Thursday, March 29, 2012

First Appointment with a Fertility Specialist

So, the big day was today. After waiting a little over two weeks for my appointmnet with a Reproductive Endocrinologist, this morning, at 8:00, Matt and I had our first meeting on what will no doubt be an interesting and challenging journey with Shady Grove Fertility. And I have to say, the appointment went as good as it could possibly go.

In this post I plan to detail what the first appointment was like, what the next steps will be, and what my feelings are about the whole process. So, if you would prefer not to hear about fallopian tubes, and the such, then feel free to stop reading now :) But the reason I will include the details is so that if someone else googles "What to expect at a first fertility appointment?" or "What to expect when meeting with a reproductive endocrinologist" they will find this blog and find it helpful.

So, Matt and I got to the clinic at 7:40, as we were instructed to get there early so that they could organize the medical records I brought from my OB as well as the male and female questionnaires, and various other paperwork that were mailed to us ahead of time.

The Physician, Dr. Mottla came out at exactly 8:00. I was impressed right from the start because how often does a Physician greet you in the waiting room himself? Not very often. In fact, never in my previous experience. He brought us back to his office and I told him that we, two Boston College grads, would try not to hold it against him that he went to Boston University. He laughed, and we were off to a great start.

He started by saying, "So, what can I do for you today?" I explained (I'll give the shortened version here) that we have been trying for our second child for 8 months now, with no success. And given my history of an appendectomy and a c-section (abdominal surgery is a risk factor for blocked Fallopian Tubes) that I am concerned I have blocked tubes. I explained that I know my body, and that I just have a sense that something is not right. He said, "In the many years I have been doing this I have learned to trust a woman's instinct. So, I definitely think I can help you. We'll talk about some tests that we can run, and hopefully, we will run them, the results will be normal, and that will give you assurance that everything is fine and you just need more time. And if not, then we will talk about next steps." We then talked for about an hour. He was engaging, honest, and soon realized that having spent my working career in medical institions that I know my stuff. He valued my opinion. He was sensitive to Matt who isn't as familiar with the medical world. He took time to not only get to know us from a medical perspective, but also personally. He wanted to know how we ended up going to school in Boston, how we ended up in Maryland, what we do for a living, etc. He didn't just ask. He engaged in conversation. To say I was impressed is an understatement. (And I am difficult to impress when it comes to doctors. I have high expectations!)

So, what did we learn and what will happen next? He has ordered diagnostic blood work (to test various hormone levels at a specific time in my cycle, day 3-5 to be exact), a baseline ultrasound (to check for things like fibroids, the thickness of the lining of the uterus early in my cycle, etc) as well as a hysterosalpingogram (HSG) which is a procedure done by a radiologist in which they inject die into your uterus and check to see that it is flowing out of the fallopian tubes appropriately. If it doesn't, that means blocked tubes. He will also do a semen analysis just to be sure, but we don't expect there to be any issues there. The best news: All of this testing is covered by my insurance and can start NOW! (Well, as soon as I reach the correct day of my cycle). This information INFURIATED me! When I saw my OB after trying for 6 months she gave me a "there, there, don't worry about it everything will be fine, just keep trying." She then explained that nothing will be covered by insurance until we have been trying for a year....WRONG! I am sure this is the case for some people. But not for us. She shouldn't make a blanket statement. She should have said, "Well, give your insurance a call and see what testing will be covered. And then, we can go from there." Overall, I love my OB practice. And I hope she ends up being right, that everything is fine, and we just need to give it more time. But I will certainly be having a conversation with her about how all insurance policies are different.

But in the meantime, I am panicked that I have blocked fallopian tubes. Not just because if I do it means we probably can't conceive naturally, but because it also can lead to ectopic pregnancy, and that can be deadly for a woman if not caught quickly. So, I am very worried about that, and I simply want the test done to know one way or another.

So, what happens if I have blocked tubes? Well, (and this is the part of the day that was a real downer for me) then we jump right to IVF. This surprised me. I read that there is a surgery that can be done that can open up the tubes. And Dr. Mottla said this isn't typically done anymore because it doesn't result in a significantly increased chance of pregnancy. He explained it this way: Imagine you have stream that is blocked by a huge bolder, and you take a bull dozer in there to clear it out. You may clear the stream in such a way that it now flows easily, but in the process you have also cleared away the small rocks, the grasses, and all the other comforting places where the fish spawn. The water may flow, but no babies are being made. Likewise, they may be able to "open" your fallopian tubes, but the cillia and tissues and other things that make it a welcoming environment for a sperm to fertilize an egg are no longer present (either from the scarred tissue, or from the procedure itself to open them up). So, even with the surgery, pregnancy is still unlikely. The surgery is rarely done now because it doesn't make sense to put a woman through a surgery without much benefit. Where as IVF has a very high success rate for otherwise healthy, fertile couples. Needless to say, I was sad. I would like to avoid IVF at all cost. I would just prefer to do things as naturally as possible, but if that is what we have to do, we will. (I also learned that my insurance has a $25,000 lifetime max for fertility treatments, and we could hit that VERY quickly as soon as we go down the IVF route, and that scares me too...But I refuse to freak out about that just yet.) So, I am definitely hoping my instincts are wrong, and those tubes are WIIIIDE OPEN!

When we finished with Dr. Mottla he shook our hands and said, "It was a pleasure meeting you, and I look forward to seeing you again soon." I said, "It was a pleasure as well. But I hope I never have to see you again. I hope I end up being pregnant this month." To which he responded, "Oh, come on. If you are pregnant let me do the first ultra sound and then I will send you on your way back to your regular OB. I need to get to do the fun parts of this job, too! So, yes, I hope I see you again, VERY soon." I said, "That's fair enough." Did I mention that this guy impressed me?

After meeting with Dr. Mottla we met with Crystal, the nurse who will be our "guide" through this whole process. She will be our primary contact from here on out. She was great and also very personable and kind. I think we can definitely work well with her. Crystal went over in more detail when the tests will be done and how to go about getting them scheduled. She was great.

And after that we met with Darlene, the Financial Counselor who reviewed our insurance benefits.

Shady Grove Fertility is very thorough, and in many ways runs like a machine. But at the same time, they have caring, kind people working for them. So, it may be a well oiled machine, but it is a machine made of soft, smooth fabrics, not harsh metals (if such a machine could exist).

So, that's where we leave off. How am I feeling about it all? Well, I am glad that I got exactly what I was hoping for today. I will have the appropriate tests done to determine if I have blocked tubes or not. If not then great, we keep trying. If I do, then we move forward from there, and at least we can move forward NOW instead of starting this whole thing in August, which is what my OB said was our only choice, as August will mark a year of trying. I definitely plan to look into what Dr. Mottla said about surgery to open blocked tubes. I want to learn more about success rates and such before jumping head first into IVF if we have to go down that path. A path I definitely dread.

And lastly, I can't write this post without mentioning the many things for which I am grateful in relation to this whole process:

1. My sister in law who watched Ryan for us (at 7:00 this morning!) so that Matt and I could attend this appointment together. She is also willing to help out, as much as her work schedule will allow, with watching Ryan as I schedule the various tests. THANK YOU, CINDY!

2. My parents who are already on board to watch Ryan and my nieces so that I can get these tests done. My mom will be having knee surgery. She still said, "We'll make it work." We'll see about that. But her dedication to her kids, grandkids, and not-yet-born grandkids is amazing.

3. Friends and acquaintences who have been BEYOND kind and thoughtful as we begin this journey. So many people have been willing to share their own stories of infertility struggles, and I have been overwhelmed by their kindness. Jessica, Abbey, Casey, Kerri, and anyone else whom I am forgetting, THANK YOU!

4. Last but not least, my amazing husband. Knowing I have the most supportive and caring husband in the world right beside me through this whole process, wherever it may take us, is my greatest source of comfort. I love you, Matt!

So, that's where we are. I will be sure to keep you posted. And if you are a woman who is just beginning this journey yourself, then please, don't hesitate to leave a comment or e-mail me. I have been gifted by women willing to share their story, and I hope I can do the same for others.

I'll keep you posted! And in the meantime, I need to get back to posting about Ryan. He is just so amazing these days. So, there will be a post about him soon. But I will leave you with this: last night, as I was putting him to sleep he said, "Mama, I love you! You da sweetest Mama in da woooold!" That, that right there and for so many other reasons is why we want to do this parenting thing all over again! (fingers crossed!!!)


  1. Glad your first appointment went well! I had all those tests run too and I was told that sometimes when you do the HSG test, the dye can push out any blockage that might have been there to begin with. Praying all goes well!!!

  2. Yay! I am glad the appointment went as well as could be. Your doctor sounds wonderful. It makes all the difference. If you are spending time in hell, a pleasant guide does make all the difference lol. Sending you guys love and light. I also have heard that about the HSG and blockages. Hoping and wishing and praying that whatever is wrong can be easily fixed. It has been so nice talking with you, my only sadness is that we are not in the same zip code to have a beer together! Looking forward to keeping in touch throughout your journey! xoxo

  3. Sandy & Casey, Yes, the doctor did mention that there is a slightly increased rate of pregnancy after a HSG. So, yes, wouldn't that be GREAT! A lot cheaper and a lot less stressful than IVF!!

    Sandy, thanks for the prayers!

    Casey, I too wish we lived closer together and could have a beer together. All my "infertility warriors" who have been so supportive are spread throughout the country! I need one nearby!

  4. Kristen, I'm really glad your first appointment went so well. It sounds like you have a doctor who really cares and will help you get to the bottom of this. Good luck, you're in my prayers.


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