Wednesday, November 7, 2007

The Infertility Stuff, Part 3

We got a referral and made an appointment with the reproductive endocrinologist through our HMO, just to see what our options were locally. The appointment didn't get off to a good start. I had to drive about 45 minutes to get there. I was running a bit late, and the nurse was not amused.

When the doctor came in, he wasn't too interested in our perspective. Forget the knowledge we had, the accumulated charts, the questions--he had his prepared spiel. So, fine. We heard the spiel. He told us that as long as Mr. X was "making sperm," I was "making eggs," and my tubes were open, they could get me pregnant. Hmm. OK. Not exactly what we were looking for. What about diagnosing and treating the problem? Nope.

So, we already things were OK on Mr. X's side of things. He wasn't too impressed with the records of temperature shifts on my charts as evidence of ovulation. So, he recommended a blood test to make sure I was ovulating, as well as a hysterosalpingogram to check whether the tubes were open. He also asked whether we had any genetic disorders in our families. We knew of a particular genetic disorder that had appeared in my family, so they obligingly said that the HMO would cover testing me for the gene.

He was unimpressed by the mention of the Pope Paul VI Institute. He outlined a plan for treatment. If I wasn't ovulating, then he would prescribe Clomid. He might also prescribe progesterone (in fact, he offered to write me a prescription on the spot, if I would promise only to take it after ovulation . . . which showed surprising confidence in my ability to identify the post-ovulatory period of my cycle!) or some other hormones. The next steps would be intauterine insemination, then IVF. Hmm. Not the procedures we were considering . . . Possible signs of endometriosis or polycystic ovarian syndrom were not particularly interesting to the doctor, and there was very little mention of treating any of those issues. Just getting me pregnant.

All in all, he was just kind of dismissive. In fact, toward the end of the appointment, he replied to a question my husband asked by saying "I'll bet your wife will be pregnant within three months." Nice. Just a little patronizing when it had already been a year at that point.

So, we went home. We decided to sign up for the testing, on the thought that more information was better. So, we got instructions on scheduling the HSG, and I was told to go in toward the end of my cycle for the progesterone test, at which point they could also draw blood for the genetic screening.

I went on what turned out to be the last day of the cycle in which I was having every-other-day blood draws at my regular doctor's office. I had a blood draw at my doctor's office (done very quickly and painlessly by my doctor's assistant), then got back in the car and drove 40 minutes to the HMO to have the other blood draw.

I am not good with needles (though I'm much better after 18 months of infertility treatment than I was before!). I can't look at the needle while blood is being drawn, and I often chatter incessantly to the person drawing the blood to keep my mind off of things.

I got a new technician.

She had to draw a whole bunch of vials.

She described to me, in detail, what was going wrong.

When she finished, she put a wad of cotton on my arm and had me hold it while she put a pressure bandage over it.

She told me not to bend my arm. In fact, I shouldn't pick up my purse with that arm when I leave.

Then she asked if I wanted some orange juice.

I took the orange juice gladly. But the weird little blood-draw bay I was sitting in had all of these vials and other blood-test paraphernelia right there, and I was looking right at it.

So, I went out to the waiting room. I dropped a book, and a nice man picked it up. Then, I felt a little woozy and put my head between my knees.

Instantly, two nurses came running and got me into an exam room, lying down. My blood pressure was something like 90 over 50. So, the nurses aide had me lie there and kept monitoring me. I have low blood pressure anyway. So, I lay there and read my library book. My blood pressure slowly climbed. Then, on about the sixth check, my blood pressure was 84 over 48. Then the nurse's aide got worried. So, she brought in the nurse . . . who came over to my left side, looked at the big wad of cotton on my arm . . . put her hand on it . . and squeezed! Excuse me? Does it sound like good medical practice to squeeze the bandage of someone who just had a really nasty blood draw?

Anyway, it all turned out fine. Mr. X was away on a business trip, which is why they made me stay so long (I'd have to drive myself home). The nurse's aide had me get up and walk around, my blood pressure went up, and I went home and drowned my sorrows in ice cream.

Tomorrow, I'll write about the test results.

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