Yogurt
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Post by Yogurt on May 6, 2018 21:43:08 GMT -6
Tl;dr What would you ask your doc to check if you had 2 chemical pregnancies this year?
Ok, so I have my routine pelvic exam coming up on Tuesday. I can't get a referral to the RE, so I'm doing what I can with the nurse practitioner at my old OBs office. (It sounds like the OB left suddenly and they are having the nurse practitioners see people while they transition.)
My backstory: Got pregnant first cycle with dd, no issues besides preemie from going into surprise labor at 35 weeks.
Tfas for 12 months/13 cycles. Chemical pregnancy in January and April. Lines got darker, darker, darker, gone/bleeding.
Nurse practitioner sent me for routine bloodwork right after this second chemical that all came back normal for clotting factors, thyroid, hcg (neg), vit d. I plan on getting an order for a progesterone check that I will go do 7dpo. I am about to list a bunch of stuff that I see people on FB and FF use (for what purpose, I don't know) in the ttc threads and maybe you can give me feedback on if it makes sense to ask her about taking these things.
B12
Folate
Baby aspirin
B6
Vitex/chasteberry (this sounds gnarly and my cycles are pretty regular, with slightly late O at cd 17-20.)
She also talked about sending me for AMH FSH tests?
So besides getting my progesterone checked, what else should we discuss?
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Tlex
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Post by Tlex on May 6, 2018 21:56:49 GMT -6
I didn't want to read and not comment, but I don't feel like I have advice to give. Just wanted to give you a hug and say take deep breaths, write down your questions, take your time clarifying answers, and I hope you feel heard when you leave.
There may not be a lot for them to say right now, as frustrating as that is. I'm hopeful they'll have some constructive advice for you. ❤️🤞🏻
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Yogurt
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Post by Yogurt on May 6, 2018 22:14:29 GMT -6
Yeah, I guess I'm just like...is it some easy fix and I need a baby aspirin and this won't happen again?!
I just feel like I want to get as much information or guidance out of this as possible, even though the answer might be it was a fluke.
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Post by charliefox on May 6, 2018 22:24:30 GMT -6
AMH and FSH levels will be good to check. Otherwise I don’t really have any advice just hugs. I hope you can get somewhere with the NP/OB for now.
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Post by charliefox on May 6, 2018 22:26:58 GMT -6
Oh, have you read Taking Charge of Your Fertility? I find the a lot of docs (yes, even OBs) just don’t know enough about TTC and any related issues, so don’t be surprised if whoever you see is less than helpful. On the bright side, TCOYF has a ton of great info.
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Yogurt
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Post by Yogurt on May 6, 2018 22:33:19 GMT -6
Oh, have you read Taking Charge of Your Fertility? I find the a lot of docs (yes, even OBs) just don’t know enough about TTC and any related issues, so don’t be surprised if whoever you see is less than helpful. On the bright side, TCOYF has a ton of great info. I have not read that, but I do feel like I have far more knowledge than my gp and the np about ttc. I guess after all this time, I should check it out. |
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Post by obscureference on May 7, 2018 5:44:22 GMT -6
I don’t understand why they won’t give you a referral to an RE. 13 months TTC should make that an easy referral. I personally would be hesitant to work with an OB. If you end up at an RE you will probably have to do all the testing again. I would push for a referral and if they refuse again, I would look for a new OB. Like, is it common for doctors to refuse referrals? That just seems crazy. Patient care and all that...
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Yogurt
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Post by Yogurt on May 7, 2018 7:13:18 GMT -6
I don’t understand why they won’t give you a referral to an RE. 13 months TTC should make that an easy referral. I personally would be hesitant to work with an OB. If you end up at an RE you will probably have to do all the testing again. I would push for a referral and if they refuse again, I would look for a new OB. Like, is it common for doctors to refuse referrals? That just seems crazy. Patient care and all that... gp does not understand what an RE is and is telling me it's only for people with diabetes or something, np says she will give me the referral, after I go through all these steps with her. There is an RE nearby that I called and the guy at the office put me on a waiting list for an appt, and that they might have openings in July. Another RE was recommended to me, and actually called me himself and spoke to me for 30 min +. He said after hearing my backstory he thinks the cp's were likely a fluke and when I read him the labs the np ordered he said he would have asked for all the same stuff and to also get the labs sent to him, which I did. But it was all normal. I will follow up with the second RE, but for now, I'll get the progesterone checked. I'm also 37 in a few weeks which makes me feel even more pressure. |
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Yogurt
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Post by Yogurt on May 7, 2018 7:14:54 GMT -6
I also have zero IF coverage, so that makes things more complicated
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Post by obscureference on May 7, 2018 7:54:49 GMT -6
I mean if you’re 37, the guideline is only 6 months TTC before moving to an RE.....are you in the US? I don’t have any IF coverage either. But my RE billed the testing in a way that was covered. I feel like your gp is making this more difficult than it needs to be and the fact that they don’t know what an RE is, well that’s just disturbing. I would be looking for other doctors.
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Post by wildhoney on May 7, 2018 8:27:16 GMT -6
I don't have much to offer except a list of the RPL testing that my RE wanted after 2 CPs.
CD 3: FSH, Estradiol, LH, Inhibin B, Prolactin, and HgB A1C
I had the above tests done, plus the progesterone at 7 dpo.
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Yogurt
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Post by Yogurt on May 7, 2018 10:42:12 GMT -6
I don't have much to offer except a list of the RPL testing that my RE wanted after 2 CPs. CD 3: FSH, Estradiol, LH, Inhibin B, Prolactin, and HgB A1C I had the above tests done, plus the progesterone at 7 dpo. Ok this is good! The NP had never heard of a repeat loss panel. Yeesh. |
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Yogurt
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Post by Yogurt on May 7, 2018 10:43:06 GMT -6
I mean if you’re 37, the guideline is only 6 months TTC before moving to an RE.....are you in the US? I don’t have any IF coverage either. But my RE billed the testing in a way that was covered. I feel like your gp is making this more difficult than it needs to be and the fact that they don’t know what an RE is, well that’s just disturbing. I would be looking for other doctors. Yeah, I'm in California. And yes I feel like I have a PhD in ttc compared to these folks. |
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Tlex
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Post by Tlex on May 7, 2018 16:09:37 GMT -6
Yogurt it didn't take long conversing with my GP for him to realize I had probably done a lot more reading on PCOS/fertility than he had. Thankfully he's really young and has the "lifelong learner" mentality that they're promoting in med school these days so he enjoyed being challenged to learn more and send me on to someone helpful. But he hadn't heard of an RE either. He kept wanting to refer me to an OBGYN which is... not the same. But the one I'm seeing seems to dally in all parts of fertility so I'm staying open to it.
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Yogurt
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Post by Yogurt on May 7, 2018 16:34:50 GMT -6
The RE called me today and said they had a cancellation and can see me Wednesday. This will likely be out of pocket, so I'm panicking a little about the cost.
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sullivan
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Post by sullivan on May 7, 2018 19:28:20 GMT -6
The RE called me today and said they had a cancellation and can see me Wednesday. This will likely be out of pocket, so I'm panicking a little about the cost. Tell them that up front, I bet they will try to work with you as much as possible, and you likely won’t run into major costs until you get to the procedure stage. Labs and testing sometimes can be covered. Just ask ask ask! I hope you’re able to get some answers & I’m glad you’re getting in this week. |
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Post by shakinros on May 7, 2018 19:41:16 GMT -6
The RE called me today and said they had a cancellation and can see me Wednesday. This will likely be out of pocket, so I'm panicking a little about the cost. I’ve had success scheduling appts with a specialist and then informing my primary doc who it is I need a referral to. Call your NP’s office tomorrow and tell them you have an appt on Weds and need a referral for the insurance. Not sure if your insurance is the same, but mine requires a doctor referral to the specialist practice (which I do through my primary’s office) then an insurance referral, which I get by calling the 800 number on the back of my insurance card. Insurance will not do their referral until the doctors office has done their part. I then have to renew it every 90 days. Worse comes to worst, my RE was going to charge $250 for the intake appt if I couldn’t get the referral in time. |
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Post by charliefox on May 7, 2018 21:00:41 GMT -6
The RE called me today and said they had a cancellation and can see me Wednesday. This will likely be out of pocket, so I'm panicking a little about the cost. I'm so glad you'll get to see someone who can actually help you!!! REs deal with OOP patients all the time, so tell them first thing. They are used to it and should be able to give you a break down of the costs of each little thing before you do it. Right from the beginning my RE broke down what was involved with each procedure and how much it would cost. Our insurance covers almost nothing related to IF until we meet our deductible, so far things have been OOP. Luckily, everything is given a OOP discount so, for example, my ultrasound for to check my follicles was billed to insurance at $230, insurance paid nothing, I got a bill for $99. Of course it adds up, but it hasn't been as bad as I imagined. |
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Yogurt
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Post by Yogurt on May 7, 2018 21:08:08 GMT -6
The RE called me today and said they had a cancellation and can see me Wednesday. This will likely be out of pocket, so I'm panicking a little about the cost. I’ve had success scheduling appts with a specialist and then informing my primary doc who it is I need a referral to. Call your NP’s office tomorrow and tell them you have an appt on Weds and need a referral for the insurance. Not sure if your insurance is the same, but mine requires a doctor referral to the specialist practice (which I do through my primary’s office) then an insurance referral, which I get by calling the 800 number on the back of my insurance card. Insurance will not do their referral until the doctors office has done their part. I then have to renew it every 90 days. Worse comes to worst, my RE was going to charge $250 for the intake appt if I couldn’t get the referral in time. I will call my gp tomorrow. He was the one that was like, you need a "fertility doctor" and this guy is like the first RE that comes up when you just Google "fertility doctor my city". So I am sure he will write the referral. But to make things more confusing the RE said they are in network for my insurance so then do I not need a referral? So confusing and zzzzzz |
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Post by shakinros on May 8, 2018 1:08:35 GMT -6
Insurance, why you gotta be so confusing! You almost certainly still need a referral Yogurt. Good that he’s in-network though! That should cut down the co-pay costs a little. Good luck! |
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cmb
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Post by cmb on May 8, 2018 5:42:37 GMT -6
I can speak to some of the meds- baby aspirin and folate are prescribed for women with MTHFR. There’s a higher risk of clotting for us that can lead to a loss and other complications, and we can’t process folic acid like the majority of people so we need folate. I also get placed on lovenox post delivery for 6 weeks because of this higher risk. Baby aspirin is really only recommended when blood clotting issues are there; some women go straight to lovenox or heparin injections depending on the diagnosis.
Your OB/NP can order the RPL panel. If anything comes back abnormal, normal course is to send you to either a RE or a MFM for follow up.
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sullivan
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Post by sullivan on May 8, 2018 7:32:59 GMT -6
I’ve had success scheduling appts with a specialist and then informing my primary doc who it is I need a referral to. Call your NP’s office tomorrow and tell them you have an appt on Weds and need a referral for the insurance. Not sure if your insurance is the same, but mine requires a doctor referral to the specialist practice (which I do through my primary’s office) then an insurance referral, which I get by calling the 800 number on the back of my insurance card. Insurance will not do their referral until the doctors office has done their part. I then have to renew it every 90 days. Worse comes to worst, my RE was going to charge $250 for the intake appt if I couldn’t get the referral in time. I will call my gp tomorrow. He was the one that was like, you need a "fertility doctor" and this guy is like the first RE that comes up when you just Google "fertility doctor my city". So I am sure he will write the referral. But to make things more confusing the RE said they are in network for my insurance so then do I not need a referral? So confusing and zzzzzz I think it depends on what type of insurance you have. HMO, PPO, etc have different requirements. You could look up your insurance plan or call them and it should be an easy answer. Maybe you can avoid getting a referral from your GP all together! |
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Yogurt
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Post by Yogurt on May 8, 2018 13:15:18 GMT -6
Appointment was pretty unsatisfying. Won't send me for progesterone check until I get another bfp. Everything as far as normal exam looks fine. She is ordering a RLP (I think, I have to get a look at the tests once I get the order in my hands), which is good. I am wondering if I should hold off on the RE, or go tomorrow? I'm feeling like the NP is actually sending me for most labs and stuff that an RE would and my insurance covers this.
Plus the REs office was supposed to to call me this morning to conform that they did have a cancellation and therefore had an available appt tomorrow, and they have not called yet. So maybe the person didn't cancel.
The NP said I should TTA this cycle and to have a period before I try again. I'm like...too late we already have been trying this month. ¯\_(ツ)_/¯ Does it even matter? I was only pregnant for 4 days.
She did say that the next bfp I get to go to the office and they would test my hcg and progesterone and get same day labs so I can supplement immediately if progesterone is low, as well as track betas.
She would not help me figure out a plan for June, where I will be testing while out of state. So if I do get a bfp in Florida, I have to just "not worry about it".
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Yogurt
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Post by Yogurt on May 8, 2018 13:22:32 GMT -6
Ok, so seeing these labs she wants makes me feel better. It's a bunch of stuff I see people talk about in the ttc forums...so I guess it's a good start, especially paired with the other tests I've had don't over the last year. No AMH or FSH though I guess? This NP worked at a fertility clinic of some kind for many years, so maybe she knows what she is doing.  |
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Post by wildhoney on May 8, 2018 13:56:43 GMT -6
Honestly, I would still go to an RE. I think that's silly they won't test your progesterone. If low progesterone is the issue and you have to wait until you get the BFP, it may be too late by the time you get your results back and start to supplement. Also, I would try to either ask about getting your AMH/FSH tested or asking about it at the RE. If it is poor egg quality, that is something you should know now and not later.
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Yogurt
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Post by Yogurt on May 8, 2018 14:15:43 GMT -6
Honestly, I would still go to an RE. I think that's silly they won't test your progesterone. If low progesterone is the issue and you have to wait until you get the BFP, it may be too late by the time you get your results back and start to supplement. Also, I would try to either ask about getting your AMH/FSH tested or asking about it at the RE. If it is poor egg quality, that is something you should know now and not later. Hmm. That is unfortunate/concerning about it possibly being too late to supplement if progesterone is low. I will call the RE to see if the patient ever actually cancelled for tomorrow. |
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Yogurt
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Post by Yogurt on May 8, 2018 17:39:28 GMT -6
Confirmed with the RE for tomorrow!
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Post by thechickencoop on May 8, 2018 17:43:42 GMT -6
Yogurt, I would still go for the RE consult. They can can retroactively send in the referral and authorization so even if it's not covered by your insurance, something still may count against your deductible (depends on your ins though). But either way, the consult is usually like $100 to $200 so not the end of the world. They would test AMF and FSH at like CD 3 or something like that I believe so if you're past that then there's no sense in testing now. I would ask about the progesterone again though, usually that's checked at 7 dpo to confirm O and then the next cycle you would just start supplementing at like 3 or 4 dpo IIRC.
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Post by wildhoney on May 8, 2018 18:53:29 GMT -6
Confirmed with the RE for tomorrow! Yay! I'm so so happy you are going. Let us know how it goes!! |
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Post by charliefox on May 8, 2018 21:50:30 GMT -6
Confirmed with the RE for tomorrow! Yay! It does sound like the NP might know her stuff but I still think the RE is a good idea. I'm so excited for you  |
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