me on clomid and never even mentioned metformin as a possible treatment. I see a regular endocrinologist for thyroid issues and had an appointment with her during the time my OB/GYN was dx'ing me. She wanted my bloodwork results and as soon as I sent them to her, she called in a prescription for met. So now I am on met through my endo. My OB/GYN left things with I should call him if no AF by July 5th, and he will have me come in and give me provera and clomid. Not sure if his plan of action will change when he finds out the the endo gave me met. So I'm wondering if I should just go ahead and make an appointment with an RE since I'm not that happy with my OB/GYN's knowledge of PCOS? What do you ladies think? I really want to get pg ASAP, and I'm worried it will take a long time to get in with an RE anyway.
Thanks!

PBLayzod · 07-01-2008, 09:53 AM

That's one of those decisions that's different for everyone. I stuck with my Gyn for Clomid, HSG, and Dh's SA. When it came time for a Lap, I decided to move to an RE for treatment. Neither my Gyn nor my RE prescribed Met at that time.

If you already are doubting this doctor and you haven't even started treatment, you might want to schedule an RE appointment. You could go ahead with the Provera and Clomid with your current doctor while you are waiting to be seen by your RE.

ready2conceive · 07-01-2008, 10:21 AM

I have to agree with pp. I stuck with my ob for 2 rounds of 50mg Clomid, SA and HSG. I just had my first appt yesterday with RE. He was so much more knowledgeable and I am getting the 2hr glucose test tomorrow to check for IR. And his plan of action is way different than my ob. My OB wasn't even sure about why I was concerned about being IR!

He is increasing me to 100mg of Clomid and IUI. If the OPK's don't work for me the 1st month doing this (they never work for me...I always get a positive since my LH is always elevated) then we move on to injections + IUI. He also wants me to take progesterone supps 3 days after IUI through the rest of the cycle. He just knew so much more and was so much more confident and aggressive. I left his office wishing I just started with him instead of wasting 2 months with my ob who wasn't as aggressive.

I would say if your insurance covers it...why not take advantage of it!

toomuchcoffeelady · 07-01-2008, 10:46 AM

IMO, if your OB-GYN is that uninformed that Metformin wasn't his first line of defense for PCOS, I'd have gotten an RE (or at least an endochrinologist) yesterday.

I'm so sorry you're having to deal with secondary infertility; your little boy is beautiful.

AprilDawn74 · 07-01-2008, 11:35 AM

I feel the same way. I was diagnosed in 2001 with pcos and was told to just stay on the pill because I wasnt married yet and he wouldnt prescribe clomid until I was married, eventhough I was with my now husband since 1998. I left that office feeling like I would never get pregnant and pretty much gave up. He never did any bloodwork, only a u/s that showed the pearl like strands and a hsg which was clear. Looking back I am so mad for wasting all that time. I have been seeing a new gyn since Jan 2008 trying to get pregnant. He did the inital bloodwork which came back normal except tsh was high and started me on clomid and provera. I was told to call him if I didnt start af or received a bfp and had to come into the office each time for an exam. After 2 failed clomid cycles with no ovulation I told him I wanted tested for IR. I was given another rx for clomid 100mg for 7 days instead of 5. He wouldnt give me 150 and was told if I dont ovulate in 6 cycles I was being referred to a re. I started taking 1000mg of metformin and was increased 2weeks later to 2000mg. I was told to make a appointment in 3 months for followup. While on a clomid break I started taking soy isoflavones this month. Fertility friend shows that I ovulated this month on cd 13. So either waiting for af to start,provera again or hopefully a bfp. I wonder if I should wait it out or just make an appointment with a re.

JustinsMama · 07-01-2008, 01:00 PM

Thanks so much for your replies, ladies! I looked up my insurance plan, and it says this:

Covered Health Services for infertility services and associated expenses including:
● Diagnosis and treatment of an underlying medical condition that causes infertility when provided by or under the direction of a Physician;

The following services are not covered:
● Health services and
associated expenses for infertility treatments including:
● In vitro fertilization
(IVF);
● Gamete intrafallopian
transfer (GIFT);
● Zygote intrafallopian
transfer (ZIFT);
● Artificial insemination;
● Embryo transport; and
● Donor ovum and
semen and related costs including collection, preparation and storage of.

I have a few RE's listed in my list of approved docs, so I'm pretty sure it is covered as long as I am going to the RE to treat my PCOS, but if I'm understanding it correctly, if I need more intensive therapies like IUI or IVF, those are not covered. I hate insurance, I would feel so much more relaxed if this stuff was covered!

But anyway, yeah, when my OB/GYN dx'd me, I asked him what the treatments were for PCOS, and he told me BCP's if you aren't trying to conceive and clomid if you are. From what I've read, metformin is the most obvious PCOS treatment, so I'm not sure I trust his knowledge, and I don't want to waste time. (Or $$$!) When I told my regular endo about the PCOS dx and showed her my bloodwork, she immediately said I should be on met and called in a prescription.

toomuchcoffeelady · 07-01-2008, 02:12 PM

April - your old doctor sounds like a jerk! Hearing stories like that really tick me off. Sorry you had to deal with that.

AprilDawn74 · 07-03-2008, 08:45 AM

Quote:

Originally Posted by toomuchcoffeelady
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April - your old doctor sounds like a jerk! Hearing stories like that really tick me off. Sorry you had to deal with that.

Thankyou. I wish I hadnt wasted so much time with a one sided doctor.

starflutter · 07-03-2008, 09:38 AM

Well I would say try a consultation with an RE and just see what they come back with. I was dx last year from my gyno. She was concerned and did bloodwork and sent me to a RE immediately...I had no idea what I was getting into. I had never even heard of PCOS. Well this RE put me on met and then I m/c and it all went down hill from there. The problem was that no one noticed that I was pg they just started treatment with my levels all wacky. Anyway I wasn't comfortable after all that. So after a 6mth break from Dr's. I found a new one, just for a 2nd opinion and just went in for consultation to see how there knowledge was and what there 1st options are for treatment. Needless to say that I loved it,every question that I asked they had an answer. I actually go in today to get all my bloodwork redone. So my advice to you is meet them and talk before they jump into treatment. I wish I would have in the beginning.

amanda112903 · 07-03-2008, 05:25 PM

Justinsmama- Looks like it doesn't exclude Ovulation Induction which means you might have coverage for injectables. IUI's cost about $300+ depending on your RE.

Seeing an RE is the best decision I have made. I wasted a lot of time with my OBGYN (who is actually VERY good, but nowhere NEAR as smart as my RE). So if you are having doubts about your OBGYN, or just think that you will eventually see an RE, the sooner you start seeing him the faster he can get to know your cycles and your reactions to treatment.

So my advice is not to wait.

gatornurse · 07-04-2008, 12:53 PM

I too advise you not to wait. Hopefully, the diagnostic tests (HSG, US) will be covered mostly by insurance. The initial meds that they start you on are usually covered (met, clomid, letrazole), or are very cheap. HSG ("trigger") is only ~$40, and sometimes they will have samples of the more expensive drugs. Even if they don't the expensive drugs range $300-$1000 per cycle..and while that sounds expensive...it is not as expensive as a baby
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