Progesterone? WWYD?

JoySeattle

I have a question that I'm hoping to get some advice/thoughts about. I often have a temp drop around 7-10dpo and my luteal phase is usually 12-14 days long. I know that 12-14 days is often still considered fine, but the temps are concerning me and I'm wondering if this could be a sign of a progesterone deficiency.

When we we ttc before, my OB said she wouldn't want me to take progesterone supps unless absolutely necessary as it could impact my other hormones (thyroid mainly since I have hypothyroidism) and I think she was implying I would wait to see an RE. My family practice doc recently said to not be concerned based on length, but we didn't talk about the temp dips. My acupuncturist said we'll do a 7dpo session to help keep it up. I haven't seen my naturopath recently or an RE at all. Since our sperm is limited and expensive, I don't want to risk a cycle where something goes wrong that could have been avoided.

Should I try to advocate for a progesterone test after insem next cycle?

Any idea how much that would be OOP?

Thanks!

JGY

Where are you in this cycle?  Is there any chance to get the 7DPO Progesterone test done this cycle before you insem next cycle?  I will look back through my bills and see if I can find what that test cost.

I FIRMLY believe that at least 2 of my insem cycles were sabotaged by the fact that I should have been on Progesterone and wasn't (my RE office didn't listen to me and insisted on testing on day 21 rather than 7DPO, which actually ended up testing me at 3DPO).

I'll check back in once I can find what I was billed.

hlke

Your charts sound a lot like C's - a drop at about 7 DPO, and it turned out her progesterone levels were low.  I realize that's very anecdotal, but I do wish we had checked sooner.

We just dealt with the bill this morning.  The lab billed $283 and our insurance's negotiated rate was $47, which is what we ended up paying.  I would definitely call a few labs and see if they have any special pricing for people who are self-pay.  I know both our alternative insemination program and our RE's office have discounts negotiated with labs for people who are OOP, so you might want to ask your OB's office if they have anything like that.

In the end though, even at full price the test is less than half a vial of sperm, and the progesterone suppositories were only $28 for two months worth.  I also think vaginal progesterone might not mess with other hormone levels as much as oral, so that's worth looking into.

Finally, we know a mom who had great luck with acupuncture to support her luteal phase, so I'd definitely be doing the 7 DPO acupuncture no matter what.

JGY

I was traveling for work when I insisted on getting this test redone, so I went to Quest Diagnostics.  The bill was $114, my insurance company's negotiated payment was $19.82, and I paid a copay of $4.96.

Hope that helps, and good luck!

BTW - my charts always had a dip or decline at day 6 or 7, but my lueteal phase was only about 10 days long. 

Two*True

My RE puts everyone (I'm sure there are some expections) on progesterone no matter what.  I think it would be worth getting a second opinion in regards to how much progesterone suppositors really would/could mess with other hormones.

JoySeattle

Thanks for responding and sharing!

So of course my intuition/panic about this last night was the result of PMS symptoms because I'm spotting this morning at 10dpo, the shortest luteal phase I've every had. Of course this would happen the cycle before we start, but I guess better now than after an insem, right?!

I've emailed my family practice doc about this, scheduled acu for tomorrow (stress-reduction!), made an appt with my naturopath for next Tuesday and a phone consult with the fertility clinic for 11/16 (too late for this cycle but it will get the ball rolling). I feel better just to have those things in the works.

I do acupuncture twice a month (CD1 and around O) when not ttc, and with ttc cycles it will be 3-4/cycle (most likely CD1, CD7, O, 7dpo).

I'm going to try to get my family practice doc, naturopath or ob/gyn to order a 7dpo progesterone test. I will call a few labs to get quotes on prices I'm assuming it won't be covered and if it is then that's great. 

 

hlke

Lots of times diagnostic testing is covered, even if you have no infertility benefit.

Also, try not to worry about the errant 10 day luteal phase.  C's had two 10 day ones in 10 months...all her others have been 12-14 days.  In general the luteal phase isn't supposed to change all that much, but an occasional short one isn't cause for alarm.

JoySeattle

Thanks for the reassurance. Because I am a pro advocate, I have spoken with a naturopath acquaintance/colleague who also reassured me about the short luteal (especially the cycle before/while trying due to excitement/stress). I have acupucture today, a phone visit with an ob/gyn in my doc's practice (my doc's on vacay) for Monday morning at 8am, and an appt with my naturopath on Tuesday. I also found out I can get a progesterone level test for about $50 oop if it's not covered, but I'm hoping it will be. I feel much better (also now that I'm CD2 and past my PMS) and will be placing a shipping order with our bank. Deep breaths from here on out.

JoySeattle

Thanks! I have a phone appointment with an ob/gyn from my doc's practice on Monday morning to discuss the use of progesterone supplements. Hopefully, they'll be on board with writing an rx for me for suppositories.

JoySeattle

Update: My ob/gyn's colleague (mine's on vacation) just called me for a phone appt and she's writing me an rx for three rounds of progesterone to start at 5dpo. She offered labs to test my levels, but also said those are usually CD21/7dpo which is after she'd recommend supplementation on an insem cycle, so I'd rather have it on board already. We're prepared to do this for 2-3 at home cycles and then make a new plan with an RE if we get to that point.