My RE appointment was a rousing success. I never thought I would truly appreciate or be comfortable with a male OBGYN but Dr. Bo is my Dr. McDreamy. He’s fantastic and probably the first person over 50, with the exception of Steve McQueen that I’ve had a complete teenage crush on. To be able to say that after a very comprehensive exam, including impromptu breast and pelvic, and woman part thesis is just incredibly hard to describe [sigh] I'm in love.
Here’s the long and the short of it. Dr. Bo gave me the most extensive foray into the fertility world than all the blog researching and prior physician visits, lab works and other procedures combined. In 90 minutes he connected the dots from all the pieces I didn’t know as well as the all the pieces I should have been informed of by the “hobby-shop-doc” or base women’s health office. It was so enlightening. Based on my verbal results of past procedures and the doctors very extensive knowledge he’s narrowed it down to possibly three items, initially:
- High insulin resistance combined with PCOS
- Enodometriosis (only diagnosed with a laproscopic exam)
- Other Ovulation problems (may be combined with PCOS, may be separate.)
Over the next few weeks my complete records package from the base clinic will be arriving to him, and Dr. Bo will be further assessing my situation. If he decides to alter my prescribed meds or thinks we’re attacking this situation wrong he’ll call and let me know.
The current plan of attack in a nutshell:
- Begin taking insulin lowering Gluchophage, or it's generic Metformin, on a daily basis. (Gluchophage is generally either prescribed to lower insulin in diabetics or specifically for PCOS.) For the first two weeks it's 500mg once and day, by the 3rd week, through the next four months, the dosage is doubled.
- Take 100mg of Clomid day 3-7 of my cycle. We're going to do 4 months of dosages.
- Monthly home ovulation testing. Rather than doing the calendar have sex day x though y of the cycle it's have sex within the 12 to 24 hr window on the test.
- Blood testing a week following each ovulation cycle.
- Weight loss.
If we aren’t successful after four rounds than we look into options 2 and 3 above.
Essentially what we learned from the hobby shop was that the high rounds of Clomid may be effective, however, there’s a good chance I wasn’t ovulating anywhere the “window” they had told me to have sex in. And if my insulin levels are too high, in combination with that, it was affecting my ovulation window and possibly preventing any weight loss. In his little thesis, with quite awesome hand drawn graphics I might add, he showed me that I will always ovulate 14 days prior to my following cycle. So if my cycle was 45 days for instance, I wasn’t ovulating until day 31. That’s 16 days past the narrow 7 day window we were forcing sex through. Ah, it all became abundantly clear. This was not explained to me before. So, taking that into consideration, he wants me to use the home ovulation kit so we know when the 12-24 hr window is and we aren’t taking stabs in the dark. Even though it’s so much fun!
Dr. Bo also gave me a standing order for the post Clomid “day-21” lab panel. This will show him how effective the Clomid is treating me. After he gets my past results back and the first of this round he’ll take into consideration possibly increasing the dosage from 100mg, depending on the progesterone levels. This is also another test that we had been doing incorrectly. That means the progesterone results of level 1 may have been correct, or it could have been that low because that is what it should be, PRIOR TO OVULATION. Yes “day-21” is actually a deceptive phrase. What it should be is a “7-day-post-ovulation” panel. Refer to the prior graph to see how much fun the prior 5 rounds of blood work have been.
The third piece (fourth?) to this little puzzle is weight loss. The working out isn’t enough. His recommendation, and many fertility sites agree, that the healthier the weight levels the lower the insulin levels and the better chance of being pregnant and having a healthier baby. (Trust me this only made me gnash my teeth knowing how many friends I have that make my meager 185-193lb size look very normal or petite and that’s before they gave birth/conceived with multiple children.) He’s right though, I would feel better and I’ve known this for a very long time. Sometimes you just need the doctor to give you a swift kick in the arse as incentive. So beginning this weekend I’m throwing myself utterly and completely into the hands of WeightWatchers.com. And I’m dragging my friend and work out buddy Shandi with me. She’s very excited. I place sole blame on my decision to follow this particular plan on the very successful results of my friend Loser Girl.
Ooh and lest I forget, while I’m all into this self-improvement and infertility obsession, I also ordered a 30 trail of Proactiv. Friend suggested and the testimonials by the bigwig celebs seem to agree on it being the divine answer to even skin tone. Since I always run around sans any makeup, moisturizer only, continual slight blemishes and discolorations are a big deal.
Thanks as always for all the support. I gave huge kudos to my online support network of buddies to Dr. Bo. You aren’t forgotten!