Getting Medical Help

With a little research on the Internet about PCOS, I knew that the root cause of the problem is a hormonal imbalance. The hormonal imbalance is associated with insulin resistance and is often treated with a medication called metformin that is also used to treat diabetes. It scared me to think that the condition I had was closely related to diabetes and put me at an increased risk of actually developing diabetes later in life, but I could see that seeing a reproductive endocrinologist would be a better idea since I would get more comprehensive treatment and the treatment would target the root cause of the problem. So I picked an RE based on which doctors were in network for our insurance provider and based on patient reviews for some of those doctors. I called her office to ask for an appointment, fearing that I would have to wait for a while before they could get me in and that maybe I should go back to the gynaecologist to try Clomid in the meantime. I was pleasantly surprised when they told me that they had had a cancellation for the next day and I could come in then. It was an inconvenient time of day for me to be able to fit in the appointment with my work schedule, but I was anxious to get things moving and to be able to start trying to have a baby again, while knowing that I would have a reasonable probability of actually getting pregnant. So I told them that I would make it work and I took the appointment.

The RE was a petite, slim lady with a pleasant face. She seemed to be quite warm and friendly with her patients. During that first appointment, she told me that the diagnosis and treatment for female fertility related issues usually begins with checking the levels of fertility related hormones on day 3 of the menstrual cycle. I was asked to call her office when I got a period so that they could schedule those tests. Meanwhile, they ran a boat load of tests to check for genetic anomalies that are common among people of my ethnic background. If I was found to be a carrier for genetically transmitted disorders, they would also test my husband for the same genetic mutation. They also tested me for immunity to various diseases. The RE also did an ultrasound to look at my ovaries. She told me that my right ovary appeared poly cystic, but the left one seemed to be normal. But, she also told me, the appearance is not a conclusive way to determine whether or not the ovary actually is poly cystic. It is only a part of the diagnosis. Other things, such as the hormone levels she would test when I got my period and the fact that I had excess hair growth on my face contributed to the diagnosis as well.

It felt strange for me to have an ultrasound scan at that first appointment. In my mind, ultrasounds had always been associated with monitoring the growth and development of a fetus in a pregnant woman's womb. You were supposed to have those when you were pregnant, not when you wanted to be pregnant but weren't. I didn't know, at the time, that I would very soon have to get used to having a lot of ultrasounds and no baby in my womb.

The RE looked at my test results from the previous gynaecologist's office and pointed out that my thyroid stimulating hormone levels were low. That would mean that I had a hyperactive thyroid gland. She said that I should definitely see an endocrinologist, a regular endocrinologist, not a reproductive endocrinologist, about the thyroid issue. It would not be a good idea to get pregnant without getting treatment for that issue first, since it can lead to various problems with the pregnancy and the baby.

She also wanted to run some tests to make sure that I did not have problems with my liver or kidneys and that I wasn't pre-diabetic. She needed all that information before she could prescribe metformin, because if a patient has liver or kidney disease, their risk of side effects from metformin would be much higher. She said it would help regulate my cycles but that it usually took a few months to start working. That was actually okay, she pointed out, since it would probably take the same amount of time to get my thyroid gland in order. She wanted me to get a hysterosalpingogram (HSG) done as well. That, she told me, was a radiological procedure with which they can determine if my uterus is the right shape and if my fallopian tubes are both open and not blocked. And my husband would also need a sperm count check, basically for insurance purposes.

That first visit with the RE was long and she gave me a lot of information, not all of which I could absorb in one sitting. But she gave me plenty of reading material to take home with me and read at leisure. She wanted me to come back after about a month when all the test results would be in and then we could discuss the course of treatment that would be appropriate for us. Meanwhile, I was supposed to make an appointment with an endocrinologist for the thyroid anomaly.

I called the endocrinologist's office for an appointment and they couldn't book me in for almost three months. I wasn't sure if I wanted to see a different doctor, because this particular one came highly recommended. So I took the appointment anyway. I was disappointed because we could not try again to have a baby until the thyroid issue was resolved, and it could possibly be a few weeks from the time I saw the doctor and she prescribed thyroid medication for me until my thyroid levels were actually in the normal range. The RE had mentioned that it would be just fine if it took some time before I could see an endocrinologist, because the metformin also usually takes a few months to start working, but I was getting more impatient with each passing day.

So I found another endocrinologist and made an appointment with her for an earlier date. I figured I could see that one first and get a prescription for whatever was needed to stabilize my levels and then see the first one, whom I had originally wanted to see, and get her opinion too. Meanwhile the medication would start working and my levels would hopefully be somewhat stable.

I went in to the RE's office another few times over the next few weeks for blood tests and for the HSG. The HSG was uncomfortable but not particularly painful. Thankfully they did not find anything wrong with my uterus or fallopian tubes during that procedure. That kind of thing would have required a surgical procedure to correct, assuming it was something that could be corrected.

I also went in to see the endocrinologist. She did not appear to be particularly friendly or warm with patients. She asked me if I had been diagnosed with PCOS. I said yes. She said she could prescribe a certain cream or ointment for me to get rid of the excess facial hair. She did not ask if I wanted to do anything about the hair, she just said she would give me a cream for it. She said she wanted to check my progesterone levels in the first half of my menstrual cycle. She was talking about all kinds of things that were really not important at the time. I mean, I came to her for a thyroid problem. I wanted the thyroid problem resolved because I wanted to have a baby. I wanted a baby and cared about having a baby. Facial hair was the least of my concerns at the time.

Anyway, she wanted to recheck the thyroid levels and run a few other tests. I tried a few times to get her to focus on the issue at hand but eventually I just gave in. If she wanted to run a few extra tests, just let her, I thought. I had to go to the laboratory another couple of times in the next few days because there were tests that had to be done at a certain time of day and there was a test that had to be done after taking a certain medication the night before. It turned out that she had written one of the names of the tests incorrectly on the papers that she had given me. I had to run from the lab to her office and find her and have her correct it for me. That was beyond unacceptable to me. Even more so when the phlebotomist drawing my blood told me that she often did this kind of thing. I was very thankful that I had kept my appointment with the other doctor and decided that I would never go back to this one.

A few days later, I called her office to ask if the results were in. The front desk staff told me that they would check with the doctor or her medical assistant and call me back. They didn't. I called them again the next day. Still no callback. Late that evening, I was in the shower at about 10 PM and heard my phone ring. I wondered who would call me at that hour. Probably a friend or family member in a different time zone, I thought. I'll call them back once I am out of the shower, I thought.

Turned out it was the doctor calling me. She left me a voice message saying that she had been trying to reach me for days and nobody had been answering the phone. I could not believe her guts. She was calling me at an hour when patients call doctors only in an emergency. Doctors do not call patients at that hour. Certainly not under normal circumstances. And she was lying to me outright. I just could not believe it. The only good part was that this doctor was part of the same network as my RE and the other endocrinologist that I was scheduled to see, so they could see my test results in the system without this doctor's office having to send the results over to their offices.

I saw the other endocrinologist, the one whom I had originally wanted to see, after a few weeks. She was a very pleasant change from the first one. Very organized and to the point. She told me that my levels were now perfectly normal, so what I had had earlier was most likely thyroiditis or a similar infection which had disappeared on its own. Since there was nothing abnormal in the recent tests, she would just recheck my levels every four to six months and check them more frequently when I became pregnant.

I also had my follow up appointment with the RE where she told me that all of my fertility related hormone levels were normal, I had no infections in my uterus or vagina, I was not a carrier for any of the genetic disorders I had been tested for, and my insulin and blood glucose levels were also in the normal range. I showed no signs of liver or kidney disease, so she could go ahead and start me on the metformin. I was a little confused about why she wanted to give me metformin even though I had perfectly normal glucose and insulin levels. She said that with PCOS, the levels are not necessarily abnormal but we still believe that poly cystic women are insulin resistant and this medication helps regulate their female hormone levels and normalize their cycles. She talked to me about the possible side effects, which were mostly gastrointestinal problems like diarrhea and nausea. But those supposedly wore off within a few weeks of starting the medication and were minimized by starting off slowly, taking one pill a day for a week, then two pills a day for another week and then three pills a day. She said that I was "petite" and so I may not tolerate the three pills a day at all, so it would be fine if I just kept taking two a day. I had never in my life been called petite. It sounded particularly odd coming from someone who was about four inches shorter and probably forty pounds lighter than I was.

She also talked to me about clomiphene citrate, commonly referred to by its most common brand name, Clomid. This drug stimulates ovulation in women who do not always ovulate on their own. She said that in most poly cystic women, a combination of metformin and Clomid gave them about the same probability of conceiving as a normal, non poly cystic woman of the same age. That was encouraging to hear. She said that with the clomiphene, we could either try naturally or choose to have an intra-uterine insemination, or IUI. She mentioned that most people prefer to try naturally with clomiphene because it makes them feel that they are doing at least something the natural way. Initially I agreed with that idea and I told her that we'd try naturally for at least one cycle and then see how we feel about it if that first cycle didn't work.

The doctor and her nurse went over details, like ultrasound monitoring to see how my ovaries were responding to the medication. They mentioned that if we did want to do an IUI cycle, I'd need to inject myself with a trigger - a medication that is chemically similar to the luteinizing hormone that triggers ovulation in a woman's body. That would help us predict the time of ovulation within a few hours, so we could time the IUI for optimal results.

That first cycle, I was supposed to take the medication from cycle day 3 until day 7 and come in for monitoring on day 14. Clomiphene was not the most pleasant medication to take either. The good part was that my body was used to the metformin by this time and I was no longer seeing nasty side effects from it. The most unpleasant side effect of the clomiphene was hot flashes. In the middle of the night, I'd suddenly feel very hot and throw the covers off. And then, as suddenly as I'd started feeling hot, I'd feel cold. It was annoying and it disturbed my sleep frequently. Often it was hard to go back to sleep. By this time, I had come to accept the fact that I would need to take medications to help me get pregnant and that they would cause unpleasant side effects, but it would all be worth it if I got pregnant in the end.

I went in to the doctor's office for monitoring on cycle day 14. I asked the ultrasound technician what she was seeing. She said she wasn't sure, but the nurses would call me later in the day after the doctor had seen the images. It was a long day, waiting for the nurses to call me. This kind of wait would also turn out to be something I would get used to pretty soon. The call came in the late afternoon and the nurse told me that they did not see any mature follicles yet. She told me to come back in 3 days, on cycle day 17. I went. No follicle. I went again on day 21. The nurse called me and said that she was sorry, but the clomiphene did not work for me that cycle.

I could not understand what was happening. I had been on the metformin for about three months at this point. I was getting regular cycles. I thought that meant I was ovulating regularly. The doctor also thought it meant I was probably ovulating. But now, metformin and Clomid, three ultrasounds and no dominant follicle.

I had an overseas trip coming up, to attend my brother's wedding and I really wanted to be in my second trimester at the time of the trip. I had read that that would be the safest time to fly during pregnancy. But the window for me to be in my second trimester at the time of that trip was closing in on me. With this cycle gone, I had just one more attempt at it. But I still definitely wanted to be pregnant when I went. I would meet a few friends from my hometown who had had babies since I had left, and I didn't think I could face them if I was not pregnant myself.

It felt like the dream of having a baby was fast slipping out from between my fingers like the sand that you hold on to ever so tightly in your fist.