A lot has taken place since my last post, almost everything BUT ovulation. HA! In a nutshell, Vitamin D course of treatment is complete, follow up blood work came back at 45. That is fantastic as levels need to be between 30-100. Good there. I also got to experience another cyst rupture followed by extremely heavy bleeding just last week. An ultrasound was done to confirm a cyst rupture, not a follicle. I had a follow up appointment today for the cyst rupture and below were the list of questions I had for my OB.
Q: What are we going to do about my recurring rupturing cysts? CAN anything be done?
A: Birth Control Pills (BCP's) would be his first course of action for somebody who is not trying to conceive. Being I am trying, we're doing nothing about the cysts. My body will rupture them and handle them on their own, but short of BCP's, there's nothing that CAN be done.
Q: What can we do to manage my Polycystic Ovarian Syndrome? (PCOS) Anymore testing that would help to get PCOS under control? Ie., repeat PCOS lab work up, check Insulin resistance, etc.
A: He doesn't feel anymore testing would change the course of action. Managing PCOS for me at this stage of trying to conceive would leave me with few options. (back to the BCP thing) Testing for insulin resistance would not change his course of action, which would be Glucophage, aka Metformin. We already went that route with me and know that my body at any dose, does not tolerate it well. So that is not an option. I am going to do an at home A1C test that I can mail off to show me my average sugar levels for the last 6 months.
Q: Can I get a standing order for Prometrium to induce bleeds?
A: Absolutely! Order will be as follows. I am to take 10 day course of 200mg Prometrium every other month, on odd months. So starting May 1st, 10 day course of Prometrium. Have a bleed. We will sit 60 days out, if no ovulation, then another round of Prometrium. He is hoping opposing the estrogen with Prometrium will get me to ovulate. We'll see. Unlimited refills so I don't have to call every time I need a bleed. Fricking yeehaw!!!!!!
Q: Would he be willing to let me try one more cycle of Femara?
A: HE actually brought it up to me! I ♥ my doctor!!! Yes, he is more then willing to let me go ONE more cycle of Femara, even with my hyperstimulation/cyst history. Although, there is a catch. He first wants me to try 2 cycles of bringing on a bleed with Prometrium (so still 4 months out??) before we do another round of Femara. Why? He wants to see if I can oppose the estrogen with Prometrium and make myself ovulate on my own. How fricking cool is that, that my dr is on board with this????? Absolutely amazing to me! Amazing!
Q: I don't WANT to do this next part but I would like to gather more info/pricing on IUI and inform myself about the procedure.
A: Cost of meds would be the same for me, free because we would use Femara and insurance covers it. Cost of IUI is $300 and includes ultrasound to monitor for follicles, semen analysis (SA) (since they have to spin it to get JUST the swimmers) and insemination. It's still not something "I" personally want to do, but was nice to still have the info.
Q: Ways to boost estrogen naturally so ovulation will happen and alleviate symptoms of low estrogen?
A: He doesn't feel that my issue is low estrogen, but instead unopposed estrogen. (If you are not familiar with this I recommend googling Dr John Lee and the Shutdown, AMAZING info) Which is still going along with what I have been learning or have read about needing progesterone to balance the unopposed estrogen. Which then lead me to picking his brain as to WHY I ovulate when on natural progesterone cream. He said almost WORD FOR WORD the same thing as that pompous ass Reproductive Endocrinologist who told me that NPC would do NOTHING for ovulation, instead it would suppress it. (see Why are some doctors so damn smug) I told him I don't know how or why, and I just might be a freak of nature, but I have 5 different cycles of NPC use that has resulted in ovulation. He is as stumped as the rest of us.
I think that was it. I'm happy that birth control pills weren't just shoved at me. I was listened to, engaged in conversation with and felt like I was heard and didn't feel rushed at all. This doc is a keeper! ;)
A: Birth Control Pills (BCP's) would be his first course of action for somebody who is not trying to conceive. Being I am trying, we're doing nothing about the cysts. My body will rupture them and handle them on their own, but short of BCP's, there's nothing that CAN be done.
Q: What can we do to manage my Polycystic Ovarian Syndrome? (PCOS) Anymore testing that would help to get PCOS under control? Ie., repeat PCOS lab work up, check Insulin resistance, etc.
A: He doesn't feel anymore testing would change the course of action. Managing PCOS for me at this stage of trying to conceive would leave me with few options. (back to the BCP thing) Testing for insulin resistance would not change his course of action, which would be Glucophage, aka Metformin. We already went that route with me and know that my body at any dose, does not tolerate it well. So that is not an option. I am going to do an at home A1C test that I can mail off to show me my average sugar levels for the last 6 months.
Q: Can I get a standing order for Prometrium to induce bleeds?
A: Absolutely! Order will be as follows. I am to take 10 day course of 200mg Prometrium every other month, on odd months. So starting May 1st, 10 day course of Prometrium. Have a bleed. We will sit 60 days out, if no ovulation, then another round of Prometrium. He is hoping opposing the estrogen with Prometrium will get me to ovulate. We'll see. Unlimited refills so I don't have to call every time I need a bleed. Fricking yeehaw!!!!!!
Q: Would he be willing to let me try one more cycle of Femara?
A: HE actually brought it up to me! I ♥ my doctor!!! Yes, he is more then willing to let me go ONE more cycle of Femara, even with my hyperstimulation/cyst history. Although, there is a catch. He first wants me to try 2 cycles of bringing on a bleed with Prometrium (so still 4 months out??) before we do another round of Femara. Why? He wants to see if I can oppose the estrogen with Prometrium and make myself ovulate on my own. How fricking cool is that, that my dr is on board with this????? Absolutely amazing to me! Amazing!
Q: I don't WANT to do this next part but I would like to gather more info/pricing on IUI and inform myself about the procedure.
A: Cost of meds would be the same for me, free because we would use Femara and insurance covers it. Cost of IUI is $300 and includes ultrasound to monitor for follicles, semen analysis (SA) (since they have to spin it to get JUST the swimmers) and insemination. It's still not something "I" personally want to do, but was nice to still have the info.
Q: Ways to boost estrogen naturally so ovulation will happen and alleviate symptoms of low estrogen?
A: He doesn't feel that my issue is low estrogen, but instead unopposed estrogen. (If you are not familiar with this I recommend googling Dr John Lee and the Shutdown, AMAZING info) Which is still going along with what I have been learning or have read about needing progesterone to balance the unopposed estrogen. Which then lead me to picking his brain as to WHY I ovulate when on natural progesterone cream. He said almost WORD FOR WORD the same thing as that pompous ass Reproductive Endocrinologist who told me that NPC would do NOTHING for ovulation, instead it would suppress it. (see Why are some doctors so damn smug) I told him I don't know how or why, and I just might be a freak of nature, but I have 5 different cycles of NPC use that has resulted in ovulation. He is as stumped as the rest of us.
I think that was it. I'm happy that birth control pills weren't just shoved at me. I was listened to, engaged in conversation with and felt like I was heard and didn't feel rushed at all. This doc is a keeper! ;)
Yay! That is tons of great news! I am so glad that you are moving forward and have a plan!
ReplyDeleteI am very excited to be moving forward Maria! As you could probably tell from my posts on the forum not having a plan and feeling like I was at a check mate, was wearing on me fast. Obviously I am not ready to give up this journey, and much like my quote I sport everywhere I go, When the World says give up, HOPE whispers, try one more time. Here is my one more time. Again.
ReplyDeleteYay! So glad to hear about your good news. Your doctor definitely sounds like a good one. Here's hopping that it all works out! I look forward to hearing how the prometrium months go and if that is enough to get you ovulating.
ReplyDeleteAlso, if your body can't tolerate Metformin, have you considered Cinnamon? It isn't as strong as Metformin, but it has been proven to help with insulin resistance.
That's the thing, supposedly I don't have insulin resistance, per my A1C testing that was done. That is why I was wanting the Glucose Tolerance Test to for sure find out if I have IR. I know I do have hypoglycemia and have for many, many years. The more I look into it, the more I believe I have reactive hypoglycemia. I have tried Cinnamon for about 6 months and the only benefit I saw from it was suppressed appetite. My sugars remained feeling the same. I definitely did not have the gastric upset that Metformin brought, and I am thankful for that.
ReplyDelete