OB vs Specialist Question (Ticker warning)

buckeyebride22

I finally talked to my OB since we are TTC again.  He said he wants to check for clotting issues and what not.  He said he'd also start me on Progesterone suppositories as soon as I get a BFP.  I don't feel comfortable with this.  Isn't there a way to check progesterone levels?  I don't want to take it if I don't need to or if it is low shouldn't I be taking it before a BFP?  I know he's the doctor....but he will never admit that he doesn't have enough experience or knowledge in an area (I work with him)  If you have had multiple losses, do you see a specialist or your regular OB?  TIA

egsquared

I've had multiple losses and see an RE. I also take progesterone to correct a short LP. I start taking it at 3dpo. Could you make yourself an appointment with a specialist to get a second opinion?

DebateThis

In the grand scheme of things, progesterone supplementation isn't a big deal and is probably something that any OB could prescribe and I wouldn't really bat an eye at it. It's sort of a "can't hurt, might help" approach to fertility treatment.

That being said - his method of prescribing you progesterone seems a bit uninformed (at best) and in general I don't trust OB's to run infertility/RPL testing correctly. Progesterone testing must be done at 7dpo to ensure accurate results and it absolutely should be done prior to supplementation, as should the rest of the recurrent pregnancy loss testing.

Along those same lines, clotting disorder testing is probably a good idea, but there is a whole lot more to RPL testing than just clotting disorders and progesterone, and it sounds like he doesn't know too much about either and really has limited knowledge about these things.

My standard response is to always, always see a specialist and not an OB when you get into infertility/RPL. OB's might be good at taking care of you when you are pregnant. They are not, however, in the business of getting you or keeping you pregnant and a lot of the time they do more harm than good.

buckeyebride22

That's kind of what I was thinking.  How did you pick your specialist?  I live in a small town, so I'd have to drive at least 40 minutes to find on.

DebateThis

buckeyebride22:

That's kind of what I was thinking.  How did you pick your specialist?  I live in a small town, so I'd have to drive at least 40 minutes to find on.

To put it bluntly, welcome to infertility. It sucks, but many people travel far longer than 40 minutes to see a specialist. There are a couple regulars on 3T and IF who routinely have to go 2-3 hours in each direction. One drives from Louisiana over to Houston (4 hours) to see her IVF doc. 

And, from someone who has gone through hell with an RE because I picked the one closest to my house - don't just pick one bc he or she is the closest. Check out SART data and reviews online. Get recommendations. Talk to people.  Good luck.

RedPhoenix625

I was already seeing an RE before my losses due to IF, but it is pretty standard to see an RE for RPL without IF as well.

You may have said this already in previous post, but I have a poor memory.  Can you give me the CliffNotes on your history, and why your OB wants to put you on progesterone in the first place?  Have you had any additional tests done to investigate possible causes of your losses (aside from clotting)?  More information will help us to give you better advice based on our experiences.

Still - yes, I would think your doctor would want to check your progesterone via b/w before just putting you on progesterone.  Even with IF and 5 losses, my RE only puts me on progesterone if b/w shows that it is low.

ETA

katharine25

DebateThis:

buckeyebride22:

That's kind of what I was thinking.  How did you pick your specialist?  I live in a small town, so I'd have to drive at least 40 minutes to find on.

To put it bluntly, welcome to infertility. It sucks, but many people travel far longer than 40 minutes to see a specialist. There are a couple regulars on 3T and IF who routinely have to go 2-3 hours in each direction. One drives from Louisiana over to Houston (4 hours) to see her IVF doc. 

True story. I work in a MAJOR metropolitan area and I still travel and additional hour from work (which means 3 hours from home) to go to my RE  -- because he tested everything I wanted him to. 

Definitely research before you pick an RE. Also research recurrent loss so you know what you need to have tested, as that the doctor you decide on will run those tests. 

The TTCAL blog is a great place to start, there's a decent list of  RPL tests on it so you know what to expect (or request)