I have a whole history of my previous GYN telling me I will never have kids, that I have PCOS, and then getting pissy and basically telling me that, after 3 years, nothing is wrong with me and I never had PCOS. (She was an idiot).
So I went to a new GYN back in March where the NP gave me my annual and I brought her 2 years worth of period information. We discussed my history, my previous doctor, my previous diagnosis, and lack of pregnancy in the past 2.5 years. She sent me over to the actual doctor (I guess the actual gynecologist? He has the degree for it) and he did a transvag ultrasound. I gave him my history again and we talked about the fact that my periods get worse when on birth control and the pain level was much higher when I was on it.
He was surprised that after 2.5 years of no birth control that I haven't had any pregnancies. He also said that he is heavily leaning towards me having endometriosis because birth control is supposed to help things, where as I was bleeding 3 weeks out of a month and if I wasn't period bleeding, I was spotting. So he decided to not put me back on birth control. (I stopped taking it May 2011) He also suspects that I am not ovulating or that my body is trying and just not getting there. But he listened and he is worlds better than the last office I went to.
He said that one of the options would be to put me on clomid to force ovulation and to put me on something else to jump start periods. He then went off on a side talk about surgeries and going to a RE as my next step. Which was the point where I got kind of scared because I know nothing about fertility and was getting over whelmed. So I agreed to chart. He said that I can bring my charts back to him in a few months and he will take a look at them to work with me on the next step.
Now, I talked to Mofongo about this she mentioned something about they can do blood tests on certain cycle dates and there is an easier way to determine ovulation or not. I don't blame my GYN for not doing it, because I didn't understand half of what he said so I wasn't pushing super hard. In other words, I wasn't advocating for myself because I had no idea what any of it meant really.
But now that I have a better grasp on it, when I go back, I want to be better prepared.
What kinds of questions do I ask? Or what should likely be happening after our next talk? Are there things I should be saying "I want this, this, and this to happen"?
He has no problems referring me to a RE, he just wanted to see what he could figure out for me because he wanted to gauge where exactly I am at. But that he is concerned that nothing is happening. But I want to be able to say "can we take this step or that step".
You - blood work on a few specific days of your cycle. Definitely a draw at the beginning of your cycle and a draw towards the end.
Your H - Semen analysis. This will rule out that he has no issues, or identify any issues he may have. We have no MFI so I'm not super clear on anything related to semen.
After your blood work, you'll probably be sent off for an HSG which will show you what your tubes & ute looks like. Now, if you are having endo or PCOS they will probably be able to see something on your HSG.
After the blood work and HSG are back, your GYN will make some decisions about if he can treat you or should refer you on.
For ME, it was cheaper to do all these tests w/ my GYN because I have no IF coverage including co-pays with an RE. So, my insurance AT LEAST covered my office visits with my GYN even though it didn't cover a lot of the testing.
If I were you, I'd want the HSG before I did Clomid. If your fallopian tubes are blocked or your uterus is not conducive to carrying a pregnancy, all the Clomid in the world won't help you, really. It might make you ovulate, but if the egg can't get out, or a fertilized egg won't take, you're back at square one. You know?
So yeah, I'd go back to your GYN with your charting/period info and then ask about these steps. Just say something like "In doing some basic research, it seems like this is the general process. What are your thoughts?"
I always recommend listening to your Dr above and beyond what you hear here or read on Google first. If you trust GBCN/Google/Whatever more than your Dr, find a new one.
Good luck, Tricky. I hope you get some answers soon.
Every dr is different, but your gyn should be able to do some testing: Cd3 labs for basekine hormones Mid-cycle u/s to look at ovaries/follicles cd21 labs to check progesterone levels, which can be used to confirm ovulation HSG
With the exception of hsg, if your gyn does them, they may be able to code them in a way that doesn't mention fertility (more likely to be covered or MORE covered by your insurance)
I think that was what he was getting at too. Seeing what all he could do for me to be cost effective instead of sending me right to a RE. Which, if that is the case, I appreciate. My office is capable of doing a lot of different procedures, including some fertility stuff, so hopefully some can be done there.
Post by thoseareradishes on Nov 12, 2013 22:29:14 GMT -5
If your insurance covers it, and you are comfortable with it, I'd recommend going to an RE. They specialize in getting your pregnant, and their offices are set up to handle all the testing, monitoring, insurance issues, etc that needs to get done. And you run into fewer pregnant women.
No matter who you choose to do to, the initial testing is as lola and FastHands said - CD3 bloodwork and baseline ultrasound, HSG, 7DPO bloodwork (for progesterone- 7DPO is the best day to get this done, but you need to know when you ovulate - if, say, you ovulate on CD20, bloodwork on CD21 may not confirm ovulation, but waiting 7 days, so CD27 in this case, should confirm ovulation) and an SA for your H.
So, what am I looking for in my insurance to determine if they handle it or not? Or is this a case of just asking the RE office?
I'm not really sure. I called my insurance company and asked what all they covered, and the RE's office also called them and they gave me a detailed write up of what was covered, and how much things cost that were not included.
So, what am I looking for in my insurance to determine if they handle it or not? Or is this a case of just asking the RE office?
I'm not really sure. I called my insurance company and asked what all they covered, and the RE's office also called them and they gave me a detailed write up of what was covered, and how much things cost that were not included.
Ok, I logged into our plan website and this is what the handbook says:
Infertility Counseling, Testing and Treatment*4
80% after deductible
*4 4 If testing is required, cost sharing may apply as outlined under Diagnostic Services. Treatment includes coverage for the correction of a physical or medical problem associated with infertility. Infertility drug therapy may or may not be covered depending on your group’s prescription drug program.
And then it goes on to say that fertility drugs are not covered.
However, my husband's union contract is being re-situated so insurance might change at any moment.
It's obviously v early, but if you get to the point of iui or ivf, I'd call the ins company and have them preapprove the sspecific treatments you have planned, since that wording is kind of vague. (Is nit-getting-pg a "condition" for which iui is a treatment? Etc)
Ok, I logged into our plan website and this is what the handbook says:
Infertility Counseling, Testing and Treatment*4
80% after deductible
*4 4 If testing is required, cost sharing may apply as outlined under Diagnostic Services. Treatment includes coverage for the correction of a physical or medical problem associated with infertility. Infertility drug therapy may or may not be covered depending on your group’s prescription drug program.
And then it goes on to say that fertility drugs are not covered.
However, my husband's union contract is being re-situated so insurance might change at any moment.
Good luck with the testing, or whatever you decide to move forward with. Just to throw this out there - if you decide to give Clomid or Femara a try, they are both VERY inexpensive. I had zero coverage for medication, and I think the Clomid was less than $9 for 5 pills. Femara was actually covered because it is a drug used to treat breast cancer (IF is an off-label use), so I only had my $5 co-pay.
Injects...well, those are expensive. I have no advice there, just sympathy.
I wonder if IUI or IVF are considered "treatment"? If so, 80% coverage is damn good.
Post by awkwardpenguin on Nov 13, 2013 6:48:37 GMT -5
I just wanted to chime in with some endometriosis information, and to reiterate a few points others have made.
It sounds like your doc is trying to do a good job with you, but it sounds like he doesn't quite have all the knowledge to diagnosed fertility problems. If I, awkwardpenguin, amateur RE were evaluating you, I'd want to do:
CD3 bloodwork and ultrasound, to check hormones and get an "antral follicle count" to see how many eggs your ovaries are getting ready to go each cycle, and check to see if you have any cysts. Mid-cycle ultrasound, to confirm you've grown a nice happy follicle. 7DPO bloodwork, to confirm you ovulated and check your progesterone levels, which need to be a certain level to sustain a pregnancy. HSG - to confirm your tubes are open, especially with suspected endo.
SA for your DH, to rule that out as a potential issue.
As far as diagnosing endometriosis, most of the time you'll just have a "suspected" diagnosis based on symptoms, and the only real way to know for sure is to confirm the dx with laproscopic surgery. I have "suspected endo", and am waiting to do surgery until I'm ready to get pregnant*. Surgery can increase your chances of getting pregnant if you do in fact have endo. Clomid can also be helpful in endo, but not as helpful as if you have an ovulatory disorder. IUI does not increase pregnancy chances in people with endometriosis, but IVF is extremely successful for people with endo.
I would see an RE, do the testing, and if endo is still the suspected dx, I'd probably do the surgery to confirm the dx. It will give you a chance to get pregnant on your own, and make future treatment decisions more clear.
So, questions to ask: 1. Why do you think I have endometriosis? Do you think it is worth confirming a suspected endometriosis diagnosis before I try other fertility treatments? 2. Why are you recommending Clomid for my particular case? 3. Are there tests we can perform to rule out other fertility issues and find out if I'm actually ovulating?
Since you have coverage, I would just head to the RE. They have so much more experience with these issues than GYNs do. Also, fertility issues break down to be a third the woman's issue, a third the man's issue, and a third a combination of both. So I wouldn't move forward with any treatment until your H has that SA.
*I hang out here because my wife is having TTTC and is trying to carry first. We both have fertility issues - fun times.
If your insurance covers it, and you are comfortable with it, I'd recommend going to an RE. They specialize in getting your pregnant, and their offices are set up to handle all the testing, monitoring, insurance issues, etc that needs to get done. And you run into fewer pregnant women.
I absolutely agree with this.
When I set up my first appointment with the RE, they took my insurance info and figured out what was covered before my consult so that cost could also be part of the discussion.
I wouldn't rule out the value of charting. Bloodwork is a part of the workup, but doing temperature charting can pinpoint if ovulation is or is not occuring and can help identify when to do the bloodwork.
Outside of the fertility issues, I'd be pressing the doctor on finding out what is causing the painful periods and get confirmation of that issue first.
If your insurance covers it, and you are comfortable with it, I'd recommend going to an RE. They specialize in getting your pregnant, and their offices are set up to handle all the testing, monitoring, insurance issues, etc that needs to get done. And you run into fewer pregnant women.
I absolutely agree with this.
When I set up my first appointment with the RE, they took my insurance info and figured out what was covered before my consult so that cost could also be part of the discussion.
Ditto. I haven't even seen my RE yet, and I've already received a call from their office letting me know what insurance covers and what it doesn't (covers diagnostics [bloodwork, u/s, HSG, etc] at 80%, no meds or treatments are covered).