Am I expecting to much?

[gobucks]

Hi, lurker here in need of advice. I'm currently 16 weeks pregnant through IVF. We used donor egg and did PGS.  I switched from my RE to my regular OB/GYN at 12 weeks and while I've only had 2 appointments I'm feeling very disappointed and frustrated with my care.  My husband feels that I have high expectations and that I'm overreacting, but I'm wanting to switch practice's.   At my first appointment she did not ask me any questions about what processes we went through and halfway through mentioned that I was AMA (I'm 35), at which time I had to remind her that I used an egg donor and had a 28 year old egg used.  She seemed like she was not familiar with egg donation or has not had many patients that used it.  She seemed very dismissive and I felt hustled in and out of the office.  Then today at my 16 week appointment She came in, listened to the baby on doppler, asked how my morning sickness was and went to leave.  I told her I had some questions- my RE had mentioned still having the quad screening done at 16 weeks. I brought this up and she told me it was unnecessary since we did PGS, but mostly kept saying that she didn't do it because most do the 12 week testing. I kept reminding her that we did not do that testing because we did PGS.... but she insisted that I did not need to have it done- even though my RE state that I did.  Then I enquired about a fetal echo since we did ICSI, she stated that she had heard there may be a slight increase in risk but that she did not recommend having a fetal echo done- but rather wait and see how the anatomy scan went and if they saw anything then to have an echo.  I'm sure I could demand to have the quad screen and echo but I'm more frustrated that she was very dismissive of my questions and concerns.  

I know that I got spoiled during my time with my RE where they gave attention and understood the anxiety that went with going through IVF and were very informative and patient.  However, I feel that my OB should also have some understanding of this process as well.  I don't want to feel dismissed and like I'm overreacting.  Did any of you have additional monitoring or once you hit 12 weeks were you just treated as normal pregnancy and no additional monitoring or testing??

Adding complication to this- This current OB works for my company and therefore I have 0 out of pocket costs for all of my prenatal appointments- I only have to pay for my ultrasound. If I change to another I would have to pay out of pocket for everything until I hit my very high deductible.  So I feel like that complicates my decision.  That being said, I'd rather pay out of pocket and be happy than frustrated for the next 24 weeks. I'll end up paying the high deductible during delivery so it's not that I won't end up paying it some time. 

Ok sorry this got so long. None of my friends think it's a big deal- but none of them have gone through all that we did to get pregnant.  And if I'm overreacting please tell me! I need to know.

[thoseareradishes]

If you aren't comfortable with your care, then I think you should switch. Those tests are pretty standard I believe, and if she's not listening to your concerns now, will she when it's time to deliver?

We also used donor eggs, and most of my doctors didn't really get it. The MFM wanted to do the cell free test (I think that's what it's called? My regular OB said we could skip it but the MFM wanted to do it...I read conflicting accounts of how accurate it is with donor eggs), and I had to put some dates of when things occurred on the paperwork and it was all very confusing and no one really knew what dates to put. It was annoying. I was also treated as AMA, since I was 36/37.

Generally, I was treated like any other pregnant woman, but did get the fetal echo. I also had the quad screen, it was standard at the practice I went to. I was scheduled for a growth scan at 32 weeks (I didn't make it that far though).

[gobucks]

Jan 15, 2018 21:21:11 GMT -5 thoseareradishes said:

If you aren't comfortable with your care, then I think you should switch. Those tests are pretty standard I believe, and if she's not listening to your concerns now, will she when it's time to deliver?

We also used donor eggs, and most of my doctors didn't really get it. The MFM wanted to do the cell free test (I think that's what it's called? My regular OB said we could skip it but the MFM wanted to do it...I read conflicting accounts of how accurate it is with donor eggs), and I had to put some dates of when things occurred on the paperwork and it was all very confusing and no one really knew what dates to put. It was annoying. I was also treated as AMA, since I was 36/37.

Generally, I was treated like any other pregnant woman, but did get the fetal echo. I also had the quad screen, it was standard at the practice I went to. I was scheduled for a growth scan at 32 weeks (I didn't make it that far though).

Thank you for replying.  Did you get the echo because MFM wanted it or your OB? I'm wondering if I shouldn't just request these things if I don't switch- although I'm thinking that switching is what is best.    

[thoseareradishes]

Hmm, I don't remember. I was referred to the MFM by the OB, and I think we discussed scheduling the anatomy scan and fetal echo at my MFM consult/NT scan.

[Mushe]

This is a hard question! I do think that while anyone who’s gone through so much with IVF, DE, etc has had a crash course in the medical impacts, it’s not an OB’s specialty. I’d be disappointed, but give one more chance before moving to the OOP route. I would go in with a list of issues, as I always found that I’d forget one or two questions.

As for the AMA designation, wouldn’t it be for more than the egg issues? I’m 39, so most def AMA, but it’d get you more monitoring, so I personally wouldn’t turn it down.

[cactuscookie]

I think you should have a doctor that you like and feel supported by. For what it's worth, I didn't love my RE; he was nice enough, but I certainly wouldn't describe him as attentive and informative. But my OB was pretty good. So I don't think this is an RE vs. OB thing, so much as an individual doctor thing. It did take me a couple tries to find an OB who seemed to understand something about fertility treatments (although all the doctors I went to were in the same practice, so there weren't insurance issues), so I don't think it's uncommon for that to be a little out of their league. And OB appointments are often very short - but she should at least ask if you have any questions and take it seriously when you do! And she should remember who you are and what testing you've had done and still need. I had a very easy pregnancy, but I had some extra testing done; my RE prescribed it, but my OB was also sent the results.

So, in a nutshell: no, I don't think you're overreacting. Whether it's worth switching doctors, considering the insurance situation, is a harder question.

[konapoppy]

Congrats on the pregnancy! I have infant identical twins after a PGS single embryo transfer with ICSI.

1. You should have a doctor you feel comfortable with. That said, I do think you are expecting too much from your OB, but it isn’t uncommon given that REs give you so much attention.

2. My OB never asked me if I had questions- I always just had to blurt them out. But I knew he was an excellent doctor and that is what I cared the most about. Your mileage may vary here.

3. You don’t need the full quad screen. My OB and MFM would recommend the blood test if I had a singleton that catches spinabifeda (which isn’t detected in PGS). I didn’t do it because I had so many ultrasounds due to twins that we all agreed it would get caught that way. I would see if you can ask the MFM’s office about this.

4. My MFM would have recommended the echo if she had concerns during the anatomy scan, but the hearts looked good so she didn’t.

5. I wasn’t AMA, but it is possible that some potential complications may be due to your age rather than the age of the egg.

Pregnancy is really stressful. Pregnancy after IF can be miserable. It is totally normal to have increased anxiety. If you are really worried about something, you have to advocate for yourself. Trust your instincts. Most OBs will treat you like any patient (not as much attention until you get closer to delivering). If you need more, find a doctor who meets your needs.

[pooh8402]

Jan 16, 2018 8:08:23 GMT -5 konapoppy said:

Congrats on the pregnancy! I have infant identical twins after a PGS single embryo transfer.

1. You should have a doctor you feel comfortable with. That said, I do think you are expecting too much from your OB, but it isn’t uncommon given that REs give you so much attention.

2. My OB never asked me if I had questions- I always just had to blurt them out. But I knew he was an excellent doctor and that is what I cared the most about. Your mileage may vary here.

3. You don’t need the full quad screen. My OB and MFM would recommend the blood test if I had a singleton that catches spinabifeda (which isn’t detected in PGS). I didn’t do it because I had so many ultrasounds due to twins that we all agreed it would get caught that way. I would see if you can ask the MFM’s office about this.

4. My MFM would have recommended the echo if she had concerns during the anatomy scan, but the hearts looked good so she didn’t.

5. I wasn’t AMA, but it is possible that some potential complications may be due to your age rather than the age of the egg.

Pregnancy is really stressful. Pregnancy after IF can be miserable. It is totally normal to have increased anxiety. If you are really worried about something, you have to advocate for yourself. Trust your instincts. Most OBs will treat you like any patient (not as much attention until you get closer to delivering). If you need more, find a doctor who meets your needs.

Ditto everything here. I was treated like a normal low risk patient even though we did IVF with ICSI, and no PGS. However, I had all the testing done and I trusted my OB that if she saw something concerning, then we would do further testing.

I tell people all the time... If you don't like the care you're receiving, switch.

[shauni27]

I think it is SO important to have a provider you feel comfortable with. After going through a loss and 5 years of treatments, my midwifery clinic was very understanding and supportive. They listened to all of my concerns and questions and worked with me to come up with a plan that made me comfortable. They were very reassuring and I never felt rushed or pressed into something I did not want. Likewise, if I thought I needed a test that they really didn't see the point of, they would explain why and really calm me down.

I only want our one baby but I joke that I would have another JUST for the experience of the midwives we used.

[janegold]

You should absolutely feel comfortable with your OB and like he or she is listening to your concerns. That being said, once I "graduated" to the OB from our RE, I was treated just like any other patient (I wasn't AMA or high risk). It is a big change to go from SO much attention with IVF to rather hands off with a low risk healthy pregnancy - but in the end, that's a good thing.

We didn't do ICSI or a fetal echo, etc. so I can't weigh in on any specifics there. But I will say that my OB practice works so that I was assigned both an OB and a midwife and I alternated appointments between them. Sometimes even they would disagree about whether or which screenings were recommended, even though they were in the same practice. So I don't think it's unusual that your RE might think one thing and your OB might think another - they have different specialties, experience and opinions. You are likely in good and qualified hands, but if you are not comfortable then you should look elsewhere.

[kellikans]

Bottom line, you should have a doctor that you are comfortable with. From what I've seen, most OBs don't give you the same kind of attention that your RE did. I absolutely love my OB. She takes time to talk and makes sure I don't have any questions. She's easy to get ahold of by email. And she is understanding of my concerns since she has been included in some of my IF journey (she did my first 2 IUI's and she did my D&C since my RE was out of town). She gets how long it took us to get to this point.

We did IVF with PGS and still did the cell-free DNA and quad screening for spina bifida. But she does this routinely for all of her AMA patients (I'm also 35). Even if I wasn't AMA, I would have asked for these to be done regardless because I like to have as much info as possible. We didn't do a fetal echo since his heart looked great at our anatomy scan.

Good luck with whatever it is you decide to do!

[konapoppy]

One more thing about quad screening. As explained to me by my MFM (who is literally one of my favorite people in the world) and my OB: besides spinabifida screening, the quad screening doesn’t make sense if you do PGS because the data isn’t as accurate since it is a screen not a diagnostic. Essentially you throw bad data after good data. It can cause unnecessary anxiety.

[shoeless]

I'll ditto everyone else that you should be comfortable, I actually switched OBs with my second DE pregnancy (MC) to find someone a little more medically conservative. That said, with my successful pregnancy (first) I did donor eggs, no PGS, and ICSI. We didn't have a quad screening and our MFM (for my heart issues) didn't do a fetal echo since nothing was abnormal on the anatomy scan. If you feel you aren't getting adequate care and explanation then I'd switch providers. Also, it was clear that with all three OBs I was either their only or one of a few ever DE patients.

[loira]

I had a lot of doctors and midwives throughout my pregnancies, which is the norm in the UK. When we moved back to Canada, I did have a single OB who wasn't my favourite, but I ended up high risk again due to a shortened cervix and an IUGR baby, so I saw the specialists at the hospital after that. I think the biggest factor for me wasn't that I needed one doctor with whom I could build a relationship, but that my concerns were being validated. It sounds like your OB is not taking your concerns seriously, and is not providing you with sound advice as to why she would or would not recommend certain tests. Switch if you can.

Also, your friends need to get some compassion. Saying it's not a big deal is supremely unhelpful.

[gobucks]

Thank you all so much for your replies. I'm sorry to have posted and then disappeared- my work schedule makes it hard for me to post on here with any regularity. I think I'm going to at least look into other OB options in the area and see what recommendations they get. I have a feeling I'm just going to be frustrated this whole pregnancy if I don't. However, I may give her one more visit and see if maybe it gets better. and then if not go ahead and switch. Thank you all so much.

[gobucks]

Jan 16, 2018 12:12:33 GMT -5 @daylily said:

Ditto konapoppy . I think you should feel comfortable with your OB but also acknowledge that the transition from an RE to an OB isn't always easy and that doesn't necessarily mean that OB isn't a good one.

A good OB should be able to identiy the limits of their speciality and recommend a second opinion. In my case, she said she couldn't really answer my questions about the necessity of prenatal testing when I had done PGS and she arranged for us to go over it with a genetic counselor. (Ultimately we decided on exactly what kona did fwiw)

I was satisfied with that approach.

I think this is where my main concern with her was- it wasn't that she didn't know the answers to my questions about the echo, it was that she didn't say- let me look that up, or ask a specialist and let you know. It was just an instant I don't know much about that, but no you don't need it. 

[gobucks]

Jan 16, 2018 12:16:23 GMT -5 konapoppy said:

One more thing about quad screening. As explained to me by my MFM (who is literally one of my favorite people in the world) and my OB: besides spinabifida screening, the quad screening doesn’t make sense if you do PGS because the data isn’t as accurate since it is a screen not a diagnostic. Essentially you throw bad data after good data. It can cause unnecessary anxiety.

this is really helpful. thank you. And I'm assuming you were sent to MFM because of the twin pregnancy?

[konapoppy]

I am glad you are going to look at other OBs. I did leave an OB after my failed pregnancies because I didn’t trust her judgment. You have to feel comfortable!

[konapoppy]

Jan 16, 2018 16:39:53 GMT -5 gobucks said:

Jan 16, 2018 12:16:23 GMT -5 konapoppy said:

One more thing about quad screening. As explained to me by my MFM (who is literally one of my favorite people in the world) and my OB: besides spinabifida screening, the quad screening doesn’t make sense if you do PGS because the data isn’t as accurate since it is a screen not a diagnostic. Essentially you throw bad data after good data. It can cause unnecessary anxiety.

this is really helpful. thank you. And I'm assuming you were sent to MFM because of the twin pregnancy?

Yep - I was at the MFM almost weekly.

With a singleton pregnancy I would have only gone for NT and anatomy scan plus any genetic counseling that I wanted (and this falls under MFM/genetic counselors in my state).

[midwest07]

My thoughts in no particular order -

I did PGS during IVF (both frozen transfers with ICSI), which resulted in our daughter and I am now pregnant. With our daughter, the only additional test that I did was the AFP screen at around 16/18 weeks. That is not going to be something that the PGS catches. I also did the AFP with this pregnancy.

With this pregnancy, I am AMA. Because of that, I decided to do the NT scan at 12 weeks. My OB was fine either way, it was my choice, I wanted to do it because of the fact it can pick up on heart issues. When we did that, we met with a genetic counselor. After reviewing what PGS tested for, and what the available blood tests actually test for and how the results come back (giving you odds and not assurances), and the fact that the NT scan looked good, we did nothing further on blood tests.

Anatomy scan for both pregnancies. If any issues had shown with the heart, I guess we would have done a fetal echo at this point. I honestly haven't heard this as being standard just because of IVF/ICSI unless a scan shows a heart issue.

As for being AMA, my non-medical opinion is this impacts you as the mother as much as the age of the egg/embryo. High BP, GD, pre-E, premature birth - I believe all of those risks are higher the older the mother. As someone else said, I would welcome the additional tests and screening for you.

I switched OBs in my first pregnancy. I liked my first OB, but I felt that she talked too freely about c-sections and intervention and I didn't like that. And the office/hospital weren't my first choice. I switched at around 16 weeks and it was fine. But I didn't have the issue that you do where it was a real difference in cost, I think I paid for one extra exam.

Have you talked with the OB about your delivery, inductions, c-section rate, and things like that? The things that are going to really matter to you at the end of the pregnancy? I would try to feel out rather you are in line on those things. If not, then even more reason to switch. But if you are and you trust the actual care, then I would probably stay.

[konapoppy]

AFM is the part of the quad screen I was talking about! Sorry for all the posts, just wanted to clarify

[gobucks]

You guys are seriously amazing. These posts have been so helpful. I have a call into the office to schedule the AFM now as well as discussing some of my concerns. Again- Thank you!!

[awick14]

I'm sorry you are not feeling great about your OB, but happy you are looking at your options.

I did not go through IVF so my experience is a little different. I left my OB because I did not feel like she listened to me, and I didn't feel like she advocated on my behalf at all. (I went through 5 losses with her.)

When I switched OBs I did feel rushed and like I was treated like a normal low risk patient a lot, which drove me crazy at times. BUT she always listened to my fears when I mentioned something to her. She was always willing to look things up and call me if needed.

I hope you find an OB that listens to you soon. And many hugs as you go through this pregnancy. We are here for you.

[starryfish]

Jan 16, 2018 16:35:50 GMT -5 gobucks said:

Thank you all so much for your replies. I'm sorry to have posted and then disappeared- my work schedule makes it hard for me to post on here with any regularity. I think I'm going to at least look into other OB options in the area and see what recommendations they get. I have a feeling I'm just going to be frustrated this whole pregnancy if I don't. However, I may give her one more visit and see if maybe it gets better. and then if not go ahead and switch. Thank you all so much.

I would give her one more chance. Definitely ask questions and don't wait for her to ask you. It's definitely very very different going from RE to the OB. And I think you will still be AMA bc your body is carrying the baby and you are AMA. Usually just means extra ultrasounds or tests which I bet you would like. I was medium risk pregnancy that turned high risk in my third tri so I got to see a MFM. But really you want to be a low risk regular OB patient, which means not a lot going on at each apt until later in your pregnancy

GL!

[gobucks]

So I went to see a new OB this past thursday and it is night and day from my original OB. I have an ultrasound scheduled through MFM at 19 weeks as well as an echo at 22 weeks. And yes, they are considering me AMA. I decided not to get any additional blood work done at this time as it felt somewhat unnecessary with all the extra monitoring. Anyways, just wanted to say thank you ladies for you insight and advice. I really appreciate it.