What should I be asking for?

[TanteAC]

Hi all,
Am newbie, so apologies if I should be posting this elsewhere, etc.

Well, we have been ttc for 1 yr naturally (well, apart from metformin x3 a day for PCOS, but you know what I mean!)and have been to new GP (after moving last year) about no AF, general appts for my prescription, etc. I have made a new appt for next week and want a referral to a fertility specialist - I want this sooner rather than later as am nearly 32, have been trying for a year, and AF has only made one short-lived appearance in that time!

In a rambling way, my question is: what should the next step be for a patient like me? I only ask because I have a feeling my GP is being a bit dismissive, tbh.

Any advice greatly appreciated!
A x
PS Sorry, lonnnng and dry post! Am more nervous about starting this process than I realised!

You should hassle your doctor about this. It sounds very much like they are being dismissive. They do say that if you haven't conceived after trying for a whole year then you should be tested for fertility issues.

Good luck.

In my experience you do need to push a bit! GPs often don't like to refer and tend to fob people off. So be very clear that you want a referral.

I am waiting for mine to be processed - we had to have a scan to get my pcos diagnosed, then had to have blood tests and swab for chlamydia. DH had to do a SA (twice, as the first was low...and had to wait 4 weeks between those tests!)

You say you have confirmed PCOS - they GP will need to complete a form to refer you and will need to fill in lots of details. If tests haven't been done (I only know about the ones we've had) they will need to be arranged and results in before the referral can actually go off.

I'd suggest when you see GP make sure you ask what the process and time scale of every stage is - it makes them tell you upfront what is involved and puts you in the picture.

Good luck.

Thanks for both your replies - I feel waaaay less paranoid now!
I have already had all the PCOS tests, scans, etc a few years ago but with a different doctor who was brilliant - feels like I am starting all over again urgh.
Will definitely be more assertive, especially if I have to do all the tests again with the fertility specialist?

Sigh...feels like the start of a long climb, eh?
At least have now found mumsnet to keep me positive!
Good luck to yu as well, Miffles, and thanks again both for your advice
xox

Tante can you afford to go private for an initial few sessions with a consultant? You can self refer to a consultant if you go privately and then they will sort out the tests you need and do it a lot faster than going through a GP. I ended up doing that as my GP was really dismissive after I'd been TTC for 18 months. You can always go back the NHS if you need any particularly expensive treatments.

If not, then definitely put the pressure on them. If you have been diagnosed with PCOS then it sounds like you need an HSG or hycosy and then to look at ovulation stimulation meds like clomid. Be strident!

Good luck! Hope it all works out for you

Has your husband/partner been checked out too? If not then get him to have a sperm test :)

Gardenpixie having a few private consultations is not out of the question, I think - any idea how much this sort of thing costs? Am in London area. 18 months!

Wow, thought mine was being dismissive...
(new GP actually told me 'just because you have no AF and PCOS and are not ovulating regularly is no reason to think you cannot get pg just like every 'normal' woman...' and gave me a leaflet on ttc (eat your greens, don't smok crack, RELAX, etc. )

Dueling ahhh yes, the sperm test has raised its ugly head (excusing terrible pun). We are in process of getting that organised. Have had to reassure dh that this does not actually involve having his member chopped off...lol

Thanks for your replies, I have been feeling like I am making this up or being demanding (have to have words with myself before GP appointments to convince myself otherwise)so feel 'normal' (what an asshole he truly was)
x

Hello Tante glad you've joined our TTC thread!

I am seeing a consultant at London Bridge Hospital. You can just call them up and say you want to see a consultant gynaecologist (sp!) and they'll book you in.

In London the costs are all roughly the same depending on where you go - mine so far have been:

Initial consultation: £200
Follow-up consultations: £130
Full PCOS blood test (loads more detail than the NHS ones so they know exactly what is going on): £345
Hycosy (to test tubes are working and to scan ovaries): £390

It's worth getting the consultant to give you all the contacts for the tests as they can often negotiate a discount for you.

FWIW I am seeing Amina Shafik at London Bridge - she is excellent although does not beat around the bush (sorry, bad metaphor for a consultant gynae)!

She gets things done soooo quickly though and really understands the frustration of having been TTC for ages. After being messed around by the NHS for an eternity, it was such a relief to dealt with quickly - within 4 weeks I'd had all the tests done and was given a prescription for clomid. It can take 6 months to sort it all out through the NHS and I'm not getting any younger!

Wow - a month! That sounds worth it. Definitely something to look into after my GP appt (in a week).
Am sooo lost without my old GP (we only moved to London lst year, bad timing for changing docs) who was brilliant - was referred to a consultant immediately, he called me personally with results he thought I was worried about, treated me like an adult with a brain/research abilities/no bizzarre hidden agenda.

The result was I have always been v calm and measured and realistic about things but with the new GP I honestly feel like I have walked in and said 'I'm 14 and I'd loooove an ickle baby someday'
Lol at your metaphor! Good to get a recommendation, thanks.
How are you finding the clomid?

Yes GPs can really make people feel ridiculous! Mine told me that plenty of people wait years to get pg and that I should just relax as it would help.

My consultant, on the other hand, was very happy to talk about all kinds of options with me from waiting a little longer to see if it happened naturally to IUI and some others in between. And she trusted what I said in terms of having sex regularly and at the right time - my GP wanted me to keep a diary of when DH and I got romantic to check it against my cycle.

Like I hadn't been furiously monitoring all fertility signs for MONTHS!!! And he said helpful things like: you can only get pg when you are ovulating. Really?? What a blinding revelation THAT was!

I haven't started the clomid yet as the consultant got everything sorted for me in less time than it takes my body to have a full cycle ... so I will be starting on it in a week or two depending on when AF turns up. Oh, or unless I get pg before then

Lol at GP - that was the same with me 'and you and your partner are having sex?'

Ah, that's where we are going wrong!
Also, would you like me to text you when we do?

Usually am not a fan of the medic-bashing but really, he is giving them all reason to complain!

Ooo fingers crossed for the clomid. Had a friend who was ttc for years and then got pg on clomid (twins!), so good luck!
Or indeed, stop writing that presentation and go get baby-making now to get pg first!

I agree with what's been said here. Push for a referral and ask to see a different GP if your one is being rubbish! I also have PCOS and I've had some very mixed experiences with doctors over the years, some have been great and others less than helpful. Keep persevering though and don't be afraid to speak up if you're not happy with what the doctors say. I wish I'd been more assertive with some of the idiots medical profession I've seen :o

Am limberng up to be v assertive!
It just seems such a shame to have to go in on the defensive after the brilliant support and treatment I have had up until now. I never really understood what others were talking about when they complained bout unsupportive GPs and ferility. To my shame, secretly always thought that because they were so sensitive and frustrated themselves, they were perceiving slights that weren't necessarily there, iykwim? .

Am getting my just desserts for that extemely patronising point of view with Dr Come-back-if-nothing-happens-by-2015, eh?

highheels are you on any PCOS meds?

I'm on my 3rd (and final for now) cycle of clomid. Doctor's have not discussed any other meds with me and if we weren't ttc at the moment I don't think I would have got anything!

Am on metformin as well - a couple of other friends got pg on this alone. It was standard issue where we lived before, but the consultant at the hospital there was a PCOS specialist and researcher, and happily prescibed what he thought made a difference. Seem to have had to jump through flaming hoops with flamboyance to get prescribed it with new GP...maybe worth asking for?

I think I need to be more demanding when seeing medical professionals! The GP after I had eventually been diagnosed with PCOS after many rounds of appointments and tests said something along the lines of "well this just means you don't ovulate and don't worry we can make that happen by giving you clomid so come back when you want a baby" or something equally helpful.

Hmm - don't know if it was different for me because I was nowhere near ttc when going through PCOS tests and diagnosis, so it was dealt with as an endonrinology case rather than fertility/gynae iykwim.
Consultant has to prescribe metformin, which has really helped others I know get pg, or even just control symptoms, if not ttc. After the first time it can be prescribed by doc - is actually diabetes med so not a big deal.
Have you tried the low GI diet thing as well? Sorry if stating really obvious starting points!
My advice is to treat PCOS as a condition not related to ttc. Too easy for doc to treat it as fertility issue when even if not ttc you are entitled to be treated for its symptoms regardless.
Ooo, got all angry there for a moment! Need another cocktail on ttc thread, methinks!

I was disgnosed after tests because of very painful periods when I had them, irregular cycles and unexplained mid-cycle pain. Was before we started ttc but did mean we started sooner than DP had expected to as I we anticipated trouble. I'm quite lucky with the PCOS, my skin can be awful at times but doesn't seem too bad just now (maybe the clomid will clear up my spots even if it doesn't give me a baby!) and I have a very rigorous hair removal routine but my BMI is okay (prompting one helpful doctor to comment "well it's a sign of PCOS but you're thin so you can't possibly have that") so I'm hoping that's a positive sign that I've not got too much of the insulin resistance stuff. I try to eat a fairly low GI diet anyway. Maybe after we stop all the ttc I'll go back and discuss everything if I find a helpful doctor. See you in the cocktail lounge :o