Monday, September 17, 2007

If At First (or Second, or Third, Or Fourth. . .) You Don't Succeed. . .

Thursday was a bad day. That is pretty much all that there is to it. I went in for my blood draw in the morning and then back to my RE's office for an afternoon appointment. Now, in case I haven't mentioned this before, my RE is a good doctor, a great doctor, but her bedside manner is slightly. . . lacking. In the appointment after we lost our 11 week pregnancy, she came in, asked me how I was doing, and as I opened my mouth to answer, kept right on talking. She also couldn't understand why I wanted to take a break after that loss, even though I was starting a new position at work and also needed an emotional breather. She just doesn't "get" pregnancy loss, especially chemical pregnancy loss, but even our 11 week pregnancy didn't seem to phase her.

She is also extremely conservative and believes that we should only test for the things that we can fix. I understand where she is coming from and I agree to a certain extent that you can chase your tail with all of this stuff and find something "wrong" that isn't really wrong. But at this point, I would just like the comfort of knowing what that something wrong is. If we can't fix it, or at least not reliably, then it's time to move on to adoption. I am just not the type to give up and when all of the doctors keep telling me that all we have to do is try again, well, I oblige them.

I went into the appointment armed with an article on antibiotic therapy and recurrent loss as well as a list of tests that I got from a woman on a pregnancy loss board. I thought that I had had all of the testing done, but it turns out, I had not had several of them, including the tests for elevated Natural Killer cells and MTHFR. So, I did get a blood test for those, as well as for a few rare blood clotting issues and another lupus check (one test had come back slightly elevated, so she wanted to make sure).

The appointment went fairly well, except for two things. The first was right off the bat. My HCG level was 2.6. Good news in that the chemical pregnancy had worked its way out. I said something to that effect and how I knew that a chemical pregnancy wasn't an abortion and she said, "Good. Then there is no reason to be disappointed."

That kind of irritated me. I think she was joking, but she isn't the joking type. So, I said that I was disappointed, if not only about this chemical pregnancy, but the other losses before it. She nodded and said, "Yes, I know this has been hard on YOU." And she definitely put emphasis on the YOU. What is that about? I wanted to throttle her. I also wanted to ask how many miscarriages or chemical pregnancies she has had, because I am pretty sure that the answer is none.

That is one thing that I am pretty sick and tired of. It seems sometimes that because we can get pregnant, I kind of get the short end of the stick. Our doctors haven't really taken us seriously, even my RE seems to think that I am making a mountain out of a molehill. But we are both healthy. I am in my twenties, my husband is in his early thirties. We have been trying for over a year and a half. We don't have a baby. That's strange.

So, I flat out said that to her. "Look, Dr. M, I know that chemical pregnancies are common. But is it normal to have five of them and one miscarriage and no babies in a year and a half?"

She agreed that it is not. We went ahead with the blood draws and we decided to move ahead to a letrazole cycle with IUI. This will be our first IUI. The good thing about that 2.6 HCG is that my body is ready to try again. In fact, my day 10 ultrasound will be Friday, so we might be doing the IUI as early as Saturday and most likely Sunday.

The second thing is that I asked her if she thought that stress could possibly be having an effect on my fertility or the outcome of our pregnancies. She had a long answer, but basically, no. I was hoping to get some time off of work for this cycle and can only do so with a doctor's note. But then, she handed me a brochure for a stress reduction counseling program that the clinic sponsors - at the bargain price of $560 a couple. I hate contradictions. If stress doesn't play a role, then why have this expensive program that insurance will in no way cover?

Anyway. Deep breath. CD 5.

Here we go again.


Polka Dot said...

gah I can't believe she hasn't done those tests yet!! Maybe they'll come back normal, but maybe they won't. And if they don't, what will be her excuse for not doing them sooner and possibly preventing several chemical pregnancies?

Have you talked to her about a luteal phase defect (LDP)? I was reading on chemical pregnancies and they list that as one of the main causes of repeated chemical pregnancy losses. A simple progesterone check 7 days after the IUI can show a low or borderline progesterone level and that can be corrected with suppositories or PIO shots (I need the PIO).

I know she's good and smart and all that ... but bedside manners are just as important and no RE should ever pooh-pooh a patient's feelings or distress. And after 5 chemical losses and 1 loss at 11 weeks, she needs to be aggressive. And if she isn't, you need to force her hand.

I'm sorry - docs who treat us like we're an inconvenience and who just don't get it piss me off : / *hugs*

Tina / Anxious Changer said...

I second the PP - with 3 losses, testing should have been done. My doc, when I had my last m/c in 3/06, started testing right away - and that was before we realized when my first m/c (a chemical PG) actually was!

That is just crazy that she has not done anything yet.

And, my doc made me take a break after my last m/c - he intended it to be a few months, turned much longer than that for us in the end. But, it was good that he forced it - there ARE things wrong with me that were causing the m/c's.

Personally, I know you want to get on with this cycle - but, I really think you should have testing done before you proceed. And, if that means finding a new RE, I think you should. Bedside manner is one thing, but not testing you after what amounts to six losses is asinine.

Kristen said...

ITA with PPs. They should have already tested you and done a full RPL panel. With my 2 losses, my RE has already done testing for antiphospholipid antibodies and lupus anticoagulant. My LA came back abnormal once and normal the second time so I don't have a blood clotting disorder. I was hoping for an answer but on we go. I hope you are able to get some answers before proceeding.

The only thing left for us is karyotyping, which my RE said isn't necessary with 2 losses. Perhaps they could run some chromosomal analysis on you and DH?

Your RE sounds like a real b***h. You just have to have some kind of bedside manner in this field. It is very emotional and you can't take the emotion out of it and be successful. You need someone who is going to be proactive and won't dismiss you. I am so sorry you have to deal with this crap.

Debby said...

Good for you for sticking to your guns and asking for more tests. I'm a firm believer in taking control of situations like this. I switched insurance and doctors a while back for this reason. As for this next cycle - if you're ready for an IUI - go for it. I personally hate to let more time tick by when it's already been such a long run. It seems like we've both been at the loss game for about the same lenght of time and I'm so ready to be done - as you are.

Take that deep breath and remember to keep breathing! And seriously...invest the 99 cents on the song I posted about in my blog. So therapeutic if you're the kind of person that music helps.