First NHS referral appointment Guy's - rant and questions

[SoutheastB]

Hello everyone,

Feeling so tangled up with so many questions and choices so just want to rant and hopefully, some of you will be able to relate or help. We have TTC for the last year and after taking 2 ultrasounds, AFC, AMH, Semen analysis it seems like our current issue is that my cycles are just irregular (around 55 days) but I do seem to always ovulate.

Yesterday we had our first referral appointment with the NHS at Guy's hospital and I walked away feeling just weird about the whole experience. The Doctor itself was as non-charming anyone could be. Of course, they are not there to be nice but her attitude was just really off the whole time which made both me and SO very uncomfortable and she did not want to introduce herself either so I am not sure even what her name is and I cant find it anywhere on my NHS app.. Any questions we had she said " its not important right now" and after taking my details she said "it looks like you have PCOS" I asked her what symptoms she was identifying this for because I suspected this myself but I do not have any other PCOS symptoms than my irregular cycle and the only thing she could say was because my cycles were irregular. Fine. Then she said that its an easy fix to this and we can just induce ovulation which has a 50% success rate (?). As this is the solution I was looking for I started asking her about if this would be letrozole or Clomid or anything else and she just said "You will have to see at the appointment". There was nothing else she could give us and I asked her if I could do a blood test as this was my 7DPO and I wanted to take the opportunity to see if I ovulated this cycle. She said fine and ordered a blood test. I also asked her if I could do a quick scan (as the scan was in the room) and I thought to myself that I might as well see if she could either see a dominant follicle or signs that I had ovulated. She was very negative and just said "We can do it but we might not find anything" until I insisted on doing a scan and she very unhappily did so. We found something that looked like a corpus luteum.

I left the appointment feeling hopeless about having a doctor that not only could just meet us with a bit of empathy but also seemed to ignore our questions and was not interested in informing us about anything. I am fortunate enough that I have private medical insurance with my company and I recently found out that I would be able to have treatment at Listers covered by insurance. I am now wondering if I have the following three options

1. Hope that my next appointment with the assisted conception team (which she said was a different team) will be better and I will have more trust in their knowledge and approach. But will she still be my Dr? I don't feel 100% comfortable having her doing our treatments as I feel like she was not that knowledgeable or interested in finding out information. If anyone has experience in how it usually works in the NHS with assigned doctors that would be appreciated.
2. Ask NHS to appoint me to Lister instead. This would be far longer travel time for me but if I can get a better Dr there it would be worth if for us. Is it possible to "transfer" the referral to Lister as it is part of NHS too?
3. Go fully "private" at Lister and use my insurance. How does this interfere with my NHS referral? I wouldn't want to cancel anything with NHS yet now that I got the referral.

Hope this blob of text made sense. I just feel so worried about this whole journey and I am disappointed that my dr was such a letdown. :( All the other nurses were amazing though and I should say that my experience with my gp that referred me has been absolutely fantastic.

Thankful for all your input. Not from the UK originally so trying to navigate how the system works.

Sorry to hear your first appointment wasn't as you expected.

No advice on the TTC side specifically.

However, I just wanted to share a different perspective. Could the Dr just have been having a bad day?
The reason I ask, is I met my DC's paediatrician and hated him! Thought he was rude, dismissive - wasn't looking forward to seeing him again...

The next (and all subsequent) appts, it was like he was a different Dr! (Positively!)

Could be and hopefully was. But unfortunately her bad attitude and not showing willingness to explain the treatment she was telling us to do made me feel a great distrust in dealing with her in the future. It's already a sensitive and anxious topic and I feel like it's gonna be so much more difficult if I have communication issues with my Dr.

Happy to hear it turned the other way for you.

Sorry you've had that experience. I have had fertility treatment myself and know what it's like to cling on to all hope with these appointments and count down the days until you can speak to someone so it must have been disappointing to then feel so unheard.

My only thoughts are that, having been through this myself, you probably won't have much more to do with the doctor for now if you go onto ovulation induction. In my area anyway once I'd had that initial consultation I exclusively dealt with the nurses and sonographers for the next few cycles and they were all fantastic. Any queries they had about dose etc (letrozole) they communicated with the dr on my behalf and then relayed back to me. I had my first appointment with the dr in January and was only due to talk to him again this week but cancelled due to just getting my BFP.

Wish you the very best of luck!

Which dept were you being seen by? Was it gynae? I had ovulation induction treatment at Guys in 2020 for PCOS (letrozole) and my team at the assisted conception unit were amazing. I saw Dr Davinia White. So it might be worth hanging on for your ACU appt, because if you do have PCOS, she is apparently an expert in the condition. 3 rounds of letrozole resulted in my DD and i felt my care was very positive.

I was also under the care of endocrinology and it was a bit more hit and miss there. But once i started with ACU, i didnt see them again until after i had DD and had a final appt to discuss a long term plan for controlling my PCOS.

Do you think the doctor you met was a consultant?
It's the beginning of August, doctors below consultant level have all just moved into new jobs and suddenly expected to know everything about their new role, sometimes at the start they are a bit out of their depth.
Especially as you said you couldn't find the doctors name anywhere.

Sorry you had such a bad experience. With the way the NHS works I doubt you'll ever see that doctor again to be honest. But I'd also say, things in the NHS are slow, so if you've got private insurance use it! It won't have any effect on your NHS referral at all. However, private insurance often doesn't usually cover fertility treatments. Check out your policy, but they will usually do all the investigations through gynae referral but if you need medicine/treatment, to induce ovulation for example or further down the line IVF, it's not usually covered.

My final point, if you know you ovulate already is inducing ovulation the answer? Do you track your ovulation with OPKs/BBT? Obviously if your cycles are very irregular and you can't predict ovulation at a regular time then it's hard to know if you're dtd around that time. Sending lots of baby dust and you get your BFP whilst waiting for all this!

Sorry to hear that first appointment was disappointing .
I also have irregular cycles and wonder about whether you are using OPKs, tracking bbt and cervical mucous?
it has been reassuring to me to also see that I ovulate every month despite it being a different day. We can then try and focus dtd otherwise would be completely exhausted.
I have wondered about PCOS myself but I believe to receive a diagnosis you would need more investigations, it isn’t enough to diagnose on irregular cycles alone surely?
in any case it sounds like you will get some further help. Just wanted to put that out there. Best of luck to you.