You can't fix me!
Recently, I had a doctors appointment with my Primary Care Manager(PCM) in order to get a referral to a Reproductive Endocologist (RE). This is always a stressful thing for me. They always question everything and while I expect this it is very often just a waste of my time and their resources. My struggles are beyond the scope of their ability.
Previously when we first started to try for a second kid the PCM sent me for one test. He wanted to check that there wasn't anything that would physically prevent me from having a child before giving me the referral. Everything came back normal and I got my referral back to see the same doctor as before. This is what I expected going into this appointment. This time though it was particularly frustrating.
The PCM walks and asks why I am there.
Me: I need a referral to an RE as we would like to try for a second child.
PCM: I'm confused it says here you have a child and conceived one other time.
Me: yes I know and both of those were conceived using a boat load of fertility medication. As you can see in my records I had previously been seeing an RE for this but the military moved us or I would still be seeing one. Since its a new place I need you go through the process all over again and get a referral.
PCM: I see it's been a while since your last cycle. I would like to put you on birth control for a few months and then see if your system sort of resets itself.
ME: I appreciate that but it won't do anything. I was on Birth Control for years and that did nothing in the way of regulating my cycle. It's also not going to fix my fertility issues so can I get that referral?
PCM: well it says you have PCOS. What if I put you on Metiformin for a few months and go from there.
Me: I had been on Metiformin for half a year back when I was trying to conceive my first child. It did nothing as my previous doctor stated in my records. I do not have insulin resistant PCOS or the medicine would have helped. I see no need to go back to it now.
PCM: hmmm... Well how about we try clomid a few months. We will start you out on a low dosage and work our way up until we find something that will work for you.
Me: Again I appreciate the effort but clomid or even Femara alone has never in the past aided in either conception or ovulation even when getting close to the maximum allowed. You can see that in the beginning of my records. My old OBGYN and my previous RE have tried various levels of both medicines to get me to even ovulate. Alone it never worked. What did work both times, once when I conceived my son and the second time with this previous ectopic was a combination of Femara, follistim, and an HCG trigger along with heavy monitoring. If you would like I have a copy of my previous charts from my RE in my email if you would like to see them.
PCM: yes I would. ( I hand her my phone with the records on them). Oh wow that's a lot of medication. Wow together? Ok well, hmmm...
Me: so about that referral....
PCM: I see you were on a lot of medication before but I really do think we should start from square one here by putting you on Birth control for a month or two then upgrade to clomid. What do you think about that.
Me: I appreciate it however I don't have that kind of time to have you try for "a few months" with the things I know in the past that haven't worked for me. Nothing you have explained to me has given me any inclination that they would work for me now when they didn't in the past. So why would I waste my time trying them? So can I just get that referral.
PCM: I don't understand what time constraints are you on? Other than self created? (Side note: I use USFHP which works with John Hopkin Doctors but works exactly like tricare prime)
Me: yes I would like children close together but this goes way beyond that. Hubby is military meaning we move all the time. We know we will be here for just about one year. We will likely be at the next location for that long as well. What this means is I have been here for a few months already trying to figure out this whole new health care thing. That time is gone. If you give me a referral to an RE today I likely won't get an appointment for another month maybe two depending on availability and assuming they can't squeeze me in under a cancellation. So at the earliest I'm going to waste 4 of the 12 months we are here just waiting to see the RE. Then once I am seen by him/her I will have to be put on medicine to cause my period which will waste a few more weeks before I could possibly do a medicated cycle. So say 6 months gone and only 6 months left. Within those 6 months I will be lucky to get a max of 4 medicated cycles in if I'm lucky. Now if you want to mess around trying things by the time I actually get In to see the RE and start a cycle it will be time to move. Once I move I go through this same process once again. The PCM thinks they can do something that an RE can't. I waste time trying things that won't work and the cycle starts all over again. It all means I get older and no closer to having a second child. I could go on but I'll stop. Basically can I just pass go and get the referral?
PCM: I see. I known plenty of people whom have conceived naturally after using fertility medicine... (Continues on with a story I tuned out)... Well I'm going to give you two referrals. One to an RE and one to the OBGYN. Once you have your second child you will need to think about a plan on managing your PCOS long term.
Me: thank you very much!
She reluctantly gave me the referral but I have it in hand which is good. However this process is ridiculous. I get it, you see I have a kid and you think you can do something for me. Yet, I'm sorry, why as a general Practitioner do you feel like you can do more for me than a specialist can? If clomid worked I would not have been sent to a specialist in the first place! This is beyond just checking things off your list. My previous PCM stated outright that it was protocol for me to have a scan but this doctor did not mention protocol once. If that was the case and she had certain boxes she needed checked then read my file. It's all in there. What more could you need to give me the referral? Come on lady use your brain here.
Frankly this whole jumping through hoops and having to push to see a specialist kills me. I know plenty of people cry wolf especially when it comes to baby making. They think when they don't get pregnant right away something is wrong. Maybe it is, maybe it isn't. However I actually need the help. It's documented, it's in my records. I'm not expecting you to fix me. What I am expecting is that you send me to the people with the most knowledge on the topic and RE is just that.
Since I now I have my referral in hand I made the call to the RE. Six weeks until I can get my first appointment. Six looooong weeks. Until then I wait.