u/BlueWaterGirl

I have PCOS and can't get pregnant without intervention anyway, but I was planning on finally doing it after optimizing my health. Now I might not ever be able to do it because I'm on Cosentyx and the American College of Rheumatology is still using old guidelines. EULAR has updated their guidelines, but I was basically told today to move to Europe when I mentioned it.

My rheumatology NP gave me two choices after she talked to their speciality pharmacy, we follow the dermatology guidelines, which say to stop Cosentyx 5 months before even trying, or follow the rheumatology ones that says I can stay on it until I become pregnant. You'd think the University of Kentucky would be willing to look at the newer research instead of just going with outdated guidelines.

My PsA is pretty severe and doesn't just affect my joints. When I'm unmedicated, it affects my low back/SI joints, my hips, my pelvic floor gets so bad that I can't use the bathroom, and my burning belly pain comes back that makes me feel suicidal. I can't live like that, especially if I were to get pregnant. Protecting the mother's health and stability is the single best way to protect a pregnancy, and that's how EULAR looks at it, especially when it comes to someone with moderate to severe disease that might not be able to take anything else. If a patient needs the drug to stay stable, the guideline supports keeping them on it, because inflammation can affect a pregnancy. But I live in the US and no one seems to care.

I was offered Cimzia but I'm afraid to switch to it since I had scary side effects on Humira (dysautonomia, SVT, chest pain, etc) and they took almost a year after stopping Humira to clear up. Also, who's to say if Cimzia will even work? So I get pregnant, go through the whole process of switching to it, and then it doesn't work? Then what? And no one can absolutely say that my condition will get better when pregnant because everyone is different. Cosentyx has been amazing for me and I don't want to give it up if it's working. This is the first medication I've found to fully work and that doesn't give me weird side effects. Enbrel never worked, Humira worked great but caused scary side effects, Tremfya only half worked and did nothing for my SI joints at all, my pelvic problems got so much worse on it. She said if I can't do Cimzia then my only other options are Hydroxychloroquine and Sulfasalazine, which neither have ever been helpful for me.

They put a referral in to maternal fetal medicine to see if they can help, usually they have more data on stuff like this. I don't get it though, some Rheumatology offices in this country seem to be fine with leaving someone on Cosentyx during pregnancy and usually have them stop at 38 weeks so the baby doesn't have Cosentyx in their system once they're born and some places seem to be super rigid. I wish everyone was on the same page when it came to this. Hopefully MFM can be helpful and will be able to write a directive for my complex case.

It hurts because the ACR seems to treat women like a incubator that can be in pain for months, but EULAR actually looks at us like human beings. I don't know what to do, I'm already 38 and feel like my window is closing as it is, but now I need to deal with this stuff on top of it. I'm so scared to be in pain if I get pregnant, I remember that lower belly burning and low back pain, it was absolutely horrible. I can't stop crying because I don't want to go back to that, but I don't want to give up wanting to be be pregnant either.

I'm overwhelmed and sorry for even making this post. I still need to see what MFM will say and do, usually they can get past stuff like that. It's just the fact that I need to do anything of this has me upset. I wish I never had PsA, I wish I could naturally get pregnant and not have to deal with this horrible condition.

I haven't even began much of my journey yet because my OB went MIA. I saw her early April and she said we could do monitored cycles, explained the process, everything. She recommended my husband get a SA first, which he did a couple weeks ago and he's fine. I tried sending a message back to her almost a week ago and I didn't get a reply until yesterday from a nurse saying they were forwarding the message. That's a long time to me and makes me feel like it's going to be like that during cycles when communication should be the top priority.

I just don't know if going straight to a RE is the right course of action yet. I just want monitored cycles of Letrozole right now, not IUI or IVF. I feel like I read about people switching to an RE after trying with their OB for awhile, but mine seemed to disappear before we could even start anything.

Did anyone just go straight to an RE instead of sticking with their OB for awhile?

I have PCOS and I don't ovulate at all. My OBGYN is out of UK and she's wonderful, but the office is so busy and I feel like I'm falling through the cracks. I'm wanting to start monitored cycles in June or at least have some kind of plan set up. I saw her in early April and it sounded promising, but now it's seems be super hard to get ahold of anyone to set anything up or answer questions. She's booked up for over a year and I got lucky just to get that last appointment with her.

If I try going anywhere else, where do I go? I know IRH in Cincinnati is super recommended, but I'm not sure if they'll take my insurance. I have ChampVA, which doesn't cover anything like IUI or IVF, but will cover ovulation induction medication, ultrasounds, and the bloodwork I'll need. That's why I thought it would be best to go to my OB, but I feel like it's taking awhile and I'm getting super anxious about it. I want to stick with where I'm at, but I feel like I should have a backup plan.

Original post - https://www.reddit.com/r/TTC_PCOS/s/Vyf5XzbrdD

I know I was told that seeing the actual numbers was better, so my OBGYNs office finally gave me the report. I've posted a imgur link to the redacted report in the comments, but I'll share the numbers here too.

It shows 111.1M/mL concentration, total sperm count is 222.20Million, and total motility is 62%, and his morphology is 3% instead of 4%.

We should have probably waited longer after his colonoscopy for him to get tested, because I think that's how the gelatinous material happened due to dehydration. But 3% doesn't seem bad, considering he has a fine count. So I'm not sure why my obgyn is being picky.

I'd like to start monitored cycles in June and I left her a reply on Friday about it, but today the only reply back I got was the report from a nurse. They said they shared my message with my doctor to see if she had any more recommendations. But I don't want recommendations, I want a clear timeline of when this is all supposed to take place, especially since his numbers look fine. I'm anxious about this, because my doctor is booked till next year, but I'm sure she can order everything without needing to see me again (we saw each other in April). I'm just anxious that we're never going to be able to start.

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My husband and I decided to start our fertility journey this year. My OBGYN, which is a highly recommend one out of a teaching hospital, suggested my husband have a semen analysis done at a fertility clinic they're linked with to make sure we're just going to be dealing with my PCOS and the fact I don't ovulate.

We should have probably waited longer to do the SA because my husband had a colonoscopy on Friday and then the SA on the following Tuesday, where he was still dealing with some dehydration. I ended up getting a message from my doctor's office today about the results, but I'd much rather see the actual report. I've asked if they can give it to me for my records, but we'll see about that. I've copy and pasted the message below, but it doesn't say much other than an abnormal consistency and a higher abnormal morphology.

I guess I'm wondering if we can still move forward with monitored Letrozole cycles. I've done some reading and it seems like morphology isn't that important if count and motility is fine, which I'm guessing it is because there was no mention of it. My husband wants to start the supplement they suggested right away, but I'd like to start a cycle or two before we do another semen analysis, since I know the biggest problem is my PCOS.

Here's the message I was sent, which seems pretty vague and mild, but I'm sure my doctor would have mentioned if anything more serious was found. I just wish I had the actual numbers, but hopefully they'll send it over next week.

"I have received the results from the semen analysis- it did show a few abnormalities. First, there was an abnormal consistency to the semen ("gelatinous material") and also the morphology (physical appearance or shape) of the semen was abnormal in a higher percentage of the sperm. When we see these mild changes, we typically recommend a repeat in about 8 weeks to confirm. Sperm can fluctuate a lot over time.

I do recommend the following supplement for sperm quality/health: Fairhaven Health Fertilaid for Men"

My OBGYN got my husbands semen analysis and all the message says is that the consistency was off and there was some abnormal morphology in a higher percentage of the sperm. The message doesn't really go into much detail, so I've asked for the report so I can see it myself. We should have postponed the analysis because my husband had a colonoscopy a few days before and was still dehydrated when he did the test, so that could explain the consistency problem.

I'm just wondering if this would stop us from proceeding with monitored cycles of Letrozole? We haven't even started them yet because I've been waiting to get iron infusions and those won't be done till June anyway. His results don't sound like a big problem and they did say it was mild. Luckily it doesn't sound like he has a bad count or motility though, which was something I was more worried about. I just rather not pay $275 for another semen analysis if it's a mild problem that might be fixed with a supplement (which I just bought) and hydration. I did go ahead and send them a message back asking if we can just proceed with the cycles in June after my infusions. I already know I don't ovulate, I don't even have bleeding unless I take Prometrium. My husband has a child from a previous relationship, but that's been 12 years ago now. I've never become pregnant, even before my husband.

Were your partners results similar and did you still get pregnant with monitored Letrozole cycles?

Here is the message that was sent...

"I have received the results from the semen analysis- it did show a few abnormalities. First, there was an abnormal consistency to the semen ("gelatinous material") and also the morphology (physical appearance or shape) of the semen was abnormal in a higher percentage of the sperm. When we see these mild changes, we typically recommend a repeat in about 8 weeks to confirm. Sperm can fluctuate a lot over time.

I do recommend the following supplement for sperm quality/health: Fairhaven Health Fertilaid for Men"

Original link - https://www.reddit.com/r/Anemic/s/Hp2lwD82kD

After my endocrinologist referred me to a hemotologist and me getting the appointment pretty quickly, the hemotologist told me she wants me to do iron infusions before I could even say anything to her. So we're going to do 4 of them starting this Monday and then she wants me to test the week of June 15th, which I know will show a spike. She also recommended I take Proferrin afterwards because it will bypass the PPI, which she agreed was preventing me from absorbing correctly. My ferritin isn't super low, but low enough for me to have symptoms. She said they may or not may make me feel better, but it's worth a try.

I feel like things have went pretty quickly once I was listened to. I also decided to switch to a different PCP, which didn't only have to do with her not listening to me about my ferritin.