Dr. Bromer

Today we met with our new fertility specialist. Dr. Jason Bromer. I say "we" because Mike also gets the pleasure of having a few tests done, although his are nothing compared to the check-list of them I get to complete! Yes this was the longest doctors appointment I have ever been to, and yes... I sat in seven different rooms today at the office.
As many of you know I was very excited and nervous about this appointment. I have not had the best of luck finding an OB/GYN who has been terribly helpful towards our situation. First one was kind enough to tell me I am fat, which yes I am aware by medical standards I am not considered to be at an ideal weight for my height. But I seriously doubt that 15-20lbs is the ONLY thing holding me back from getting pregnant. The next got my hopes sky high that he had the end all be all cure and then they were crushed just a few weeks later when he announced that he would no longer be able to help me. Needless to say I was nervous as to how this appointment would turn out. I figured, if worst came to worst Mike would be there and at the very least we could have a good laugh about it later.
So for the last few weeks I have been running around and calling doctors like crazy attempting to get all my paperwork complete for this appointment. There was a three page(front and back) questionnaire about my sexual and reproductive history, some of the questions even made ME blush. I hoped upon hoped those questions were not going to be discussed in specific detail. I also had to sign about a dozen waivers, Mike also had a questionnaire(his was only two pages total...) and we both had to sign a waiver saying that I had the right to use his sperm if we chose IVF. I am surprised we didn't have to sign saying they would have the right to our first born if we chose not to pay our bill... Or did we sign something...
So, stack of papers in hand we tote ourselves to the office, which coincidentally is in the same building where Molly had her tubes put in. I figured that was a good sign because we love her ENT and all the nurses that helped with her surgery. I was immediately overwhelmed by the friendly office staff, this is a big thing for me. It is a real turn off for me to encounter cranky receptionists, especially in a place that I have to call frequently for questions and what not. We were not made to wait very long at all after getting checked in.
Dr. Bromer was not at all what I expected, he is much younger then I was picturing and his office was very warm and inviting. Displaying tons of pictures of his wife and son, who we found out later was conceived through IVF. Even bigger bonus to find out our doctor has been through what we are going through. Probably not the exact same scenario, but at least similar enough to understand the difficulties.
We went over details of both mine and Mike's medical history, mine was much more extensive because(lets be honest) we already know I am the one with the issues. Although Mike does get to submit a "specimen" for analysis anyways, just to rule things out. Before I continue I would like to say, I was given permission to talk about this by my husband. Yes... I did ask. : ) The rules for his specimen collection literally made me laugh the entire way home. I seriously felt sorry for whoever had to type up that piece of paper because I would not have been able to keep it together. They even brought him his take home cup in a gift bag, how priceless is that?! And as we were checking out the receptionist reminded him to keep the sample close to his body on the ride there so it stayed warm. I JUST ABOUT DIED. Mostly because he gets pulled over on a regular basis for various things, and I really would love for him to try to explain that situation to a cop. Besides... Sperm is funny... Tee Hee. : )
Back to the appointment. Dr. Bromer did an excellent job discussing PCOS with me, most of it I already basically knew, but he was able to explain a few more things about it. He really did an excellent job of explaining our options to us. He also went over my thyroid problems with me, he didn't realize at first that the thyroid issue came first then the PCOS diagnosis. He was thrilled with all the tests my endo has already done. He even made sure to send her a note saying so. He says as long as my TSH stays under 2.5 he is happy with anything she has done. I also got complimented on my ability to withstand 2000MG of Metformin. Which is traditionally given to PCOS patients to help with insulin resistance. And is very very hard on the stomach. Many patients cannot even take one pill a day, and I have been taking four a day since the end of February. It was like an awesome pat on the back for me and Dr. Ruby.
He then explained that we are considered to have secondary infertility. Infertility is defined as trying to conceive for a year or more and not being able to do so naturally. And secondary is because we have already had one successful pregnancy with no difficulty conceiving. So then the question becomes, what is not working now that was working before. Three things to try to rule out, sperm abnormalities, my irregular cycles and lack of ovulation, and the miscarriage. He said at this time he currently isn't worried about the miscarriage for a few reasons. It is the only one we have experienced so far, and at the time I was taking clomid but was not being closely monitored. He has confidence that the next time I become pregnant I will be able to carry to term with close monitoring. Basically, frequent ultrasounds and taking progesterone early on. One of the most common reasons for an early term miscarriage is low progesterone. And woman with PCOS are more likely to have low progesterone, we simply just don't produce enough on our own. Which causes problems because it's basically the "sticky glue" to the pregnancy. Helps the egg attach securely to the uterine wall early on.
 First thing he wanted to do was run a few diagnostic tests, luckily I was able to get two of them knocked out today because I had started my period on Monday. One test was a blood draw on day three or four of your cycle, and also an ultra sound on day three or four. Mike and I were both excited about the ultra sound. Mike being a biology major was interested in my "chocolate chip cookie" ovaries. The term is used to describe how the ovaries of a woman with PCOS look. Basically a normal ovary looks, on an ultra sound, like a plain cookie. But PCOS causes many small follicles to form on the ovary, these show up as dark masses on the ultra sound, making the cookie look like it has chips in it instead. Dr. Bromer showed us both each different part he was looking at, first my uterus, pretty boring. Then both ovaries, one criteria for PCOS is over 12 follicles on each ovary. I have 22 on my left and 26 on my right. So although it is over, still not considered an "extreme" case.
The next test I have to have done is an HSG. This stands for some horrendously complicated name that I can't remember. Basically what they do is inject a dye into the uterus and take a series of x-rays. This is to check for blockages in the uterus or fallopian tubes. That has to be scheduled for sometime next week. Here's hoping I can get that scheduled! After that I just need one more blood draw, and Mike too, to rule out Hepatitis B, HIV and a few others. Mostly just routine prenatal screening. After those things are complete we just need to wait for all the results to come in, then our nurse(who works closely with the doctor but handles the majority of the phone calls) will contact us and set up our second appointment. This will be the time to review all the tests and discuss a course of action. I am also in love with our nurse, she is very friendly as well(which is a big plus because I will be talking with her the majority of the time when I have questions).
Last step today, meeting with the financial adviser who works with Shady Grove to discuss the benefits on our insurances. This was probably the only down fall for the day. As it turns out, because I am on my parents insurance as a dependent I will only get coverage for consultation and testing. Which means they will not cover anything that is considered treatment. So, even if we wanted to pursue IVF or IUI we would not be able to because we would have no insurance coverage. Luckily it currently isn't something we are interested in. But, it looks like the majority of our testing will be covered and any prescriptions I am given(clomid or other fertility drugs) will be covered as normal. Lets just hope they don't change there minds at the last minute.
Overall it was a really wonderful consultation, I am very pleased with the direction our/my treatment is taking, and I really do feel hopefully that a healthy pregnancy is in our near future. Maybe I will be getting that May Baby after all! Just a year later than originally planned. : )