Back in August I talked a little about my very unpleasant appointments with one of the reproductive endocrinologists (REs) I saw this year. What I haven’t shared is the wonderful RE experience I had over the last couple of months with a different one. It may sound harsh, but I’m going to refer to these two as Dr. Good and Dr. Bad. Because some of these REs really do their patients a disservice and deserve to have their motives questioned. Yes, some couples will need expensive, invasive interventions to achieve a pregnancy. But not every couple should be treated as though they will from the outset. My personal experience has been interesting, and one that I think will apply to other women.
My husband and I are ready to start trying to get pregnant again this month. It’s been a long year of tests, research and diagnoses but I really feel like we’ve seen positive results from the steps we’ve taken. Back in July our pregnancy prospects were looking grim but there have been encouraging signs over the past few months. Before I get into that I want to contrast my two experiences, first with Dr. Bad and then with Dr. Good. Because I think doctors like Dr. Bad really frighten women and intimidate them into what may sometimes be unnecessary treatments and procedures without addressing the root causes of their infertility. Some may say that perhaps this is their job. These REs aren’t trained to focus on the health and wellness of the prospective parents but instead to use technology to quickly solve the infertility problem. Well I say bollocks to that because sometimes technology won’t even help the parents in their particular circumstances. In some cases it may even make the problems worse.
This post will get too long if I relay the details of every appointment, so instead I’ve prepared some bullet points:
- Thought my hypothyroidism was being over-treated when in fact I needed more medication at the time.
- Dismissed my MTHFR gene mutations as nothing to worry about and questioned why I would even test myself for it. She agreed to prescribe the Neevo prenatal but I got the feeling she thought it was unnecessary.
- Made negative comments about my insurance and what was covered vs. what wasn’t. I felt like an ATM machine from that point forward.
- Talked to me about Clomid before even seeing my lab test results.
- Ran a female hormone panel that did not include important tests like prolactin, testosterone, DHEAS and insulin. I was incensed to receive a bill this week for the testing she did order, which was geared towards the identification of whether or not I would be a good candidate for IVF, instead of just sending me to the lab that would be covered (our insurance pays for fertility testing).
- Told me that I had irreversible damage to my eggs, likely from toxins and there was nothing I could do to improve my egg quality and ovarian reserve. She told me that if I were older she would tell me to go straight to donor eggs. Then she told me that my husband’s 2% morphology was a big problem even though all other sperm analysis results were good. He is homozygous for the MTHFR C677T mutations and had barely begun methylated vitamin treatment at that time. C677T has been linked to morphology issues.
- Refused to pay attention to my cycle temperature tracking charts and felt strongly that I had no luteal phase (LP) issues. Another RE and my maternal fetal medicine specialist (MFM) have since disagreed and told me they wanted me on progesterone after ovulation.
- Recommended Clomid and intrauterine insemination (IUI).
- Even though many REs have the reputation of not being up to date on the most effective testing and procedures for evaluating thyroid patients, he knew a lot about thyroid problems and made sure that mine was functioning adequately. He also spent a lot of time with me explaining what happens during a woman’s cycle with the different hormones.
- Listened to the assessments of my MTHFR doctor and thought that getting my methylation and nutritional deficiencies under control, along with my new diet and lifestyle would definitely have helped my egg quality.
- Wanted to see what my body could do on its own before even talking about fertility drugs.
- Had a discussion about my medical and menstrual history and ran the appropriate female hormone tests.
- Loved my cycle temperature charts and paid attention to my LP issues.
- Tracked my follicular phase using ultrasound and estrogen testing. We saw follicles developing on both ovaries and the dominant one was giving off a good amount of estradiol (150-200) and had a good size. I ovulated normally. He decided that there was nothing wrong with my follicular phase and that was not what was causing the issues.
- Tested my progesterone and based on that and my charts recommended progesterone supplementation in the LP.
- Reassured me that things like FSH and AMH fluctuate from cycle to cycle. He also said that if all other factors of the sperm analysis were good that we should not worry about the morphology, especially given the improved dietary and methylation factors.
As I write this I realize that it might sound as if perhaps Dr. Bad was simply being more conservative while Dr. Good is perhaps a little too optimistic. I guess time will tell. But I am not simply looking through rose-colored glasses here. Dr. Good’s recommendations did not come out of left field for me. I had read the book, Inconceivable by Julia Indichova (Broadway, 1997). Dr. Randine Lewis makes similar points in her book, The Infertility Cure. She states that, on average, women do seven cycles of assisted reproductive technology (ART) before they either fall pregnant or quit and even young women only have a 20-30% chance of conceiving that way (5). The techniques don’t work for everyone and why put your body through all that when you can determine the root cause of your dysfunction? It is interesting to note that the MTHFR A1298C mutation, which I am heterozygous for, has been connected to higher FSH levels and my testing was done after only about three weeks of beginning a methylated vitamin protocol (it takes a few months for diet and supplement changes to affect your egg quality). Because we knew we had MTHFR-related issues, we decided to wait awhile before trying to get pregnant again.
Dr. Lewis also cautions against the use of Clomid for every patient. When this drug is given to a certain group of women it can actually cause more problems such as ovulatory dysfunction, diminished cervical mucus and thinning of the lining of the uterus (11). As a Traditional Chinese Medicine (TCM) doctor (who was also a Western medical doctor) she evaluates system dysfunction a little differently. She advises against Clomid in cases where a patient has Liver Qi stagnation, heat symptoms, Blood deficiency or Yin deficiency. If you experience severe symptoms while taking Clomid that may be an indicator that it is making your problems worse (269). She also cautions against using Clomid in cases of polycystic ovarian syndrome (PCOS) without also addressing egg health and endocrine balance in the months prior to conception (229).
Interestingly, I am actually one of the people for whom Dr. Lewis thinks Clomid could actually help. I have a tendency towards Kidney Yang deficiency, Spleen Qi deficiency and dampness. Personally I’m of mixed opinion on whether Clomid will be right for me, primarily because of my recent adrenal issues. I’ve heard stories of people who completely crashed while taking the drug and others who have had wonderful successes right away. I may try it if we don’t get pregnant in four to six months, however, I believe we will conceive on our own based on the positive signs I have experienced over the last few months.
The rest of this post may provide TMI (too much information) about me personally so feel free to click away if this doesn’t interest you. After changing my diet, lifestyle and supplements as I’ve been documenting over the last several months on this blog, doing acupuncture and addressing my toxin issues, I’ve noticed dramatic changes in my menstrual cycles. I’ve gone from having a 10 to 12 day LP with spotting from day nine to a 13 day LP with no spotting. I have increased cervical mucus. There was also the positive tracked cycle that I mentioned above. Things may not, however, be perfect yet.
Even with the good quality egg I had a strong temperature dip in my LP last cycle. This tends to happen between days seven and 10. Last month the progesterone recovered all by itself and I still had a good LP length. There could be two explanations for this. The first is that this is simply a “secondary estrogen surge” that normally happens during the LP (Weschler 361–2). Or the cause could be something called progesterone stealing, where my body is taking the progesterone and converting it to cortisol because I am still deficient. I have not re-tested my cortisol because I no longer have symptoms of adrenal fatigue as I did back in September. Both my RE and MFM want me on progesterone from three days past ovulation because of my previous short LP history, and I also take high quality fish oil supplements in large quantities along with vitamin E (all forms) to assist with progesterone production. My MFM also has me on low-dose aspirin because I am compound heterozygous for MTHFR.
At some point we have to just hold our breath and go for it. I’m a little nervous but cautiously optimistic. We’ll see what the next few months of trying to conceive will bring…
Lewis, R. (2004) The Infertility Cure. New York, NY: Little, Brown.
Weschler, Toni (2002). Taking Charge of Your Fertility (Revised ed.). New York: HarperCollins.