OBGYN Update and advice

June 23, 2009

Thanks for all your well wishes and for your advice. I went to a different location to see my my doctor.  This office is located inside of a bigger building, a pediatrics building. Babies, everywhere. I was seated for my consult and looked out the open door. I was sitting across from the Ultrasound room. 22 weeks is about how far I would’ve been. You can guess the thought that went through my mind as I sat waiting.

The meeting went fine. She gave me  a progesterone  ‘script. She’s running blood work to check on what caused my miscarriage.  She told me to get an HSG done and for Jack to get a sperm analysis. Here’s my question: I got pregnant. So clearly the sperm is swimming and my fallopian tubes are open . . . right? Is this standard operating procedure? This is my tentative time line:

July: Get a period and get HSG test and SA done.

August: Get next period and start Clomid. Three Cycles on Clomid.

November: Clomid +IUI. Three Cycles.

February: Fertility Specialist.

She told me to exercise and watch what I eat. Check, and check. She told me to calm down and not stress too much [don’t you LOVE that nugget of advice] because that can affect when I ovulate.

I got off the phone with Jack and he started whining: I don’t want to get an SA. I almost broke down and started bawling. Really? Jacking off into a cup is too much for you? You want to get the HSG done?!? Then when I explained the process he was like Um, do you really want to do all that to have a baby? What the FUCK? I tried to keep my cool and said You told me you were fine with me seeing an RE. What did you think they were going to do? Read my tarot cards and give me herbs to wear on my head while I danced around a fire pit? He said he didn’t know. We’re supposed to talk about it over dinner tonight but I’m really afraid because I don’t want to fight. We’ve been really strong and together on this IF front and I don’t want to break down.

So I have a few questions to throw into the blogiverse:

1) If I have a chance for insurance to cover more if I stick with my OBGYN, what is the increased benefit that an RE would provide. I know that they’d be more knowledgable but if they’re going to give me clomid, IUI’s etc, then why not stick with the doctor I have and let insurance cover some of it?

2) Did any of you have HSG and SAs done post-miscarriage? I’m confused as to why I’d need this see we can clearly get a baby into my belly.

3) Have any of you had to convince your significant other to go through with procedures, etc? I hope I don’t have to go through any convincing, but if I do, do you have any advice for me? I think he’s just overwhelmed. He also doesn’t want it as bad as I do. He’s point blank told me: If we never have kids I’m okay with it though having a child will be wonderful. Some say this should comfort me, one person needs to be the rock. I don’t know, sometimes I agree, sometimes it makes me feel alone.


  1. the benefit is that re’s are fertility specialists and ob’s are not. i’ve never even heard of anyone having an iui at their ob’s office, i mean i’m sure there are others who do it besides yours, but all the bloggers i know use re’s for procedures like that. that doesn’t mean your ob doesn’t know how to do it, but honestly i wouldn’t even mess with an ob at this point in the game, you’ve got pcos and that alone is reason enough for me. you can’t really understand what a difference it makes until you actually switch and see for yourself. i’ve got a really great ob, but this is what my re does EVERY DAY, not just occasionally for a few patients here and there, you know what i mean?
    as far as the husband issue goes, i think all men are resistant to the idea of all these procedures and fertility specialists at first, they don’t want to even to CONSIDER that their boys aren’t strong enough, i don’t know, i think it’s just a weird guy thing. once i had my laparoscopy and we found out i have stage III endo he changed his tune, he is very supportive with everything we have to do to make us parents. he says the occasional thing without thinking, like, “you owe me, BIG time,” after “collecting” his “specimen,” but i know he’s not trying to be inconsiderate about all the shit i’ve had to go through, he’s maybe joking a little and maybe feeling a little embarrassed about doing his business in a doctor’s office.
    i guess you just have to do whatever you feel comfortable with, and maybe staying with your ob is what’s right for you, but if i were you i would make an appt for a consult with an re asap.

  2. We had an HSG and sperm analysis done, even though we’ve gotten pregnant on our own before (once, ended in miscarriage) and have no other known fertility issues. My OB said that if my husband has sperm issues, it’s possible we just got lucky the first time and that is why it is taking us so long to get pregnant again. Regarding the HSG, my OB said I may have gotten a small infection after the miscarriage – I had a D&E – that is causing a blockage and is preventing conception. My OB said she expected both the HSG and sperm analysis to come back normal, which they did. But now I at least have the peace of mind knowing that neither of those two possibilities are what has kept us from getting pregnant. And that it may just be bad timing and/or bad luck. When giving me my HSG results, my OB also mentioned that, even though my tubes weren’t blocked, the HSG clears out debris, which could only help us conceive. So, it might be worth doing just to know.

  3. With my clinic, SA are standard. Before they did anything else they requested that. My OBGYN actually suggested it before referring me to my doctor, so we had it in hand when we showed up for our first appointment. After that, I actually had to fight for testing with my RE. I regret that decision now. I was frustrated because he automatically assumed there was something wrong with me and want to jump straight to clomid, IUI or IVF. I wanted to know if there was a problem first before we started any of that. I wasted a lot of time. Luckily, the one thing my insurance did cover was diagnosis so all the stuff I had done before hand was covered so we didn’t waste any money, just about a year of time. I wish now I had jumped straight to the IUI, but I just couldn’t see recommending that sort of treatment before they found if there was anything wrong with me. I still sort of feel that way, but I also can’t help but think maybe I’d have a baby by now if I hadn’t insisted on the testing. They still never found anything that they could definitively point to as the problem. I’ve said before, I think they just diagnosed me with PCOS b/c they couldn’t find anything else.

  4. As to number 1, I was NOT advised to do an HSG or SA after my m/c. My obg kept emphasizing how fertile I clearly was, having gotten pregnant once, and chalks the m/c up to a statistical fluke. She was more interested in checking my thyroid and stuff like that – i still may do some extra blood tests but am staying away from HSG unless it’s recommended to me. Strongly.

    As to number 3 – I could have written that question myself. Your DH sounds exactly like mine on all counts. Gets all freaked out about a simple procedure like a blood test without realizing that such a thing represents one/onebillionth of what I’ve been through already. He also could do without kids and any sign I get that he’s at least consenting to have them really excites me. You are not alone on this. I’ve been told that for a lot of guys, this is typical behavior. THat doesn’t make it suck any less. It is scary to be the ‘rock’ on this issue, it’s scary to feel like you’re pushing your DH to the brink and then wish he would get over feeling like that and have an ounce of consideration for what it’s all doing to you. My approach is just to mention every phone call, every beta, every incident that I go through so when/if I do have to ask him to do something simple, he’ll just do it. He’ll have some perspective. At the same time tho I think it’s important not to overwhelm him with my own worries and wants and obsession with babymaking. I leave that all out ’cause I think that makes him feel like he’s coming in second to our unborn baby. As big of punks as they can be, they still need a little ego-stroking once in a while. Guys are unbelievable and there’s nothing like the TTC process to make me fantasize about becoming a single mom, ironically.

  5. I have a few things that I have learned/ been told during our ttc journey

    1. Low morphology can cause miscarriage. SA will determine morphology. We have low morphology.

    2. My HSG was not bad at all. It took less than a min. to complete. I had HSG and Sono Hystergram. The Sono HSG showed polyps and scare tissue (we have o idea where scar tissue came from) and as a result of the sono HSG I am having surgery to take care of these issues. HSG showed clear tubes as well as the scar tissue.

    3. My husband needed pushed to get the SA done. He was not happy but got over it eventually. If you live close enough to the Dr office he may be able to do his sample at home and then take it to the office.

  6. The HSG and SA are standard. It gives the doc a good baseline to start from, and it can rule out any scarring/adhesions from your m/c. Also (may be TMI) but a lot of ‘debris’ came out of me after the HSG. I think it just helps clear you out. And studies show there is a slightly increased incidence of pregnancy immediately following an HSG.

    The timeline and plan your OB/GYN laid out is straight-forward and I think an RE would have a similar plan. You really accomplished a lot with this visit. If your insurance is covering more with your OB/GYN I would stay with her (him?) for a year. I’d at least wait ’til all your test results are back, ’cause an RE is going to want to start with the same tests.

    My DH didn’t want to do the SA, either. When he found out about it, I thought he was going to scrap everything! So he decided to do a practice run on his own. Then we did a practice run together, making it a game. Now he’ll drop ’em anywhere, anytime! He’s not fazed a bit. Use a ziplock, let him do a trial run, it’ll take the pressure off. Also, we’re close enough to the office that he can do it at home and I can drop it at the office w/in an hour.

  7. Thanks guys for all your comments with advice. I think reading through your comments helps me understand a little more why Jack is nervous about doing the SA and that its a typical guy reaction (not necessarily great, but typical).

    Kate, thanks for your advice. I am talking about it with Jack and considering our finances a we make the decision. I wish these things weren’t so complicated but thanks for giving me so much great advice.

    Lil Sumo, and Michelle, thanks for explaining to me why they asked Jack to do a SA despite one pregnancy that proves his sperm swims. It helps me respect the process more.

    Astrid, why are you steering away from the HSG? Is there any particular reason?

    Meggomae, I think you did the right thing to do the testing. I mean, I like you would have been in the same boat. My first OBGYN Wanted to stick me on Clomid without any testing and I switched doctors. I know how that feels. At the end of it, a year later, like you I’m where I would have been… but I dunno, in some ways its good to also know what you DONT have, too…

    Stacey, I didn’t realize you could do it at home and deliver it to the doctor’s office!!! Thanks for the idea, I’m going to see if his office will do that. That will help matters considerably.

  8. so you have a lot of great comments on this, so I won’t repeat what you’ve already heard.. but i’mm just say I’m GLAD you got your progesterone and I’m glad she agreed to blood work.. and go ahead and run the tests.. who knows what you will find, and it’s better to know. honestly the HSG is uncomfortable, but not.that.bad. seriously, it’s not.

    and yes, guys are weird about the SA. they just are. every guy is different – you know the way to reward/appreciate/motivate your guy, so keep those things in mind before and after.

    And, yes, go to an RE. all these tests, blood work, etc, – do with your obgyn, that’s fine. but go to the RE for any ART procedures.

    We’ll all be here for you during this whole mess!

  9. No, no particular reason to steer away from the HSG except that I’ve heard they can range from uncomfortable to exruciating and it’s the kind of thing I’m a baby about – unless I really need it I tend to shy away from more procedures ‘down there.’ And I don’t feel like I need it having had one loss the cause of which was probably choromosomal, rather than structural. But I didn’t mean to sound alarmist. It’s not something I would absolutely refuse – and if my Dr. recommended it I would probably do it. My resistance is just the fear talking!

  10. Thanks for the encouragement Gabby and for your support. It means a lot. 🙂

    Astrid, thanks for explaining. I also HATE it when I have to do procedures “down there”. It’s very frustrating. If you don’t have to, why do it, I say? Thanks for clarifying.

  11. […] saw my therapist today and we talked about my plan. I told him something I’ve been scared to admit to myself, I am so scared to start the plan. […]

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