Starting to think my ob/gyn doesn't really know what she's talking about...

JenJen80 · 09-22-2009, 03:41 PM

As I've posted in a few other threads (sorry to repeat myself!) I finished my first round of Clomid (50mg CD3-7) on Aug 30 and went in for a P4 on 9/14. It only registered as 1.3 so apparently ovulation did not occur. But after putting yesterday's temp in FF, I got crosshairs on CD26. I was told by the nurse at my ob/gyn's office to call back on CD30 or whenever I started AF, whichever came first, to have them call in a new Clomid script. Well, today is CD30, and when I called I told them I may have O'd based on my temps. The nurse discussed what the next steps were with the doctor and called me back. She told me that I had a choice - either come in for a serum pg test today and if that's neg (and at only 5DPO, even if I *am* pg, it's likely to be -, right?!), induce AF now w/ Provera and start 100mg Clomid on CD3, or wait a few more weeks to see if I get AF or BFP before doing anything. OK, *WHY*, if I O'd, would I want to start round 2 without waiting?! I asked if I should go for another P4 to see if I O'd. Nope, she said. And this is the kicker...the nurse said that the doctor told her to tell me that if I did indeed O, it likely wasn't caused by the Clomid because CD26 is too late for it to have been that. Whaaaa...???!!! I get that as an ob/gyn she isn't an infertility doctor, but at least know the basics if you're going to try! So yeah...I think if I have to move onto round 2, that will be my last with her before moving on to round 3 and another ob/gyn and RE!

chelseabare · 09-22-2009, 03:49 PM

Provera will not force your body to have a period. Lots of women take Provera to KEEP their pregnancy because of a progesterone deficiency. Provera has some side effects yes, but lots of women do tak it in their LP.

Yes, more than likely a blood test for HCG would show negative at only 5dpo.

Lots of Ob/Gyns think charting your temp is a waste of time, and others just think everyone does it wrong. It very rare to find a dr who is in agreement with you on that. I would go ahead and do what your dr asks, but dont take the blood test into consideration if its negative. Expect a negative right now. After your Provera, and your period doesnt start the dr will give you another Prego Test anyways.

If she doesnt, then go to another dr before taking Clomid. Side effects on a fetus are dangerous if you take Clomid WHILE pregnant.

neechelle · 09-22-2009, 04:00 PM

That doctor does not elicit much confidence in me. Provera, from my understanding, causes periods when it is stopped, so that the lining begins to shed from the sudden drop in progesterone. I would say avoid the provera, because she's probably going to prescribe you enough to induce AF. I hated that about my OB, that they wanted to do a CD 21 serum progesterone check. But I didn't O on CD 14! Some months on CD 17, some on CD 31, and once on CD 36. I believe the serum progesterone test should be done 7 DPO. I would ask your dr. for a serum prog. then. Why wouldn't she? If she's concerned about what insurance will and won't pay, then remind her that it is your choice since you pay anyway in the long run. My prog. checks weren't covered and they were about $125 each.

charisse** · 09-22-2009, 04:04 PM

Hey Jen, I say just wait and see ! Your chart did have a big spike which would indicate O, and the p4 could have been done too early.
I think you are on the right track with getting a new doc.
GL, I hope this is your BFP !!

TiffanyTully · 09-22-2009, 04:52 PM

I hate my new dr. right now too... She made me poas when I havent had a period in like forever! Not to mention she had no clue what was offered to me on base or how I would get a ref. off base...she was just very clueless and made me come to the conclusion that its going to take months before im helped. With that said if you dont feel comfortable go to a new dr. who is more willing to go above and beyond for you! My old RE WAS a GOD SENT and so was his Nurse...i miss them sooo much! If anyone lives in the Tampa FL area check them out at the USF health clinic on Davis Island Dr. Silvia...oh the good ol days

~Traci~ · 09-22-2009, 04:59 PM

I would just not contact them, take an HPT @ 14DPO & then find a new OB & RE.

Good Luck!

AnotherDreamer · 09-22-2009, 05:08 PM

Gah! I would totally find a new doctor.

That sounds like my old ob/gyns office. I was with them to do a few Clomid cycles before seeing an RE, and one time the nurse told me I had Ov'ed... I asked for my P4, and she said it was 1.4 and that I should wait for AF or a BFP- yeah, I didn't Ov, so unless some miracle happened... They also told me to wait for AF on a different cycle, even though I had not Ov'ed and therefore would not be getting AF on my own... eek.

I hope that this cycle is the one for you and you won't have too... but if not, find you a new doctor, because you are wasting your time with them. As I always say, ob/gyns know about pregnancy and delivering babies- they don't know anything about getting pregnant.

JenJen80 · 09-22-2009, 05:08 PM

Quote:

Originally Posted by TiffanyTully
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

I hate my new dr. right now too... She made me poas when I havent had a period in like forever!

Oh don't you love that one?! That's one thing I can say about my current ob/gyn...at least they GET pcos. My old one (who actually diagnosed me w/ pcos so I gotta give her that...but she was always rushed and didn't spend nearly the time w/ me my current one does) - every time I went in for my annual exam and they asked when my last period was and I was like...I don't know...a really long time... They'd look at me like I had a 3rd eye and inevitably, always say "how do you know you're not pregnant?" Well DUH, read my chart!!! It *should* say that I pretty much never have one on my own!

Thanks for the input ladies. I am going to go ahead and wait out the 2 weeks before doing anything else...10 days to go...
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

wannaova · 09-22-2009, 06:48 PM

I vote you skip the OB and go straight to the RE. I wish I had done that -- esp. because the RE will monitor your clomid cycles and has extra training, knowledge and experience. Besides that, when I went in for my P4 blood draw last week, the walls of the exam room are super thin and I could hear the ultrasound heart beat of a baby and a women laughing and repeating, "that's my baby's heart! that's my baby!" A bit upsetting to me. And then the nurse came back in and before she took my blood, she asked if I had any other problems or health issues and I said, "no, aside from the fact that I can't get pregnant, I'm good." Awkward.

Anyway, good luck if you stick it out with the OB, but really consider finding an RE instead.

Samie · 09-22-2009, 08:30 PM

Quote:

Originally Posted by neechelle
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

That doctor does not elicit much confidence in me. Provera, from my understanding, causes periods when it is stopped, so that the lining begins to shed from the sudden drop in progesterone. I would say avoid the provera, because she's probably going to prescribe you enough to induce AF..

Provera is synthetic progesterone, yes it is used to induce menstruation. BUT it can also be used to supplement early pregnancy especially if low progesterone or short luteal phase is suspected. Even if you stop taking provera or prometrium and your pregnant, you won't shed your lining because at that point, the body should be producing enough prog. and HCG to sustain the pregnancy.
One thing that a lot of women do, is start progesterone supplementation 3-4 days after ovulation, and then at the end of the 2ww, get a beta done, if it's negative, progesterone is stopped, AF comes along hopefully. If its positive, the dr will make a decision whether or not for you to continue supplementing to support the pregnancy.
Clomid though is a BIG no-no during early pregnancy.
And yes, provera, prometrium, etc all say Do not take while pregnant, its a blanket CYA statement required by the FDA because in very small studies, where they have given pregnant rats or mice 1000 times the normal weighted dosage, yes, there were some birth defects. But there is absolutely no conclusive evidence that it causes the same in Humans, and prog. supplementation has been used by dr's for years.

AnotherDreamer · 09-22-2009, 08:39 PM

To the OP, if you have Ov'ed you would not need to start the Provera. You should get AF or a BFP if Ov did occur. If you did not Ov, then you would need the Provera to bring on a new cycle.

Quote:

Originally Posted by Samie
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

Provera is synthetic progesterone, yes it is used to induce menstruation. BUT it can also be used to supplement early pregnancy especially if low progesterone or short luteal phase is suspected. Even if you stop taking provera or prometrium and your pregnant, you won't shed your lining because at that point, the body should be producing enough prog. and HCG to sustain the pregnancy.
One thing that a lot of women do, is start progesterone supplementation 3-4 days after ovulation, and then at the end of the 2ww, get a beta done, if it's negative, progesterone is stopped, AF comes along hopefully. If its positive, the dr will make a decision whether or not for you to continue supplementing to support the pregnancy.
Clomid though is a BIG no-no during early pregnancy.
And yes, provera, prometrium, etc all say Do not take while pregnant, its a blanket CYA statement required by the FDA because in very small studies, where they have given pregnant rats or mice 1000 times the normal weighted dosage, yes, there were some birth defects. But there is absolutely no conclusive evidence that it causes the same in Humans, and prog. supplementation has been used by dr's for years.

Just some comments on progesterone in pregnancy-

Actually, from my understanding they don't prescribe Provera in pregnancy because it is synthetic and may cause birth defects. Only natural progesterone is prescribed in pregnancy- like in Prometrium or Crione (sp?) because they are safe.

Suddenly stopping progesterone while pregnant can cause a miscarriage, it doesn't do that to everyone, but it is still dangerous. The sudden drop is still a sudden drop, whether the body is making enough or not. And some women don't make enough, and require the supplementaion. If they stop it, they can miscarry.

duramater · 09-22-2009, 09:11 PM

What I've learned about Provera was that when it was routinely prescribed (to see if women were pregnant - if they weren't then they'd have withdrawal bleeding when it was stopped), they did see a slight increase in birth defects. The current hypothesis is that it caused fewer early miscarriages, so abnormal embryos that normally would have miscarried on their own ended up surviving and being born.

(So if your embryo is actually normal, by this hypothesis, Provera won't hurt it.)

HRkswildcat · 09-22-2009, 09:14 PM

Quote:

Originally Posted by ~Traci~
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

I would just not contact them, take an HPT @ 14DPO & then find a new OB & RE.

Good Luck!

I agree with this poster...hope you can find a new doctor!!

Samie · 09-22-2009, 10:14 PM

This is very informative on Progesterone supplementation, orally, vaginally and intra-muscular. It is somewhat hard to read for a lay person, as it was written specifically for doctors, but there is information on the effectiveness of it during early pregnancy, and the risk vs benefit to baby.
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

This is the paragraph on risks, and what the FDA concluded in 1999:
In 1999, the US Food and Drug Administration (FDA) conducted a thorough review of the relevant published scientific data, which yielded the following key findings:
􏰀 Controlled studies show no increase in congenital anomalies, including genital abnormalities in male or female infants, resulting from maternal exposure to P or 17a- hydroxyprogesterone (17-OHP) during early pregnancy.
􏰀 Analysis of the published literature relating to maternal progestogen exposure during pregnancy and virilization of the genitalia in female infants indicates that most reported cases involved high doses of progestins derived from androgens, particularly ethisterone and norethindrone.
􏰀 Most reported cases of masculinized female infants are associated with maternal exposure to methyltestoster- one, methandriol, and danazol.
The FDA concluded that class labeling for all progestogens warning of an increased risk of birth defects was inappropriate because it would apply without regard to the indication for which the drug is prescribed. The FDA also noted that use of P for luteal phase support in IVF cycles had become routine and that the agency had itself recently approved a P gel for use in infertile women under treatment with ART

Now I'm on a research kick.
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

Samie · 09-22-2009, 10:18 PM

This is from Fertility and Sterility, and is really side notes, comments from a doctor. The authors of the original article responded as well, they are specifically talking about using provera, or medroxyprogesterone acetate
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

Hope this helps.
Some dr's do prescribe provera for prog. supplementation especially if the patient has shown resistant to absorbing it from other means. I have known some dr's who start out with provera and then move to suppositories, or the oil. It is somewhat dependent on what is considered protocol in their area/practice.