Questions for Dr. Mottla

Well, I wasn't able to go in for my follow-up appointment with Dr. Mottla today because I can't keep taking so much time off from work. So, I sent an email to the morning nurse, Joyce, to see if she could have some questions answered for me. Here's the email I sent to her and her response:

Hi Joyce,

I just completed my my first IUI cycle and unfortunately, I did not get pregnant. I understand that the odds for a successful IUI (let alone the first IUI) are pretty slim, but I just had some general questions about how I responded to the first protocol. I was hoping you could help me with some of the questions I had:

1. How was my response to my first protocol? I understand that I did "well" and had two nice-sized follices (18 and 21) at time of trigger (CD8). I was a bit concerned that I stimmed too fast and because my e2 on CD8 was only 417. Did I stim too early and too quickly? Isn't it better for the follies to grow slower and steadier?

2. My husband's sperm count was 31 million pre-wash, yet it was only 4 million post-wash. I have heard that we typically lose about 1/2 of the sperm between pre- and post- washing. Why did my husband's numbers decline by such a large amount? How did the other factors play into the effectiveness (morphology, motility, etc.) of this IUI?

3. I was a bit concerned about the timing of my IUI (as probably all first time IUI-ers are). I'm sure SG has things timed to a science and I had nothing to worry about, but I most definitely was stressed about it on the day of my IUI. My IUI was 38 hours post-trigger. Isn't that too late? I understand that some offices perform their IUIs 24 hours post-trigger or do back-to-back IUIs.

4. Here's another timing question. I had my IUI at 11:45 am. I dropped my husband's sample off at the office at 9:00 am. Could the amount of time between the drop-off to the insemination have been too long? I know of other clinics who perform the IUI within one hour after the drop-off. Could the time lapse have been the reason for the poor post-wash sperm count?

5. Why was I prescribed the prometrium suppositories? Is that a standard prescription for every SG patient who has undergone an IUI or IVF or was there a personal reason for concern for me to take it? Does SG prescribe the PIO shots for anyone undergoing IUI or IVF treatment anymore?

5. Does my insurance cover IVF? We have been struggling to conceive since April of 2007.

6. I have not yet received my SMA genetic testing results. Have you received these results?

Sorry for all of the questions - I'm trying not to be too high maintenance. :) I just am someone who likes to have my treatment specifics and know where I stand. I have an extremely high level of confidence and trust in Dr. Mottla - I have heard such good things about him and I know he works hard to help women get pregnant. I would just really appreciate some feedback regarding my protocols and how I am responding to them. :)

P.S. Will you also please pass along to Dr. Mottla how impressed I was with Kelly, the ultra-sound tech? She was one of the few people (other than you and Dr. Mottla) who really made me feel comfortable, informed, and at ease. When she first came into the treatment room, she actually introduced herself and stated where I was in my treatment and gave me information as to what she saw during the ultra-sound (without any prompting by me, which was a relief, as well). Her level of empathy and the brief information she provided was so comforting and helpful. It takes a very special person to care for women who are in the world of the infertiles and you, Kelly, and Dr. Mottla have the skills to successfully accomplish that and for that I am grateful.

Thanks so much for your kind help.

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Hi – I spoke with Dr. Mottla about some of your concerns. His feeling is that your questions could be better addressed face to face and he suggests that you schedule a follow up visit with him. At that time he will be happy to go through your list and answer your questions. See you soon.

Joyce

So, Shady Grove won't be able to answer my questions unless I meet with Dr. Mottla for a paid consulatation. I still don't know if I will have the time to meet with him, but I feel better knowing that he is now aware of my questions in case there really is something to be concerned about.