The Consult

A month ago, my sister-in-law (an unexplained infertility survivor) passed on these words of advice: “OBGYNs are there to listen to you, fertility specialists are there to get you pregnant.”  She unintentionally filled me with fear – am I wasting my time with this appointment?  If I saw an RE would they tell me they can’t believe I’ve waited so long and I can start treatments immediately?  Do I want to start treatments?  It doesn’t help that every time I call my gyno’s office they volley me between the receptionist and nurse, asking me to again explain exactly what I’m wanting done, so that they can in turn explain why that won’t be happening.

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As I mentioned in my last post, I was scheduled for a little conversation with my doctor to discuss next steps (even though we all know the next step is supposed to be the HSG).  Per my usual routine, I called the doctor’s office three times in the same day  – trying to play with dates and times to get me in there earlier this cycle.  I figured if I could get the consult over with early on, that she would happily schedule my HSG for this same month and we could all move on with our lives.  I wanted, no NEEDED, that HSG this month!  After “can you please get me in sooner” call #3, the receptionist told me, “The date you have is the earliest time we can get you in for your kind of appointment.”  My kind of appointment?  What is THAT supposed to mean?!  I imagined my appointment booked as “Impatient TTConceiver Gone Mad” at 9AM.  Fine.  Two can play that game.  I came loaded with questions – prepared to blow her out of the water with the evidence of my struggle, all the things I’ve tried, and end with my closing argument that I must, I must, be scheduled for an HSG (oil-based, preferably – I hear that’s the type that can help you conceive shortly after).  We’re playing by MY rules now.

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It was like going into an interview – dressed to impress (does this sweater say “I deserve to have a baby?”) and armed with a resume of everything I’ve tried this past year (“yes you read that correctly – I mastered my shoulder stand in Month 5”).  I even made sure to do my nails – as if she was going to say, “No betch with chipped polish is gonna get an HSG in my office!” – I’m fairly certain that’s exactly how she speaks outside of work.  The worst part was feeling like I was owed this procedure, but knowing she had all the power.  Nothing makes you feel quite as impatient as someone completely disregarding your timeline.

When I first walked into the office, I could feel everything.  The ultrasound room pulsed behind the door like it had its own heartbeat.  I’ve been there since the ectopic (love me some blood work), but this felt different.  Failure whispered around me.  I wanted my next official appointment with my doctor to be because I was pregnant, not because I hadn’t had any success.  I wondered about the women who were providing urine samples, or meeting with my doctor in her official office – were they getting confirmations on pregnancies while I was prepared to get down on my knees to beg for a dye injection?

The nurse who brought me back completely underplayed my ectopic experience by starting with, “How are you doing?  I know you had a kind of rough appointment the last time you were here.”  Rough?  Let’s try worst-day-of-my-life appointment.  I had to keep myself from looking at her incredulously when she confirmed, twice, that we were actively trying.  Trying to conceive has become such a part of my life that I’m surprised people can’t smell it on me.  Pheromones of desperation creeping from my head.  She kindly noted that we wouldn’t be able to do the HSG today (does my chart say “this woman will try anything – be as straightforward with her as possible, immediately?”) if my doctor does approve my request, and left me seated on the paperlined table.

I immediately went back to memorizing the notes I had made in my phone, like I was preparing for the biggest test of my life.  My doctor was running thirty minutes late (which I can no longer complain about as I took her away from appointments during my ectopic diagnosis) and the room was uncomfortably hot.  I was on edge – thinking she’d come in to see sweat running down my face as I stuttered about ‘years’ and ‘tests’ and ‘please’, forgetting all my key points and “must mentions!” on my list.  I have never left a doctor’s office with answers – heck, I can’t even leave them with prescriptions now that everyone knows I’m trying to conceive.  This was do-or-die; she was either going to immediately say, “Of course you can get the HSG, I promised you could!” or come up with some ridiculous reason for why I couldn’t get one – like I have sensitive tubes from the methotrexate and if they push dye through them they might disintegrate.  She could’ve offered me anything and I would’ve been happy with it – a step!  Progress!  

Doctor Kate (might as well give her a name) then descended straight from the heavens, down into the room I was waiting in.  Okay, maybe she knocked and shook my hand when she came through the door, but it sure felt like she was an angel when she gave me this gift: “Some doctors might say that you got pregnant with the ectopic and they’ll reset the twelve month clock, but if you started trying in February and you’ve been consistently trying for twelve months (she didn’t even mention the three months that the methotrexate made me wait!) then we should move onto next steps, because you want a baby.”  My heart exploded.  I couldn’t believe it – she was on my side!  

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I had prepared for battle, but not for a win – I was speechless.  She went on to describe what exactly those next steps are, which don’t include an HSG yet (heart deflates – I wanted that oil based sauce up the cooch!), but instead there’s an ultrasound (hello, my old friend) with saline that will show what my tubes and uterine lining look like (OPEN!  THICK!  Please please please!)   Apparently, one problem on my end could be if my right tube was all scarred up from Little Sac.  It seems a bit ironic to me that you’re better off with a totally blocked (or removed) tube than a slightly damaged one – am I supposed to ask them to seal off righty if the path is lined with shards of my ectopic memory?  I sheepishly asked if fertility was higher after this procedure (a sonohysterogram, add it to my TTC dictionary), as I had read that it was for the HSG, and she said Y.E.S.  Lady, I can’t handle all these lovely words at once!  

She kept dousing me with information after that: but wait, THERE’S MORE!  She went into a discussion where she attempted to dumb down clomid and IUIs for me and I wanted to say, “Yeah, I’ve heard of these things, I’ve been trying for a year – remember?”  But I couldn’t get the words out because she was telling me I could do this next month.  This could be my real life in a matter of weeks – I could join the realm of drugs and trigger shots and sperm injections.  I’m trying to not get ahead of myself – IUIs are generally not very successful, buuut neither am I, so maybe it’ll be just what the doctor (literally) ordered.

She gave me a list to outline what my next cycle could look like if we went the sono and IUI route and I shuddered in pleasure.  A list!  A timeline!  A PLAN!  Her final parting words, “Call us on the very first day of your cycle to get started, and obviously if you’re pregnant this month then all of this will be moot.” – Aaaadorable.  I grinned sarcastically, “I’ll call you.”  

Now I’m torn on this decision.  Do we go all in next month?  Or should I take it one procedure at a time?  If the tubal flushing could make me (potentially) more fertile, shouldn’t I start with that?  But then you play the what-ifs: what if my right side is too scarred to transport a healthy embryo?  Then maybe they wouldn’t let us do IUI in April, which would push our first attempt back to May.  Should I take everything I can get?  If I end up going through IUI anyway, isn’t it worth it to do everything in one go?  I’m slowing starting to put my walls of pessimism back up as I’m debating my options – caution whirring in my head.  Why are they already throwing IUI at me as an option?  Is it that unsuccessful that they don’t even care when you start?

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I can hear my sadistic genie hissing in my ear: be careful what you wish for.

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