Update on the nurse saga and another question

LO95

So after not getting a call back DH called again and we got another call from a different nurse.  She was friendlier and said that for the last six months my doctor has stopped people from taking progesterone if he likes what he sees on the initial ultrasound in terms of lining.  She then said that there is some small risk of birth defects in boys, but that I would probably be okay to just take 200 mg of Prometrium per day if it makes me comfortable but that I will definitely have to stop by 8 weeks.

I am still confused because this office is the only office I've heard of taking  that stance. Every other thing I've ever read in any literature discusses the continued use of progesterone until close to the end of the first tri.  But okay, I'll play along that research is changing.  That said, the birth defect comment just rattles me.  Everything I've researched suggests that Prometrium is safe in the first tri- with an emphasis on Prometrium being safe because it is a natural progesterone instead of synthetic.  But when I double-checked this with my pharmacist today she read the label to me saying something about how it's synthetic because it comes from plant extract but mimics progesterone from the ovaries.  (If it makes a difference I'm on generic...)

So...I'm 7w1d. God willing I will get to 8 1/2 week u/s next week, things will be perfect and I can get back to my regular OB.  But what do you make of this birth defect comment?  Do you ignore that comment?   I am pretty sure so many women on this forum have done promethium (brand or generic otherwise) and not had complaints.   But when it's said that way it makes me second-guess everything.

beachy6

Ignore it. Everyone I know who has done IVF has been on progesterone much longer than 8 weeks. I was on until 12, started spotting and was put back on until 24 weeks. I literally just came off of it a little over a week ago. My baby is just fine.

I was doing the PIO and suppositories through 9 weeks. At 9 weeks, I went down to just the suppositories. Because of the IVF, you aren't making your own progesterone so you need the support from the meds. If I were you, I'd just refill my script and take it through 1st tri. I also noticed that your siggy said you have endo? I've read multiple studies that say women with endo need progesterone support longer because of the hormonal imbalance caused from the endo. So, I was fine with being on it longer!

Sometimes you have to do what your heart and head tell you to do and if your feel like your doctor is so different than what others are doing, go with your own gut. The progesterone won't hurt your baby and if it gives you some comfort, stay on it.

LO95

beachy6 said:

Ignore it. Everyone I know who has done IVF has been on progesterone much longer than 8 weeks. I was on until 12, started spotting and was put back on until 24 weeks. I literally just came off of it a little over a week ago. My baby is just fine.

I was doing the PIO and suppositories through 9 weeks. At 9 weeks, I went down to just the suppositories. Because of the IVF, you aren't making your own progesterone so you need the support from the meds. If I were you, I'd just refill my script and take it through 1st tri. I also noticed that your siggy said you have endo? I've read multiple studies that say women with endo need progesterone support longer because of the hormonal imbalance caused from the endo. So, I was fine with being on it longer!

Sometimes you have to do what your heart and head tell you to do and if your feel like your doctor is so different than what others are doing, go with your own gut. The progesterone won't hurt your baby and if it gives you some comfort, stay on it.

beachy6 Out of curiosity, what dose were you on?

southernyankeegirl

It sounds like he is sort of conducting his own clinical study with his patients to see if progesterone support is necessary or not after 6.5 weeks. I can see why it's worth questioning, but I would rather follow standard procedure then be part of an experimental group.

I know plenty of women who have very healthy babies with progesterone support, and none of the women who I know who have gone through fertility treatment and had babies have birth defects (obviously not saying that fertility babies are less likely to have birth defects, but I don't believe they're more likely based on progesterone support).

LO95

That's my feeling too.  I feel like I'd rather just do what everyone else seems to be doing. 

Hmmm... Well, hopefully 200 mg is enough.  I've had two different nurses tell me that now, but again, same clinic so perhaps that their new protocol.  Who knows.

Milagros315

FWIW, it is standard practice at my clinic to stop progesterone supplements around week 8. I stopped between 8 weeks and 9 weeks because my doctor was on vacation and I didn't have my second ultrasound until then. Everything turned out fine for me.

Some of the drugs used during IVF inhibit progesterone production, but I don't think that means that your body doesn't produce any. When they checked my progesterone level with my first beta, it was over 300. I've heard that Crinone does not effect the P4 level in a blood test. If that's true, then my body was producing plenty of progesterone on its own. I also have endo, so it seems like that didn't cause any issues for me.

Canuck13

My clinic also requires progesterone support only until 8 weeks, which for me is this week. I'm a little nervous now after reading about so many ladies staying on longer, but my clinic is well respected and has good success rates so I feel I should probably just follow their instructions. When I went for my u/s last week the nurse asked how much Crinone I had left and I told her I just opened a new box so she said, "ok just finish that box then" which will take me to about 8.5 weeks.

LO95

Canuck13Milagros315  I still can't figure out why he'd risk stopping me at 6.5 weeks so I'm still taking the one 200mg until my next appointment...

Canuck13

I take 2 Crinone applications per day, one in morning and one at night.

Milagros315

I think I was only using Crinone once a day. 

You were high risk for OHSS, correct? Have they mentioned whether you still have a bunch of follicular cysts? I wonder if their decision to stop earlier has anything to do with that. If they believe that you have enough cysts producing progesterone on their own, it might make sense to stop adding more, especially if it's a synthetic supplement. That's just a guess and I don't even know if it's a reasonable guess.

LO95

@milagros315 Good question.  I was a high-risk OHSS because of my BMI/AMH, but didn't get close to it with my E2 levels before retrieval. As for follicles, hmm... He didn't say.  Do you know if the follicles are left when they retrieve the eggs?  That's part of why I was freaking out when  they wanted to stop me cold turkey.  One of the sites I've read had a doctor saying that follicles are often taken (or damaged? I forget) when they retrieve the eggs and that's why he wants people on a supplement through first tri.  Either way, it makes me feel better to hear that you're on something once a day.  You've been my "role model" on TB.

Milagros315

Mine were definitely not taken. My ovaries were covered in cysts as late as my 12 week ultrasound. I was on strict activity restrictions until after 9 weeks because of this. I have no idea if they were producing progesterone, I just know that my levels were very high and this should not have been related to the Crinone.

I'm glad that I can help! I completely understand why you're concerned and I absolutely believe that your nurses and doctor should have done a better job of explaining to you what was going on and why. You should do whatever you feel most comfortable with, I just wanted to share that my clinic also stops supplements than earlier than what I often see on TB!

pblge

I decided to stay on my 0.5 ml for the time being, and I'm 9+2. I need to figure out when my next appt is so that I can request another test. I'm not going to start weaning off this low dose unless I know my levels will be checked again. I feel like I didn't have a lot of a cushion from my last test.

This is hard.

hopeby2015

I was on prometrium until week 14. Started weaning off at week 12. I was also taking PIO until week 13. Started weaning off at week 12, I believe. I think they left me on a little longer than most places but my P4 levels were pretty low. I agree with pp, do what makes you feel comfortable but if it was me, I'd rather stay on em until at least week 10. It's just better safe than sorry. Also, from everything I've read, you should never just stop cold turkey with progestrone. You should be weaned off it. But maybe you were on a lower dosage?

Good luck!