My First RE (Reproductive Endocrinologist) Visit
May 22 – Took a home pregnancy test. The threshold for the hCG on the test is 20 miu/ml . My test results are negative. This is actually a GOOD sign (at least I tell myself) because that means the hCG from the pregnancy is diminishing and I’m recovering well from the miscarriage.
Today is my first appointment at Reproductive Medicine Associates (RMA) aka the Baby Factory. The waiting room was empty save one couple, however there were empty chairs everywhere. Like enough to fill the DMV (if they were nice enough to provide chairs). I was very confused how a medical office of this size needed THAT many chairs. It was as if they were expecting half of Times Square to drop in for fertility treatments. We are in NYC, but this office didn’t even occupy the entire floor of this midtown high rise. How many doctors could possibly be in this space?? Were they all crammed into cubicles in the back?
I am instructed to “sign in” which involves putting my name on one label on a sheet of labels. I was then handed a stack of paper. It was a printed copy of the questionnaire I had filled out online. I was asked to read it and sign it to confirm its accuracy. The font was so large, I was suddenly so grateful that the waiting room was mostly empty. Otherwise all my prescription meds were printed largely for the world to see or least anyone seated closely to me in the waiting room.
I go into meet the doctor and right away I am surprised by how large her office is…that means this medical space occupies even less professionals than I previously thought. I work in mid-town Manhattan and offices this size are nearly unheard of…anymore.
The Reproductive Endocrinologist is very nice, she reviews my paperwork. She asks about my work and educational background. This seemed a little odd, but whatever. She comments that the supplements and pills I am taking seem to be a lot. She looked up Spirulina and Chlorella to see if they were ok for pregnancy. She told me if I got pregnant that I would have to stop taking the Vitex (Chaste berry) and to talk to my GP or OBGYN about the Zoloft, since it is a Class C drug category. (My OBGYN recommended Zoloft for pregnancy.)
Seems pretty straightforward so far. Then she asked…did you try at all in your early 40’s? Why did you wait so long? My heart sank. What difference did that make? Unless she was going to tell me it was just too late. I gulped and told her that after I had my daughter 23 years ago, I had just been busy getting my life “on track.”
She raised her eyebrows. "You have a daughter?" she asks as she shuffles my paperwork in her hand. "You didn’t put it in your questionnaire. That is good news that you carried a baby to term." She seemed relieved. I sighed. She stressed it was still not going to be easy with my own eggs, still about a 1% chance.
The fact that I had the miscarriage only proved that I could get pregnant. It didn’t prove I could carry ANOTHER pregnancy to term. She said the miscarriage was likely due to chromosomal disorders due to my dusty old eggs. She said she would NOT consider IVF with my own eggs as that would be borderline malpractice. Besides she said, it would cost me $15,000 per cycle. I just sat dumbfounded. Wow. Alright then.
She said “let’s not get ahead of ourselves, though”….YES, DOC! Let’s not! She said we would start with natural cycle and use Clomid. I told her I read that Clomid would dry the cervical mucus and thin my endometrial lining. (I didn't tell her I read it on Dr. Google) She said we could use Letrozole (Femara) even though it was “off label” and then she said something about it being less harmful for my breast. Something to do with Estrogen and breast cancer. Hmmmm….
We then walked over to an exam room so she could perform a trans vaginal ultrasound. I was left to undress and she returned with another woman (a nurse?). The doctor notices my perfect positioning on the exam table and comments ‘Oh, you’re well practiced at this” Let’s just say…you don’t have to tell me to scoot down. I got this, woman!
Now down to the facts! She hunts around looking for the right ovary. She announces there was only one mature follicle and comments that is why IVF would be a “waste of time.” She confirmed ovulation (released left side!). (Side note: I remember that a lymph node was swollen on my left side. I wonder if this was connected?) 6-7 mature follicles on the left side. She says it is “age appropriate” and I frown. She then modifies that stating my antral follicle count (AFC) is slightly better than expected for my age, actually. Still not great. (Cher flashes through my mind….If I could turn back time! )