Friday, October 13, 2006

ANSWERS AND QUESTIONS

Again, thanks to all of you wonderful friends who supported me through the great medical records fiasco of 2006 (GMRF). I am actually quite over the whole situation, I'm left more with a "fuck them" feeling than anger towards what happened. What I am not over is my mother's reaction to it all: "You should bring them a coffee next time you go, to suck up to them a bit." Ummm... First off-I don't feel the need to suck up to them; second-it is likely that I won't be back there. (To which my mother replied in horror: but then where will you go? I guess I will have to talk about my mother's reactions to our IF in another post.)

Now that the GMRF is dealt with I can finally move on and talk about what I have intended to talk about this whole week.

The Urologist, The RE, The C and Me

First the appointment with the urologist on Wednesday. We both really liked Dr. C. He was not alarmed at all by The C's 2 sperm analyses, and suggested he do a third analysis as a "tie breaker", so we will have a pretty good idea of what's happening down there. Dr. C also told us that it is not unusual to have sperm charactersitcs that The C's tests showed, seeing as he had undescended testicles that were corrected with surgery when he was about 6 years old. He did say that if everything were to be normal (my words, not his) with me, it is likely that his sperm would be able to impregnate me. (As all is not normal, I am not holding my breath, but this was interesting to know.) The C then had some blood drwan to look at his hormone levels, and we made a follow-up appointment where the doctor will preform a testicular ultrasound. (Really, the doctor seemed more concerned in checking out that all was ok in The C's package in terms of cancer etc... becasue of his undescended testicle issue, than with the semen analysis. I know this is most likely due to the fact that I don't ovulate, and we certainly have to correct that issue more than the sperm issue. He did reassure us that there was plenty of sperm for IUI.) Follow-up appointment: December 9. (The C can't take any more time off than he has already asked for until December.) We enquired that if we decided to go with another clinic for me, would Dr. C still see us at this clinic for the C. He said yes.

Next up: the RE, who we saw yesterday. The C was thankfully able to come with me as it was not busy at work (as opposed to Wednesday when he walked out and it was like a zoo.) We met with Dr. H who seems to have lots of experience in the field. He took a look at all the reports that I brought him, and took a history of what we have done so far. He was satisfied with the findings of the ultrasound that I had in April (ie: PCO-like ovaries), noted that all my bloodwork that my gyn had ordered looked good, and had little interest that the 2 cycles of Clo.mid that I tried didn't work.
With all this info under his belt Dr. H proclaimed that I must take Met.formin, as it has an 80% chance of inducing ovulation in me. And if I ovulate, it is possible that The C's sperm will do the trick naturally. And declared that if I do ovulate using the Met.formin, and I still don't get pregnant, he has no problem moving on to IUI.
In terms of testing he wants me to do an HSG (duh! But which I am afraid of doing having read all the accounts here in the blog world), and STD testing for me and the C. Of course, the HSG has to be preformed between CD7-10, so he prescibed Pro.vera to bring on my period. And also a prenatal vitamin, because HORRORS! why have I not been taking one up until now?! (I pointed out the obvious-that there was no way I was getting pregnant, so why waste the money.)
Then it was my turn to ask the questions. I had a page and a half full, and told him to hold on to his seat. He did not seem at all put off that I had tons to ask. Most of the questions were about how the clinic is run, as we are trying to make a decision about whether to go with this clinic or another one where we have an appointment in 2 weeks time. Below are the answers to some of the most pertinent ones.
Will I always see you (Dr. H) when I come in? No. There is a team of 5 or so REs. I will always see one of them, but not always Dr. H as he is not there every day.
Will you preform all my procedures? Again, no-it will be the doctor who is in the clinic that day.
So your role exactly? He is more like my case manager.
When I call with questions who should I/will I get to speak to? Usually a nurse will be available to answer my questions. If I need to speak to a doctor, I will speak to the one who is there that day.
Can I leave messages for you? Yes, but he won't return them until the day that he is in the office. But he assured me that there is always someone there to answer my questions, and that they work as a team of docotrs and nurses.
Do you have one nurse who is assigned to work with your patients? No. There are 5 nurses and they all work with everyone.
Are all procedures done in the clinic? Yes, all except those that need general anesthetic (ie: lap)
Which hospital do you operate at? I was satisfied with this answer (there are about 5 hospitals in the city.)

Throughout this question period I had time to process the "treatment" he was prescribing for me at this point, and had a whole other host of questions.
How long will we wait to see if the Met.formin works (ie: induces ovulation)? I couldn't get a clear answer from him. It was more of a let's wait and see. He did say (rightly so) that the Met.formin takes time to build up in the system. It won't work "right away", and so I am taking the Pro.vera to bring on a cycle so we can get the HSG done (which he he believes will be clear.) I got the feeling it was more of a we will know if it works, because I will be getting my period. (For the record, I am willing to give it about 2 cycles time before raising hell.)
So let's say I get my period... will that indicate 100% that I am ovulating? It will indicate 99.9% that I am ovulating. Because I don't get my period now without ovulating (as with some people), if I do bleed, it will be because i ovulated.
So I keep getting my period (the Met.formin is working)... but I am not pregnant, now what? We will move on to IUI to help the sperm get where they need to be.
What if the Met.formin doesn't help me ovulate? Then we will move onto other drugs. (I didn't push him on this, I know what the other drugs are thanks to you guys.) He did reinforce the fact that 80% of PCO women ovulate with Met.formin, so that gives me a very good chance. He pointed out that if I had an 80% chance of winning the lottery, wouldn't I buy a ticket? Yes indeed.

These are the things that I am taking away with me from our appointments:
1. The C's sperm is ok. Not great, but ok.
2. Met.formin may work, let's give it some time. (I am not willing to wait longer than January to give it time.)
3. My gyn suggested months ago that I take Met.formin. I am kicking myself now for refusing on the basis that I had heard horror stories about the side effects. Because here I am months later with the same thing from a different doctor.
4. 80% isn't bad, but I am likely to fall on the 20% side.
5. Dr. H seems open to moving on in treatment. IUI and even IVF were mentioned liberally throughout our conversation.

And my conclusions about the clinic:
1. I don't like that I won't always see Dr. H (or the same doctor consitently.)
2. I don't like that he won't answer my questions until he has a day at the clinic.
3. I like that there is a team of doctors and nurses that work together so that there is always someone available.
4. I am worried that because of the team approach I may get lost in the shuffle, or may get conflicting opinions from the docotors on how to proceed with treatment.
5. They run a busy and successful clinic, so should my concerns really worry me? They are obviously doing right by many other couples.
6. I like the personal touch, and personal attention. I don't know if I will be getting that here.

General Conclusions:
I have an appointment with another RE [RE-Original] (The original clinic that I made an appointment with 7 months ago, but am still waiting to see) in 2 weeks. I will hold off making any decisions until then. I am going to start taking the Met.formin, becasue it is likely that RE-Original will prescribe it anyways. I will start the Pro.vera, so I can get the ball rolling for the HSG, which I am certain RE-O will also want me to have. As a matter of fact, CD 7-10 will fall after my appointment with RE-O, so if I decide to go with RE-O and not Dr. H, I can do the HSG at RE-O's office, or I can do it at Dr. H's Office and have them send the results to RE-O. Also, I can have all the bloodwork that I have had done at Dr. H's clinic transferred to RE-O, if I decide to go with RE-O. At this point, it's a bit of a win-win situation, though I still don't see any pregnancy happening in my body anytime in the next number of months...

One final thing (I know... ENOUGH ALREADY! With all my rambling posts, this may be the longest yet.)
Ladies who have taken Met.formin: Can you please share your experiences with me?
What were your reactions to the medication?
Did it help you ovulate?
Did you get pregnant?
How long did you take it before you decided to move on?
Did you continue to take it as you persued further treatment options?
What is your PCOS like?
(And thanks in advance...)

Over and out.

19 comments:

Amy said...

Hello! I can only speak to my own experiences on Met, but I really *like* taking it. It took a few days for my system to get used to it, but then it decreased my appetite a little--just sort of took the edge off. Also, I don't have any scientific proof of this, but I think it really improved my moods. Less highs and lows. More of a happy medium.

That said, I did not ovulate until my third cycle on it (used Provera in between). So if you can, maybe allow some extra time for it to start working. The cycle where I finally ovulated also happened to be the cycle where I started exercising every day and cut out as much sugar as I could, so that might have had something to do with it, although my doctor says not. I've only just completed my third month now, so who knows what the future holds. I'm hoping, like everyone, I guess, that I'll start ovulating regularly now. But even if I don't, I really like being on the Met.

Best of luck to you!

Krista said...

I have taken metformin for almost a year now. It does have some nasty side effects. The good news is that once your body gets adjusted to your dose and once you learn what foods are not tolerable, there are no problems. Build up to your dose gradually. I take 3, 500 mg pills a day. I started out with 1 a day the first week, 2 a day the second week and 3 a day the third week. That made it a little easier for my body to adjust. Also avoid greasy foods, alcohol and high fat content dairy products. Or at least that's what I have to avoid.

The HSG is different for everyone. I tend to have a very low pain tolerance and I did not have problems with it at all. For me it was like a rough pap. Don't worry about it too much.

I am glad you are getting things moving and are making progress.

Erin said...

It sounds like quite a busy appt! My RE uses a team approach with the RE's themselves, but each has a nurse who works exclusively with him/her. So Nurse L is always the one who calls me with test results, etc. I do like that I don't feel quite so lost, though I've only actually seen my RE once or maybe twice in the last 6 months. That bothers me a little.

I've been on Met for almost 18 months now, and was on it for 2 months before getting pregnant with P. Then I stayed on it through my first trimester. Here are my experiences:

What were your reactions to the medication? I'm on the extended release version, and have very few side effects from it. It takes a few days to adjust to it in the beginning and there is some stomach upset, but I've heard the XR version is much easier than the regular version.

Did it help you ovulate? Not really, I'm one of the lucky ones with PCOS who ovulates on my own, albeit more than a month after my cycle starts. It might speed it up by 3 or 4 days, but it's pretty negligible.

Did you get pregnant? Yep, that's all it took with P. This time around, no.

How long did you take it before you decided to move on? While TTC#2, I took it exclusively for 6 months before pursuing further treatment in addition to the Met.

Did you continue to take it as you persued further treatment options? Yes, it still helps keep blood sugar levels and my weight in check, as well as some of the hormonal problems. Also, women with PCOS have a 3x higher chance of miscarriage after getting pregnant, but Met reduces that risk down to the level of someone without PCOS. Given how bad my spotting and cramping were from time to time while pregnant with P, it may have been the only thing that kept him in there. I took it throughout my first trimester with him and will probably take it throughout my pregnancy if I get another one.

What is your PCOS like? Not bad. I mostly have the hormonal effects. My ovaries are not actually polycystic and I have very few of the physical signs (hirsutism, acne, etc).

ms. x said...

Coming out of hiding for a moment to voice some concerns...

I would be concerned with the fact that Dr. H said that getting your period naturally means that you are ovulating. That is an irresponsible statement to make. I can guarantee you that getting your period does not mean 99.9% that you ovulated. I have had fairly regular 28-32 day cycles for years and I know for a fact that I was not ovulating. A lot of anovulatory women with PCOS have regular bleeding. It is called breakthrough bleeding and while it isn't considered an actual period, there is little way to tell the difference. Don't let anyone tell you that period = ovulation.

Also, simply putting you on Metformin is kind of a lax treatment, as it can take up to 3 months or more to build up enough in your system to make a marked difference. I would definitely take that into consideration and possibly ask why he isn't looking at a more aggressive treatment.

-x-

TeamWinks said...

My PCOS leaves me with acne, a bunch of added weight, nearly insulin resistant (something they will monitor,) and with mood swings.

Now, as for what Mrs. X said...I agree. Just because you are getting your period, does not mean ovulation. I have regular 32 day cycles, and have a normal period. However, I do not ovulate. I also agree with the rest of what she said. Just something to think about.

Heather said...

Can you please share your experiences with me? put on Met in Jan of 06. I was put on 1700mg and he did not tell me to work my way up to that dosage. I thought I had thyroid problems because my Mom does and I had similar symptoms.

What were your reactions to the medication? I was ill. Work up to whatever dosage the dr. wants - do not take full strength at the beginning. Make sure you have some immodium and tums for the first few days each time you increase. Each person reactes differently to different foods. Salad and pizza are hard for me to handle on met. So pay attention to how your body reactes to different foods. Keep a food journal if you have to.

Did it help you ovulate? No. Good Doc said I probably never ovulated in my entire life until Cl0mid with Dexa. Even when I had my cycle every 28 days on birth control - never ovulated.

Did you get pregnant? Never.

How long did you take it before you decided to move on? I still take it because it makes me feel better than I did before. I think my dosage may not be high enough but I haven't asked. Most people who have PCOS take it through the end of their first trimester - but that is between you and your dr.

Did you continue to take it as you persued further treatment options? Yes, I take 850mg at 8am and pm regardless of what else I'm taking.

What is your PCOS like? Tired, lethargic, moody, losing hair on my head and growing hair other places I shouldn't (chin), some (few) skin tags, bad acne, insulin resistant, obesity (I kept gaining no matter what I did), lots of cysts, and I'm probably forgetting something - pretty much all of the symptoms except dark skin patches. I didn't have all of these symptoms before but when I got off birth control they started to appear more and more the longer I have been off.

Good Luck and email me if there is anything I can do or you want to talk...

sariel & shlomit said...

Yaaaaayyyyyy!!!! FINALLY an appt with an RE!!! You sound like you were super organized (no surprise) and i like the things you are evaluating the clinic on...good stuff!!! I can only speak to the clinic experience since i am not taking metformin, nor will i be (yet?!)....We go to a REALLY BUSY fertility clinic as well so i think your questions about possibly getting lost in the shuffle are relevant...we have one RE and she is almost always available to us in the clinic (so far the only exception is that they rotate weekend coverage...so often we have her, but not always)..and she is always available by phone (if not right at the moment than certainly that day)...there are also a bunch of nurses available and they've been helpful...you probably will encounter different doctors having slightly different approaches (ex. the RE last weekend wanted to give me an hcg shot and dr. g. never mentioned that so we chose to hold off til dr. g. ret'd)...i think it's important to also be your own case manager (which i KNOW you are good at!!)...and ask lots of questions all the time...i think the risks of getting lost in the shuffle decrease when you are mainly dealing with your own doctor...anyway, you will figure it all out and it's great that you now have a choice!!

re: the hsg...i too had heard MANY horror stories and i too usually fall in the small percentage of people to whom the wierdest and most unusual things happen...so i was expecting absolute agony and complications....my doc gave me 2 ponstan to take an hour before the procedure...it was a little uncomfortable but really cool to see your uterus and fallopian tubes on the monitor...i had some pretty intense cramping right after the procedure for about 45 minutes and slightly less intense (but still intense)cramping for a couple of hours...but that was it!!! but i must warn you that i had the WIERDEST discharge afterwards which is apparently from the stuff they use to 'wash' your cervix....

it will probably not be as bad as you've been told but EVEN if it is, it's over fairly quickly (5 or 10 min) and you will have a better sense of what's going on...

glad to hear that things are moving along as they should and good luck with the meds, your decision and the hsg!!! OH! and that's GREAT abt the C-man's swimmers...yaaaayyyY!!!!!

shabbat shalom, my friend.
peace
shlomit

Mary Ellen and Steve said...

I am on Metformin, and it does make me ovulate, but not regularly. I did have some nausea with it at first, but that did pass in time.

Good luck with it. I hope that it works for you.

~r said...

I was worried about met but it hasn't been that bad for me. The first couple of weeks were rough, but I was ok after that. Once I switched to the met XR, I had next to no side effects. Now it's only a problem if I overdo it on the greasy or sugary stuff.

I noticed a difference in my cycles after about 2 months, and got pregnant after 5 months of met (tho I didn't stay pregnant).

I was on met alone for about 7 months, moved on to clomid/IUI after my miscarriage because of B's SA. I still take my met, but now I'm also on femara and I watch my sugar and carbs.

I'm not sure how to describe my pcos - other than I'm considered 'atypical'. I had two different doctors fail to see ovarian cysts (so they can't be that bad), and I've never been significantly overweight. I do have some excess facial hair, and I'm definitely insulin resistant.. but I also ovulate on my own fairly often. It wasn't unusual for me to skip a period or three, but it wasn't til the last two years where I really started having anovulatory cycles more often than not. I haven't had an anovulatory cycle since I started the met, so I'm guessing it's doing something.

.. and good luck choosing an RE - you've made a great pro & con list. I hope your appointment with the next RE makes for an easy decision, whichever way it goes.

VanillaDreams said...

Hey, all you guys that have been diagnosed with PCOS -- what what your blood work results like?

I'm told they diagnose PCOS with a ratio of bloodwork like FSH to LH....something like that???

I'd be curious to know what everyone's blood work looked like since we have some women commenting that they were "atypical" PCOS patients, and some saying that they didn't hardly have any symptoms....

Also, exactly HOW does Metforim induce ovulation in PCO women? Do the doctors even know??

So, if any cares to share that info, I would appreciate it. Thanks! :)

Ms. C -- sounds like your appointment went well. I ummm, wouldn't worry too much about the "personal attention" from any one specific doctor. To be frank, it's just "how it's done" in Canada. We are not like the US, where one can find an IF clinic across the street from every Starbucks..... So, I find usually the Canadian clinics are busier, and they usually do operate with that "rotation" of doctors.

For example, at the " Calgary Foothills Regional Fertility Program" -- they have a staff of four doctors, and say you are being monitored by ultrasound for stims or lining checks, you will see whatever doctor is available for your scan that morning (they take turns daily).... BUT, if you booked an actual regular appointment or consultation, you would see "YOUR" RE, the one who will go over test results, prescribe meds, procedures etc.

And of course, there is a large staff of nurses and medical assistants to deal with patient inquiries, etc. It really does work quite well.

You are lucky that Montreal apparently has more than one clinic! Very, very lucky. It's my understanding that the clinic here in Calgary is the ONLY ONE in Western Canada save for the one out in Vancouver!!!! So, yes, that's right, ONE IF clinic serving Manitoba (although I imagine some may go to Ontario for treatment), Saskatchewan, Alberta, and even parts of B.C.!!!!!

ANYWAY, this turned into a terribly long post -- good luck with everything, and especially your upcoming appt's!!! :)

Take care,
N

lunarmagic said...

I am stealing your questions that you asked your RE. Yay! I am gathering info for my first RE visit. :)

Karaoke Diva said...

I take Metformin even when I'm not TTC because it really helps me maintain my weight (I'm about 100 pounds overweight thanks in part to the PCOS). The worst part is the first two weeks after you start taking it. You will crap like you've never crapped before in your life. Then it should mellow out.

I don't ovulate at all on my own or even with Metformin alone. I need a Met/Clomid cocktail to get these eggs popping. I'm currently TTC with 1500mg Metformin and 100mg Clomid. That's what got me pregnant (along with an IUI) with my son 3 years ago.

What is my PCOS like? I suffer from obesity, hirsutism, acne, and anovulation. Don't I sound lovely?

Nico said...

Don't get yourself worked up about the HSG - some can be bad, but they can also be just fine - I felt a few mild cramps when they injected the dye, but nothing worse than mild period cramps. And nothing afterwards. And that was without any painkillers...

Thalia said...

I have nothing to say about metformin, but on other topics:

1. I felt nothing on my HSG, maybe a tiny little bit of pain with the speculum, but really nothing bad. SO don't be scared.

2. Seeing multiple doctors during a cycle is par for the course, no one person could see you every time, otherwise they'd never have a day off as cycles are unpredictable. So long as he is reviewing your notes etc and involved in critical decisions, that's good enough. But by all means go and see the other clinic, too.

My Reality said...

I don't have PCOS, so I am no help there.

The HSG hurt, but it was over really, really fast. I didn't even see the dye go through on the screen because I had my eyes closed. It was over before I knew it. I was crampy afterwards, but it wasn't too bad. Take as much advil/ibuprofen as you can stomach and it really won't be that bad.

Once you see the second RE, you might have a preference for the different clinics. You and the C will have to decide which one will be best for the 2 of you. I hope things go well with the second appointment.

flygirl said...

Hey! I have trouble getting your blog to update so that's why I'm late. I was shocked that you weren't already on Metformin! I've never heard of bad side effects (aside from upset stomach if you don't take with food).

FYI, I always ovulated but usually very late. My cycles were about 50-60 before Metformin. The Metformin brought my ovulation to within normal range within a month. My doc says that it DOES start working right away (even though it might not perform miracles right away - it should start making a difference right away) and I just stopped taking it at Week 10.

Just be sure you always take it with food and you'll be fine. I worked my way up to 3 pills a day within a week or two.

Also, your clinic sounds EXCACTLY the same as mine. All the way to Dr. H. If I didn't know better I would think you were coming to Ottawa for treatment.

BTW, my HSG, while uncomfortable and not my favourite thing in the world was not terrible. I know some women that thought it was a complete breeze.

Keep your chin up! I hope the metformin works for you. I've heard lots of wonderful success stories. Unfortunately, I still had to go through Clomid and then IUI but I can say for sure that Metformin made a difference.

Asha said...

I have no experience with Met, I just wanted to say congrats on getting this far... I just read through your blog and what a relief to finally be in Oct and getting to your RE appts. I am breathing a sigh of relief for you -- what a hectic journey you've had just trying to get into the door.

Mandy said...

Hi, I'm new to your blog and hope you won't mind an additional comment. I'm glad the metformin thus far seems to be doing as little damage as possible, regarding side effects. They do get better. Also, as someone who knows - avoid iceberg lettuce for a while. Some of us (those with PCOS) have MAJOR intestinal troubles if we eat a salad made mostly of iceberg (as some restaurants provide). Other greens are totally fine. Wait until you've been on the met a month or so and then try a small amount. You'll know then if it's an issue.

Also, regarding your dose - Most RE's seem to agree that 1500 to 2000 in the most effective dose for cysters for conception as well as for the other symptoms of PCOS. I don't know if your doctor mentioned his recommended "full" dose or not.

If you have any questions I can help with, please feel free to let me know.

Mandy said...

I also wanted to add - those looking for support and a central place to ask questions about pcos might enjoy visiting one of the following two websites:

www.soulcysters.net
www.pcosmommies.com

PCOSM is a smaller, pretty drama free site so I spend most of my time there. Just because "mommies" is in the title doesn't mean that you won't get lots of help and support. Many of us on that site do have children, but not all.

Finally, I'm not affiliated with these sites in any way other than I'm a member.