Big News and a Tale of Two Countries

I have an announcement. It’s a big one. In fact, it’s HUGE. So prepare yourselves, sit securely in your seat, this is going to Blow. You. Away.

I have started charting.

Um, so maybe it’s not that big an announcement. And my chart doesn’t look like much yet. But I’ve never done it before, and to be honest I didn’t think I ever would. It’s just not that big a deal in the Land Down Under and in my experience it’s not common for TTCers to take temperatures, chart cervical mucus and analyse graphs. In the end I made the decision to chart because the inactivity of my last 2WW almost drove me crazy, and I hope that the small daily act of charting might give me a sanity-saving – although totally false – sense of control. 

This difference between Australia and the US made me think. One of the things that I have noticed from all my blog reading is the difference in fertility treatments between Australia and the US.  The drugs are much the same, and some of the protocols are similar, but the process itself is totally different.

To start with, unless they have specific gynaecological issues, most childless young women here do not have an Obs/Gynae. They see their GP for pap smears and the like. So right from the start of the IF process we are referred to a Fertility Specialist.

And that’s another thing. In the Land Down Under our IF docs are trained O&Gs who have sub-specialised in fertility. In theory it is possible to be a fertility specialist by training as a physician, specialising in Endocrinology, and then sub-specialising in reproductive endocrinology, but I don’t personally know any doctors who have done that.

Then there is the amount of monitoring throughout a cycle. I’m doing 4 cycles of Clomid, with no monitoring except for one blood test on CD23 (LH, β-hCG, Progesterone). This suits me, although sometimes I do wish there was more monitoring just to give me a sense of purpose! I’m sure I would get more monitoring if I was doing injectables, but even so… you gals in the US sure do have to undergo a lot of blood tests and ultrasounds!

In terms of IVF, the level of monitoring seems more similar. But the big difference is that in Australia and New Zealand it is uncommon for a FS to transfer more than one embryo. They will only do it if, after lots of discussion, the couple absolutely insists. While it is common for REs in the US to routinely transfer two or even three or four embryos, any FS who routinely transferred two embryos would be considered a renegade, and to be honest would probably find it difficult to get a job in any major clinic. They are absolutely prohibited from transferring more than two embryos. Fertility clinics consider multiple births a blight on their reputation, and the aim is always one healthy baby and one healthy mother. Which system is best is a matter of opinion. Based on some (admittedly haphazard) research our rates of pregnancy per IVF cycle are lower (around 30% per egg retrieval), but so are the rates of complications. There are two main IVF clinics in Melbourne, and they differ slightly. The pregnancy rates and hyperstimulation stats are roughly equivalent, but the clinic my FS is linked to base their model of care on day 2 transfers and do less monitoring than the other clinic.

To be honest, despite the fact that I like to feel proactive, the relatively non-invasive treatment plan suits me. I work at a job that is almost totally inflexible and getting time off for appointments can be tricky. Doctor’s appointments play havoc with my psyche because although I usually feel reassured after one, I feel uniformly anxious beforehand. If we need to move on to injectables or IVF I’ll do what it takes to make it work, but in the meantime I’m enjoying the sense of normality that the system here provides. That’s one of the reasons that I chose to see a FS linked to my particular clinic – the less disruption to my life the better!



Filed under Charting, Doctors, Infertility

8 responses to “Big News and a Tale of Two Countries

  1. Yes,there are many difference between our (Aussie) system and the US and some of the things I have found very hard to stomach recently. Last years changes were the last straw for me, I get angry thinking about it. I hate that they have significantly reduced funding, we were one of the most affordable countries for IVF previously but now, not so much. Oh and the police checks – don’t even get me started on the discrimination of this little chestnut. Sorry, will get off my soapbox now.

    Good luck with your charting – I did it for one month and then found out about JourneyMan’s not great test results and then gave it up.

    Happy ICLW

  2. Interesting to hear abt the LDU vs US systems.

    As for charting, I got into it last month. I heart it! While not a perfect science, it did accurately pinpoint ovulation and once I saw my temps falling on CD12, I knew my period was a ‘comin. It lets you down a little easier than a BFN. But NO LETDOWNS for you this month! Hoping for a beautiful chart and hight temps through the 2ww! 🙂

  3. Yay for charting! For me, charting was a huge step in figuring out what was “wrong” with me. I didn’t realize for the first four months I was TTC that I had any trouble ovulating. At that point we were very optimistic that it would “just happen” for us.

    Charting gave me such insight into my cycles– if and when I was ovulating and what I could expect towards the end of my cycle. As Egg said, seeing temps going down was much easier than a BFN. Plus, charting my temps every day made me feel like I was actually DOING something for my fertility.

  4. I’m a charter, too, and now that I’ve started, I can’t stop. When I started seeing my RE he told me I didn’t need to chart anymore and I was like “Phew!”, but I soon realized that I missed it too much and so I started again. It’s so comforting having that daily reminder that I’m doing something and that I know what my body is doing!

    It does sound like things are different over there. I personally like the monitoring for all the same reasons I like charting – I feel more secure knowing whats going on “down there.” But it adds stress, too, if things aren’t going exactly as you want them to!

  5. Interesting about the similarities/differences between the US and Australia/New Zealand.
    I still don’t chart. I am simply too lazy and know I will forget. I am really anal (I can admit it!), so I think I’d just get annoyed with myself and over analyze it. Lots of people do it with great success – it certainly can’t hurt!

  6. Red

    Good luck charting. I have never done it, but then my problems lie in the pregnancy itself, never in getting there.

    I feel the frustration at times of just having a GP as my point of contact. She is wonderful, but has just as much knowledge about the common cold as she does miscarriage.

  7. Al

    Very interesting about all the differences between the US and Australia. When OBs give out Clomid, they also don’t do any monitoring at all generally except for the blood progesterone test 7 days past ovulation. Before TTC, I went to my GP for paps, etc, just b/c it was easier since that’s who took care of my thyroid test, etc.

    I hope you like charting – it’s a pain, but I like to have the positive feedback and the heads up when my period is coming.

    Good luck this cycle!

  8. Jin

    Honestly, outside of the IF community, charting isn’t a big thing here. Seriously. In the real world, I think most women know MAYBE one person besides themselves who chart. A lot of women think it’s “doing too much” or they just dont want to know about their cycles. They only start trying if they end up at that one year TTC mark and their doctors are having them chart to see if they’re ovulating and stuff.

    I went 2 cycles of clomid without monitoring or bloodwork when I was with my gyno’s office. When I went to an RE that’s when the monitoring started. It sucks, but at least I know how my body is responding to it.