I had a followup with my local NaPro Ob/Gyn. As usual, I had my list of questions ready & DH & I were all set to tell her that we would be looking into PPVI as the next step. Well, things took an unexpected turn.
- After reviewing my history, she told us that endometriosis was possibly the only remaining cause for my miscarriages. She started reviewing my charts for the last few cycles. I explained to her the brown bleeding/mucus I had during the last cycle & she said it was expected of a miscarriage cycle. I pointed to my chart & tried convincing her that I have TEBB for 2 days most cycles and asked if I could be on antibiotics in case there is inflammation.
- And guess what, she surprised us by telling that she would do a Laprascopy at the beginning of my next cycle for possible endo and if so, she would laser it out. She will also do a hysteroscopic D&C to get samples for endometrial culture. If the culture shows any kind of infection, she will put me on antibiotics. If the endo is extensive and on places such as the bowel, she will recommend me to PPVI. Until last year, she was recommending her patients to a NaPro surgeon 3 hours away. Unfortunately, that NaPro surgeon moved to St. Louis. I don't know if that's the reason why she herself is doing the laparoscopy.
- She also told me that my mucus scores were not indicative of endo but we will never know until we do a lap. Since I had a laparoscopy for my ectopic & not laparotomy, she said the possibility of scarring/adhesions was less & that it was more common after a laparotomy. I also asked her what would be done if they find Poly Cystic Ovaries during the lap. She recommends diet & medication for PCOS & ovarian wedge resection is only for severe cases of PCOS.
- I asked her for Metformin since it can improve ovulation. She wanted me to get a Fasting Insulin test before she will consider Metformin. I have been tested for this before and it was normal but I will get it done again because it's been a while. She doesn't want me to try a new medication unless there is a real problem though I would have preferred being on Metformin & antibiotics for TEBB. :(
- I asked her about Thyroid antibodies and she had ordered the blood work for it. She said if I test positive for Thyroid Antibodies/Hashimoto's, there is nothing much that can be done other than continuing the Thyroid medication which I am already on. How does Dr.H.il.ge.rs treat Thyroid antibodies?
- I asked her about HCG and she said it was reasonable to try HCG at this point since I have already been on Progesterone for many cycles. She prescribed me 10,000 IU of HCG post peak P+3,5,7,9 & said I could get it at any regular or compounding pharmacy. How much does HCG cost & where do you all get it from?
- I forgot to ask about the selective HSG which Dr. H does during lap. Are there any other things which I need to ask?
So ladies, this is where I am now. If I am interested in going ahead with the laparoscopy, it can be done during my next cycle. I have the convenience that it can be done at a local hospital and so my insurance will likely cover everything. I will also get to know if I have endo sooner than later.
This is what is worrying me. I don't know how good my local NaPro doctor is with Endo/Adhesions. And we all know that PPVI is the best. However, it will be a few months until I can get into PPVI for a surgery & it is going to be out of network. So, we are wondering what needs to be done. It is not an easy decision! We are praying for clarity & guidance.
Any suggestions would be appreciated.