When do you trust your doctor?

This story about whether to trust your doctor was shared on the discussion board, and because I know from women over the years that our doctors are not infallible and fertility science is not always perfect, I’m posting it here as a point of conversation. Please offer your comments below.

I have now missed 2 (medicated!) IUIs in a row. The first because I was out of town and I (of course) ovulated earlier than I have ever ovulated (EVER!) — even on medicated cycles. AARRGGH! But… on to the next cycle.

So this cycle I have all my usual signs of pending ovulation. I’m using multiple brands of ovulation predictor kits (OPKs) and on Day 20 (a normal range for me), two different test that have both been reliable in the past pick up an LH surge, so I make an appointment of an IUI the next day. Because I’d been sick for two weeks with a G.I. bug and had really not been feeling/eating/sleeping well at all, I talked my way into having an ultrasound the morning of the planned IUI.

My regular RE was on vacation, but one of the other Docs at the clinic (who has a good reputation) did it. She said there was no dominant follicle on the right and though initially she had some difficulty seeing the left ovary after poking around a bit, she said she had good visualization and there was no dominant follicle — or collapsed follicle indicating recent ovulation — present there either. She said I was, if anything, days and days away from developing a dominant follicle and that most likely it was a false positive OPK.

That made absolutely no sense, given that my typical ovulation signs were present, the timing was right, and and TWO different brands said yes to LH. But when an RE tells you there is no dominant follicle (nor one that looked like it just released an egg) what do you do? You cancel your $300 IUI with your $700 vial of donor sperm.

I thought I had a pretty good understanding of the physiology involved. But I certainly don’t know everything. Does anyone know if it is possible to have an LH surge in the absence of a dominant follicle? Or to see a rise in basal temperature if ovulation did not occur?

I am very puzzled about this. Either something is very wrong with my own physiology, or the RE involved was overconfident in her assessment that there was no way there was anything close to a dominant follicle present, now or in the last 24 hours. Or perhaps my understanding of how it all works is off.

Women chimed in, generally with encouragement that she did the right thing in not using her more expensive vial of sperm for the less expensive procedure, even though she had spent money that cycle on the medications and thought it was a go. They expressed hopes that she would eventually solve the mystery and be able to find the right time for insemination, despite the delays. Then, she wrote with her follow-up:

Frustrated. A progesterone blood test showed that I did indeed ovulate. The Doc was wrong in stating that there was no dominant follicle. She just couldn’t SEE it. But she left no room for the possibility that it *could* be there. She was quite definite that it wasn’t. I missed the cycle for nothing.

And now because the clinic closes the week over Christmas I either am stuck missing another cycle (I would be due to ovulate right in that week), or move forward to IVF now (2 cycles earlier than I need to). See a follow-up post on this question here.

Frustrated.

I am left wondering: RE incompetence, vs RE overconfidence, vs RE simply not realizing that we actually do have way more insight into our own bodies than we are given credit for, vs part of RE’s grand plan to get us moving to IVF sooner??!

Editor’s Note: This is the big question women face time and again — how much can the doctor know, and when can they know it, and how much do we know, and when those two “knowings” conflict, how do you know which person to trust? How well do you know your doctor’s abilities to predict things that aren’t, despite amazing reproductive technology capabilities, always knowable? Or, whether they are simply having an “off” day, rushing to get somewhere else? Because when we’re spending money cycle after cycle, we’d like some reassurance, if possible, that we’re in good hands. How do we KNOW?
The answer, of course, seems to be that we can’t know. So cycle after cycle, we’re needing to trust someone we don’t know particularly well with costly decisions that have a huge impact on our journey to motherhood.
Personally, big picture, I feel that there IS a “right” time when our child comes to us — I’ve heard that from many women as well over the years. But, that’s not science — that’s something more akin to faith in the universe, which is very much a personal philosophy. What about you? Use the comments field to share your own philosophy when it comes to struggling about where to place your trust. — Mikki
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  3 comments for “When do you trust your doctor?

  1. May 14, 2014 at 1:27 pm

    While frustration at having missed opportunities is understandable and not inappropriate, one has to wonder what would have happened in the reverse circumstance, had the RE had the same evidence, said “Go ahead,” and ovulation *not* have happened. Likely, the RE would have been blamed for approving the exercise—and when condemnation is likely in both cases, is it not better to take the less expensive option?

  2. Andrea
    January 24, 2014 at 1:08 pm

    My previous RE started a conversation with me about IVF as I layed on the table approximately 30 seconds after my second IUI. What a great way to start off the two week wait. I’ve just had an appointment with a second RE who tells me on the one hand that the previous guy underestimated one of the fertility indicators, but still thinks I should try only two or three more IUIs before moving on to IVF. Meanwhile my friend did 10 IUIs before conceiving almost all unmedicated and she was the same age I am now.

    So, who do I trust? Those with hammers and to whom everything looks like a nail? Or do I do what so many others have done and keep trying? A single round of IVF would wipe me out completely- no more retirement account nothing. (I work at a nonprofit, I don’t have much money.)

    And why does every decision feel like it’s the single most important one in my life? The doctor said stress doesn’t affect conception. At least I don’t have to stress about how stressed I am.

  3. Kyrsra
    December 3, 2013 at 12:46 pm

    My entire fertility journey was something of a trust/don’t trust smorgasbord. There is only one fertility clinic within a reasonable distance where I live and I had to travel an hour and a half to get there (the only alternative is four hours away). When I went in for my initial consultation I had already done four double ICIs at home, multiple blood hormone screenings, and an HSG. One thing I knew – from my charting for over a year, horrible luck with OPKs (I would have a positive but ovulation wouldn’t show up on my chart for another 2-3 days) and the blood tests was that I had low body temperature and low progesterone in the luteal phase (still enough to indicate ovulation but not enough to sustain pregnancy). So I went in with this in mind.

    The doctor I saw – a cofounder of the 20+ year old fertility clinic – told me in a very cold way that my ovulation was mediocre and he was putting me on clomid. I asked if progesterone suppositories would help with the luteal problem and he said he didn’t think it would help at all. I immediately thought he was wrong (I know my body better than anyone afterall) but didn’t say anything because – despite the horrible bedside manner – he’s the expert here, right?

    My first IUI was a lesson in trusting your gut on who and when to trust and a horrible mistake in trusting when I shouldn’t have. I sat there, excited and nervous with the vial that would – hopefully – help me get pregnant when I heard a conversation happening outside between a doctor and nurse. The doctor was basically discussing and reviewing (in an inquiring sort of way) how to do an IUI.

    I thought, “This isn’t my doctor so nothing to worry about.” Well, I was wrong. SO WRONG. It was a different doctor than I had seen for my consultation but he was going to be my IUI doctor. I have never reacted well to speculums. They HURT me and my gyno always takes this into account for papsmears and the like. I explained this before hand to the nurse and it was supposedly in my chart but I felt like I was being torn apart and burned from the inside. The doctor took forever because he obviously didn’t know what he was doing and had to ask the nurse several times what to do next. He kept telling me – frustrated – to relax.

    I was an idiot for allowing this to happen in silence and I felt pretty violated afterwards. A few hours later, when it was time to take the packing out, I found he had OVER FILLED the packing and I ended up bleeding all over the place because of the force I had to use to get the thing out of my cervix.

    But what did I know? Maybe it was like that for everybody.

    My second IUI was on a Saturday. I was super nervous but not in a good way and the doctor who came in was – again – different and at first, I didn’t’ trust him at all given my previous experience. This was a younger man with the most peaceful air and bright smile. He sat down and talked to me before hand and I told him about my previous experience. He was very reassuring and told me it wasn’t supposed to be painful and that he would do everything to make this as comfortable as possible, that one must be relaxed to make babies and he didn’t want me to be stressed.

    When the nurse came in with the speculum, he immediately told her to go get another model then went with her to pick it out. He came back and told me that if I felt any pain to tell him immediately and we would try something else. And he made good on his word. We had to switch out the speculum twice. After that it was smooth sailing and he wrote down exactly that information on my chart and told me that – if I had to come in again – to let the doctor or nurse know to look in my chart.

    After my third IUI failed, I was scheduled for another consultation with the same doctor I had my initial consult with and he gave me three choices – another IUI with injectibles or clomid as we’d been doing (with progressively higher dosage), IVF, or laparoscopy. I was pretty much heartbroken, especially when he said (and I will never forget these words), “Given your age, health, and family history, I have to assume something is wrong with you.” At this point, I no longer trusted him, especially after I asked – again – about progesterone supplementation and was denied (I had seen all my results from every blood test and every visit and my progesterone was getting LOWER on clomid, not higher as expected).

    Ultimately, I decided on the laparoscopy and following that, I decided on an injectable cycle. I had already decided it would be my last try before IVF or adoption. I was simply sick of it.

    My fourth IUI was my best experience and showed me just how much I should NOT have trusted the doctor whom I consulted with. The doctor who performed this IUI was an elderly woman who reminded me of my grandmother (as uncomfortable as that sounds!). She was very sweet, gentle, and sat with me while I waited after the procedure was done, just talking and keeping me relaxed. When she was about to leave, I asked about progesterone suppositories and mentioned that I had historically low progesterone. She looked over my chart and said – with real surprise in her voice, “I don’t know why they didn’t give that to you sooner. I’ll have the nurse put in the prescription.” Then she got my pharmacy info and left.

    I conceived from that cycle. It was performed on May 6, 2011, I got my BFP on May 19 (at 4 am) and my son was born Jan. 15, 2012. I will always wonder if it was the injectables, the progesterone, or a little bit of both. I plan on trying for #2 at the same clinic, and I fervently pray the consult doctor is no longer practicing at that time. I will definitely be more outspoken regardless.

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