Seeing the gynae next week. Advice needed please.

[poutintrout]

Hi,

Am ttc#1 and have my second appointment with the gynae next week and would appreciate some advice as to what I should be asking him next.

Bit of a background (sorry is a bit long). Have been actively trying to get pregnant for around 11 months, though had been using the withdrawal method for at least 3 years prior to this which bothered my GP, she said I should have "accidently" got pregnant by now(!). Was diagnosed by my GP as having mild PCOS from an ultrasound though 21 day blood tests done in Sept came back as being within normal ranges but high for my age (am 35).

Was referred to the gynae for help with the PCOS/fertility investigations. I really didn't like the gynae very much. He looked at my ultrasound results and said in a very dismissive way that they were very "unremarkable" and when my fiance said that I seemed to have symptoms of insulin resistance which is often the cause of PCOS he jumped down his throat and said that they weren't symptoms at all (which was contrary to research we had done) and didn't understand why the GP had suggested a low GI diet or the metformin tablets.
He made a really big deal of how he "didn't understand" my GPs letter to him and made us read it and explain it to him. He then sat back and asked us what we wanted him to do for us, all the while referring to me as "she" or "her". I felt quite taken aback and stupidly was intimidated so didn't say very much during our appointment as he made us feel like we were wasting his time.
After consulting his colleague he grudgingly ordered more 21 day and some 5 day bloods and an HSG.

I have subsequently got a copy of the letter that he has sent to my GP about this consultation and am really annoyed that he appeared to not have listened to anything I told him about my cycles which have over the last few months changed to being erratic and scanty. He in fact put in his letter that I had a normal 28 day cycle and heavy bleeding. Not true, UCL 26-34 days with scant bleeding.

I am now dreading my follow up appointment with him. Should I question him about the letter he sent to my GP and insist that he amends this so that my GP doesn't wonder why I told her something completely different?

If my bloods and HSG come back normal what do I ask for next because I worry that he will just discharge us.

Also I am concerned that I have high prolactin levels because I appear for the last three months to have been lactating. My internet searches have indicated that if this is the case it would explain my longer cycle lengths and lighter mentstrual flow and obviously lack of BFP. Because of his reactions to our previous concerns and questions I am really worried to mention it. Are prolactin levels routinely checked as part of the 5 and 21 days bloods?

Sorry for the long post but would appreciate some advice as how best to get the most from this referral and how best to deal with this doctor. At present have just been made to feel like I am a moron and a time waster.

[Ariesgirl]

As ever I am shocked by the fact that some gynaes actually seem to dislike women. I'm sorry, I don't have any constructive advice, but I wonder if you could ask for another one somehow. He seems rude, unhelpful, unsympathetic and mean - in short a prick.

[LittleSquirt]

So sorry you are going through this! Feeling like your body is not doing what it should is hard enough, but having to put up with this awful consultant is terrible for you!

My advice is: go back to your GP and ask for another consultant. They can't only have one they can refer you to? And if your GP says no (I would be very surprised though) you could point out that the cons didn't even listen to you properly, as confirmed by his very basic mistakes when he described your cycles! You cannot have that.

You need another consultant who you feel can help you and who you can talk to. That's it.

Good luck, keep us posted! :-)

[MommyMayhem]

Hi poutintrout, is there any way that you could go private? You really don't need me to tell you that time really isn't on your side.

[Tansy70]

Extraordinary! I would keep your appt, get your results from your bloods, ask a few more questions and then go back to your GP to be referred to someone else...This sort of behaviour doesn't surprise me quite frankly, it is so hit and miss with doctors and gynaes.
If there is any chance you can go private, then that may be worth it, if you can. I think it's £250 for a first appt but they will give you individual attention and hopefully not give you the brush off like this man.

[rocketleaf]

I am with everyone else, get the results, give him another chance (he might have been having a bad day) and if he's still a wanker then ask your GP to refer to you someone else pointing out the fact that he hasn't listened to you and doesn't seem to think he can help.

On a more positive note, we were also using the withdrawal 'method' for over 7 years and were then not using it for 3 years with the last 12 months actively TTC. We had been referred for IVF by a similarly dismissive and condescending consultant (unfortunately its not that extraordinary!) when I finally got pregnant naturally at 38. There might be something stopping you getting pregnant so you should definitely insist on full investigations but it can sometimes just take that long I'm afraid.

If you aren't already then I would get a basal body thermo and some OPKs and start charting, it seems like a pain in the arse but you get to know your cycle that much better and should be able to tell if/when you are ovulating. It also helps to know you are doing something proactive. Worked for me. Good luck!

[rocketleaf]

Oh btw, he can't just discharge you, if you have been TTC for longer than 12 months (which you will be shortly, just tell him its 12 months now) and are 35 even if all your test come back normal then you should offered fertility treatment. Next step would be to assess if there is a problem with your partner. Hope that helps.

[AttilaTheMeerkat]

There are some really crap gynaes out there I am sorry to say.

I would attend this next appt and if this gynae is as equally dismissive this time around then ask the GP to refer you to another gynae.

Can your man go along with you?. I ask this as such appts anyway can cause considerable nerves and he can give you moral support and ask questions of thus gynae. It is vitally important that the three of you can work as a team and from what you have written so far this does not look like this will happen with this person.

Prolactin levels are not normally checked as part of day 2 and day 21 bloods (other hormone levels are measured for both these tests) but high prolactin levels can certainly interfere with ovulation and is therefore regarded as a problem. It can be treated with tablets.

You need a proper diagnosis first and foremost.

I would refrain from using temp charts and OPKs even though you may think you are acting proactively. Also you are really beyond the stage of using such things besides which the GP gave you a previous PCOS diagnosis. If this is indeed accurate then both OPKs (particularly them) and temp charting will not be helpful to you.

You will need to be persistant in order to get answers.

[MummyAbroad]

So sorry that you have been treated like this. I agree with the other posters that you should ask for a second opinion.

I disagree with Atilla that "you are beyond using such things" (charting/OPK's) She also told me the same thing a few months back, but as it happens charting and OPK's helped me get my diagnosis. I discovered that I was ovulating regularly, and did not have a hormonal problem (as my gynecologist said) but rather a structural one (I have Ashermans Syndrome) so they do have their uses.

I DO agree that you need a good diagnosis and you should use all available tools to get it. The blood tests seem particularly important and relevant in your case, but charting and OPK's used correctly can also be useful to confirm (or otherwise) the diagnosis you get from the doctors (who as you have discovered, dont always listen) . If you cant detect ovulation with your temperatures, have EGCM at times other than ovulation, or get frequent positive results on OPK's this is more evidence that you may have PCOS. This is certainly not the best way to diagnose PCOS but it can give you clues which point you in the right direction.

If you want an excellent explanation of charting, monitoring cervical fluid and cervical position and using OPK's/monitors etc then I would recommend you read "Taking Charge of Your Fertility" by Toni Weschler. Its very informative and includes some examples of charts by people who have PCOS. Why not look for a book about PCOS too? There are many on Amazon (sorry cant recommend anything in particular)

Anything you can do to inform yourself will help you feel more able to stand up to dismissive doctors, you will know when they are fobbing you off and telling half truths. The best defence against this kind of behaviour is being able to ask the right questions. Keep a pad of paper handy all the time and as you think of questions write them down, take your list with you to each appointment and ask all of them. Hand over the list if need be, many doctors find this more efficient and are happy to do anything that speeds things up.

Above all, dont give up. You must be your own advocate and speak up for yourself, it is really worth doing, I cant tell you how much better I feel having a diagnosis and treatment plan compared to the 7 months before when I just worried and worried. Put on your thick skin, and keep asking questions until you get what you want and deserve.

good luck to you,xxx

[weimy]

I think it's a really good idea to write down what you want to say and take it in with you. Good luck xx

[poutintrout]

Thank you ladies for your advice and comments.

Was wondering whether I was being over sensitive in expecting a bit of politeness or sensitivity from this consultant - glad that I am not alone in thinking that his manner was a bit crap!

Will keep this appointment and hope that he is better next time, though if things don't improve I think that I will talk it over with my GP who has been lovely so far. I have asked my partner to be more forthright at the next appointment. He's "Mr Science" so shouldn't have any problems in fighting our corner a bit more!

Feel relieved to read that I can't just be discharged, that was probably my biggest fear TBH.

Thank you again.

[womanlytales]

I have seen three consultants - Two were crappy and one was fantabulous. Sadly with the NHS one doesn't get to choose..so I am still with the crappy one who is part of the team of the fantabulous one... Also when I took my DH in for our last appointment Mr.Crappy did a 360 on me and DH came out wonderning WHY I thought he was crappy. Basically some of these consultants are not even comfy relating to a woman...but with a man around, they actually start to come into their own. LOL
In your case, seems like the chap was just overall crappy. The ironic thing is if you saw the same chap in Private he'd probably be much nicer but that's another story.

I have PCOS and agree with Atilla that charting, temping, Ovulation tests etc were all pointless - ie, they did not make me more aware of my body, they did add to my stress levels and so that was a case of inviting trouble. However women with PCOS are not all similar..in fact just the opposite -- so give it a go for two cycles and see if it's helping you get a better grip of your cycles & helping you feel more aware of your body.

In parallel you should absolutely insist on getting on with the investigations and while you're at it, try and ignore the crappy part of your consultant and instead focus on getting the answers to your questions. For example, I will repeat the same question three times if I have to -- and then I also repeat back the answer to clarify that I have understood what he's telling me. It makes my crappy consultant roll his eyes and tell me I am really slow... but I can at least leave the room knowing where I stand.

I am 35 yrs old, have PCOS, tried Clomid for 3 cycles, did not ovulate and now will be starting injectables in February. My biggest struggle is coping with all this in my head..so slotting the cons in the crappy bucket and then ignoring his lack of any consulting skills helps me keep him at the low priority that any consultant merits... The consultant is just a medium to reach our goal. If I had Mr.Fantabulous as my consultant and I didn't reach my goal to have a healthy baby - I would not be any happier... So the goal is most important ..how you can keep yourself fit and healthy to get to your goal gets the number 2 slot in priority ... Having clarity on the HOW part is Number 3 and being able to follow through with the to-dos is Number 4. The cons falls into the 'How' part but even that his personality gets slotted at a much lower priority. Thick skin and a bag of salt - that's what we all need in this journey :)

[womanlytales]

oh dear not sure why part of the message was struck out.. might have to do with some extra -- I put in

[poutintrout]

I'm sorry that you too are having problems Womanlytales. Your comment that the goal is important not the personality of the consultant really struck a chord.

Not sure that I want to start with the whole temping and charting thing. I know that it might help me to get a better picture of things but I don't want to add to my worries that all isn't well. Am feeling a bit fragile at the moment anyway thinking that maybe a baby isn't mean't to be and I've left it too late (probably because 2010 has been and gone and I'm looking at being right back where I started on my TTC journey) so don't think that this would be a good time to possibly add more uncertainties to the equation. Instead will focus on being less pathetic and self indulgent and only worry about the certainties not the what ifs! Scurries off to buy a big bag of salt and a crappy bucket...

I really hope that your treatment goes well and that you have some good news soon!