Count Specula.
Yesterday was my appointment with Dr. Doctor. Never one to miss an opportunity to heap insult where formerly there was only injury, I scheduled a Pap smear for the same day. Yes, that’s right: I spent my Friday with my legs spread for two different medical professionals. Not at the same time, of course—I’m not that kind of girl. I saw a Nurse Practitioner in St. Paul before lunch, and then crossed the river for an afternoon appointment with my Minneapolis-based RE.
I get around, you see, girl-about-town that I am. Next week I will schedule back-to-back colonoscopies.
The day got off to an auspicious start when I attempted to leave work and found I could not turn my steering wheel. It seemed obvious that I had broken my car, so I sat in the parking lot for a tearful fifteen minutes, the key wedged uselessly in the ignition. I had just gathered the courage to walk back inside and call a tow truck when I realized that I had a manual in the glove box. Apparently, steering wheels may be “locked” to discourage “theft,” or even “operation by the car’s LEGAL OWNER.”
But my first exam was uneventful—I was undressed and in the stirrups without being told, and when the NP had trouble with the speculum, I suggested she try a little to the left before offering to find my tilted cervix myself. Really, I could have done that entire exam at home, or one-handed as I drove to my next appointment.
I arrived at my clinic in the afternoon to see a baby racing around the waiting room, cooing irrepressibly as her father mocked chasing her with a stroller. The baby’s mother flipped idly through an issue of Lucky. Now, I know that occasionally people have no choice but to bring their small children to infertility clinics. For instance: the morning of your Day Three blood work, your husband–a volunteer firefighter–is called in to fight a blaze at a nearby animal shelter, rendering him unable to care for your infant son during your appointment. These things happen to the best of us.
But couldn’t this Lucky-reading woman’s husband have conducted his giggly toddler chase scene in another part of the hospital? When the mother was called back to the exam room, the father and baby followed, only to return 45 seconds later and depart, leaving the mother at the clinic. So…were they just keeping her company in the waiting room? Isn’t that what her magazine was for?
I had plenty of time to wonder about all of this, because I waited for 65 minutes to see Dr. Doctor. It also gave me a chance to reacquaint myself with a few of my least-favorite songs, via the radio in the corner. Nothing puts a girl in the mood for a pelvic exam like hearing Paula Abdul request to be told, “straight up” whether I am going to love her forever (oh, oh, oh). A regretful “No,” Paula.
My beloved Dr. Doctor looked different—her hair was lighter, maybe—but she had retained her bountiful charm. We shared a torrid embrace upon the exam table before getting down to business. She agreed that if the Metformin were going to restore my ovulation, it would most likely have done so by now.* She also agreed, sadly, that my month of nearly-ovulation was probably due to that cycle being my first after three months on the pill. The pill has always had marvelously restorative effects on my fertility (up to and including pregnancy), which is not uncommon in PCOS patients. Ovarian suppression, blah blah blah.
I told Dr. Doctor that the Actually and I had decided to cleave to tradition and not do any IUIs before the wedding. As my grandmother always said, “Nice girls don’t thread catheters through their cervices without rings on their fingers!”
She was old-fashioned, my grandmother. Other sayings attributed to her include “Don’t count your chickens before assisted hatching!” and “Why buy the cow when you can get the milk for $15,000 and a sharps container?”
Anyway, Dr. Doctor and I discussed Letrozole, and a much-cited clinical study regarding birth defects. We scoffed over tiny control groups and inherently flawed protocols, and agreed Letrozole is far superior to Clomid—especially for women with PCOS.** I nattered on about half-lives, and as we finished each other’s sentences and quoted success rates and swine-pregnancy statistics Dr. Doctor asked me again what I did for a living and why I hadn’t gone into medicine.
“I really shouldn’t charge you for these appointments,” she said, shaking her head. I batted my eyelashes and figeted with a stirrup.
“It’s so nice to find a doctor who doesn’t mind that I do a little research,” I murmured.
“I think it’s wonderful,” said Dr. Doctor.
And then we spooned.
In the course of things it came up that I have still never had an HSG. I’ve collected a liter of my own urine and given more blood than is currently circulating in my body, but it’s true: I have never had radioactive dye shot up my most delicate parts while pictures are taken.
But I won’t be able to say that for long, because guess what I’m doing about ten days from now? The films should make an interesting addition to my Flickr account…
And that’s it for now. HSG this next cycle, and the cycle after that a prescription for Letrozole. Which I probably won’t use.
I don’t know—one minute I can’t wait any longer, the next I am certain that my 50+ hour a week job, a full load of college classes, and a wedding to plan are enough for now. I remind myself of the weight I want to lose and the living room walls that need painting. Not to mention the sundry writing projects awaiting completion, their deadlines creeping ever closer.
So for now, just the HSG. But I have to admit, it is oddly comforting to know that I can call at the beginning of a cycle and have a prescription—or, as I prefer to think of it, a chance–if I want one.
*I really wanted to be a Metformin success story and I don’t want to discourage anyone who is currently taking the drug. Metformin works to restore or improve ovulation in about 50% of women, with most showing the effects within six months. I appear to be in the other 50%. But I will be remaining on the Met—it has been a miracle drug for me in many ways, evening my blood sugars, making my mind clearer, improving my energy… If all I get from Metformin is fewer hypoglycemic episodes and a decreased miscarriage risk, well, isn’t that enough?
** I won’t bore everyone with the science regarding aromatase inhibitors vs. SERMs, but if you are interested feel free to email me.
18 Comments
And by night, do you fight crime, too? Or are you tied up in your basement lab finding the cure for cancer?
interesting statistic about the Metformin — I hadn’t heard that before… and as someone who is just finishing her first month on it, I was getting curious… thanks for sharing.
that reminds me of the time my OB told me i was ready for my board certification in rheumatology! i do love doctors that aren’t intimidated by an informed patient.
Of all the procedures, the HSG is not so bad. And it’s kind of cool to see your tubes and uterus, you know, just in case you had doubts that they were there at all.
I had a MUCH better response on the one cycle I took Letrozole than on any of the three cycles I was on Clomid. Also, Letrozole did not make me bat-shit crazy. My RE actually told me he thought Clomid was a pretty crap drug, and that even though most clinics (including mine) were pulling back from Letrozole usage after that study came out, he felt that it was only a matter of time before everyone started using it again.
My steering wheel locks all the time. I find that if I jiggle the wheel and the key and pump the clutch all at the same time (in a sort of humping the wheel during a seizure-type motion) it usually unlocks itself.
I am about to use up my last try with Clomid, and had never heard of Letrozole before. I’m glad you mentioned it, so next month I can suggest it to my RE.
Good luck with your HSG. In my experience, they suck.
Dr. T ‘n’ A had wanted to put me on Letrozole, but I asked for Clomid instead as Clomid is covered by my insurance. Sounds like T ‘n’ A uses Letrozole in most cases. I seem to be responding well to the Clomid (in terms of follicle count, at least), so we’ll see. Perhaps if the next few cycles don’t work, we can see about Letrozole. Isn’t this FUN?!
Having recently done 4 cycles on Clomid and now on my first on Letrozole, I can attest to the decrease in side-effects. At first it was making me very, very dizzy and I thought it might be worse. But then I realized that if I took it right before bed, I slept through the dizzy part. I still have hot flashes and some forgetfulness, but the mood swings appear to be gone! That right there is enough to make me swear off Clomid forever.
The caveat is that I’m only on d12, still getting a low reading on my monitor, and don’t know if it’ll actually make me ovulate before d18. But I have hopes!
I’ll have to respectfully disagree with TB on the HSG.
Premed, is all I’m saying.
One of the things I loved most about both my OB and my RE was that they appreciated all the research I did on my own behalf. I even used to give my OB the latest articles about different fertility treatments, and he actually thanked me for it. Such lovely fellas, though we never did make it to the spooning stage.
For me, Letrozole was a million times better than Clomid (both in terms of side effects and effectiveness) and a gajillion times better than Met. Didn’t get pregnant on the stuff, but for oral fertility meds, I personally think it’s the best. Good luck with it, and with your upcoming HSG!
Ha Ha… had to laugh about the nurse!
Good luck with the HSG, hope yours is one of the easy ones.
Take care
I hope your HSG isn’t too bad. I found that it was more (very) uncomfortable than painful, though it wasn’t fun. For me, the worst part was getting the catheter through my cervix. I had cryosurgery years ago, and the scar tissue has made my cervical opening smaller. The dye wasn’t that bad, and I did appreciate seeing everything on the small screen.
I had horrible cramps after my HSG, mostly because one tube was blocked. Take your Advil before you go in. Good luck.
And then you spooned. So sweet.
Yes, Advil before the HSG is a must. Ask Dr. Dr. if she would recommend antibiotics beforehand as well (some drs do). A stiff drink afterwards would also be a nice thing to schedule. Mine didn’t hurt that badly, but I wasn’t expecting it to be as invasive as it was.
Dude, I agree with above. “And then we spooned.” I lost my shit right there. My new classes start tomorrow–good luck!
This remind me, I need to spread my legs to the good doctor soon myself.
Ah…vaginal exams. Thanks for reminding me.
Legs in the stirrups twice in one day! Now that’s my idea of a fun way to spend the day.
The worst part of my HSG was the horrible doctor who performed it. Definitely take an advil beforehand and have a cocktail waiting for you when you get home. It was interesting to see my bits and pieces on the screen though.
And all that you have on your plate - you’re making me exhausted!
That’s one hip granny! Ha!