When will they test?

jcohen721 · March 2012

So I have lost 2 pregnancies very early on. They were considered chemical pregnancies. My doctor says she has to wait until I have a 3rd to do any kind of testing other than the regular prenatal stuff they do before you even start trying.

When I was taking a run outside today I ran into an old friend from college who is pregnant. We got talking and she told me she had 1 chemical before this pregnancy and her doctor did a progesterone test and it came back very low from where it should be so she got put on a suppliment and now she is 13 weeks pregnant. It got me thinking that I should call my doctor and ask about this test and see if they would do it since hers did it without her asking and after only 1.

The nurse who called me back (because my doctor never calls back) said insurance probably won't pay for any testing because although we have been trying for over a year we have been "successful" even though none of the pregnancies have lasted. Does this make sense? She also said that they don't usually test progesterone and that if I wanted that test done I would have to go to a specialist which my insurance doesn't cover. Does that make sense? I didn't realize progesterone was a difficult thing to test and I am confused becauase my friends obgyn did it for her.

The nurse is going to talk to my doctor, but I am just so frustrated. I really do like my doctor a lot, but I just can't imagine having to go through this again only to find out it was something they could have tested for and treated earlier.

caliblondieus · March 2012

Testing after 3 or more used to be standard, but frankly, that's old school now. If you look at recent studies (I'm sorry, the one I usually refer to as at home and I don't have access to it) they have discovered that they are just as likely to find the same issues at pregnancy loss #2 as they would at #3 so many are moving to testing after pregnancy loss #2. You may even find this recommendation on the American Pregnancy Association website and be able to refer to it when talking to your doctor.

However...the progesterone issue is still very controversial and I think you should get a clearer understanding of what progesterone does in fertility before talking to your doctor (see my information below this). I've been on progesterone a long time and I just had a convo about it with my IVF doctor yesterday. There is still very little scientific evidence that this is what causes miscarriages. Many docs will just prescribe the supplements because studies have also shown progesterone not to harm the fetus so they figure why not just throw it at you? My RE actually had the nerve to say that she just prescribes it because it makes her patients "feel like they are in control of something even when they're not."

You might have to push your insurance to be tested. This is standard. They are in the business of denying you. You need to line your ducks up in a row and come back at them. Pregnancy is not just getting pregnant, it's about STAYING pregnant and having a live birth so what that nurse told you is BS. I can tell you, many of us on here have blown by the nurses because they don't know s*** and they all tell you something different. If you can't get your doctor to return a call, find another doctor. You have to be your own advocate. I know it's hard when you're in the throes of grief from loss but you're the only one in your life who cares ONLY about you having a baby. Everyone else (like the doc's office) cares about many other people that want to have a baby. Catch my drift?

Last but not least, here is a mini education on the role progesterone plays in fertility. Progesterone has a couple of different ways to show up and potentially be a problem. First is getting your progesterone checked on a non-pregnancy cycle at CD21. This is approx 7 days after ovulation and checks to see if you ovulated and how strongly. This can be the first sign that there is an issue. Second is how long your luteal phase is. Do you know how long it is? Anything under 10 days is usually accepted as Luteal Phase Defect (LPD) and is reason to give a progesterone supplement starting about 1 day after O. Last but not least is getting your progesterone checked as soon as you get that BFP. And if it's low, checking you regularly during the first 12 weeks or pregnancy. At about 12 weeks, the placenta takes over in the development of progesterone and you no longer need the supplements.

Hope that helps! good luck with your doctor.

Krista

jcohen721 · March 2012

Thank you Thank you Thank you!!!!! This is just what I needed. I am going to make my doctor talk to me and if she won't I will call my friends doctor! You rock! Thanks!

holly321 · March 2012

caliblondieus:
Testing after 3 or more used to be standard, but frankly, that's old school now. If you look at recent studies (I'm sorry, the one I usually refer to as at home and I don't have access to it) they have discovered that they are just as likely to find the same issues at pregnancy loss #2 as they would at #3 so many are moving to testing after pregnancy loss #2. You may even find this recommendation on the American Pregnancy Association website and be able to refer to it when talking to your doctor.
However...the progesterone issue is still very controversial and I think you should get a clearer understanding of what progesterone does in fertility before talking to your doctor (see my information below this). I've been on progesterone a long time and I just had a convo about it with my IVF doctor yesterday. There is still very little scientific evidence that this is what causes miscarriages. Many docs will just prescribe the supplements because studies have also shown progesterone not to harm the fetus so they figure why not just throw it at you? My RE actually had the nerve to say that she just prescribes it because it makes her patients "feel like they are in control of something even when they're not."
You might have to push your insurance to be tested. This is standard. They are in the business of denying you. You need to line your ducks up in a row and come back at them. Pregnancy is not just getting pregnant, it's about STAYING pregnant and having a live birth so what that nurse told you is BS. I can tell you, many of us on here have blown by the nurses because they don't know s*** and they all tell you something different. If you can't get your doctor to return a call, find another doctor. You have to be your own advocate. I know it's hard when you're in the throes of grief from loss but you're the only one in your life who cares ONLY about you having a baby. Everyone else (like the doc's office) cares about many other people that want to have a baby. Catch my drift?
Last but not least, here is a mini education on the role progesterone plays in fertility. Progesterone has a couple of different ways to show up and potentially be a problem. First is getting your progesterone checked on a non-pregnancy cycle at CD21. This is approx 7 days after ovulation and checks to see if you ovulated and how strongly. This can be the first sign that there is an issue. Second is how long your luteal phase is. Do you know how long it is? Anything under 10 days is usually accepted as Luteal Phase Defect (LPD) and is reason to give a progesterone supplement starting about 1 day after O. Last but not least is getting your progesterone checked as soon as you get that BFP. And if it's low, checking you regularly during the first 12 weeks or pregnancy. At about 12 weeks, the placenta takes over in the development of progesterone and you no longer need the supplements.
Hope that helps! good luck with your doctor.
Krista

I just wanted to add this is what I was told too.

Also, with my dr. they consider first miscarriage unfortunate, but something that happens. I was told there would be testing if it occurred again. But, I did miscarry later in pregnancy than most do.

britny08 · March 2012

I think each doctor is different on the issue of when they will test to see if there is anything physically or genetically wrong that is affecting your ability to go full term in a pregnancy. When I was told I was going to have a miscarriage I was told my P4 level was extremely low. It was at a 1.5 when it should have been an 11. My doctor did blood work to test my beta HCG level and my P4 level. I had to get more blood work taken two days later to see if they had increased or decreased. This was my first miscarriage and we asked the doctor what happens if this happens again. He said the rule of thumb used to be women had to experience 3 miscarriage before testing was done. But that seem torturous and inhumane so most doctors now only suggest 2 miscarriage to occur before testing. And the main reason they wait until 2 is because the tests can be stressful, expensive and hard on the body for some. He did say if and WHEN(I saw when because I have faith that I will one day) I am able to get pregnant again they will immediately keep a close eye on my P4 and begin to give me a supplement if there is any indication that it might be low. He made it clear that that is not my reason for my miscarriage (since we don't know the reason) but supplementing next time could help narrow down the options if i do miscarry again!

MissRachel621 · March 2012

I recently had my second m/c, and although we were told that the vast majority are just by chance, we are having some testing done. A routine panel for me to check blood levels of EVerything, and chromosomal / genetic testing for both my husband and myself. I can't get my blood drawn for 2 more weeks, to let my levels get back to normal, but we should have results 4-6 weeks after that. I'll definitely share the info when we get it, in case it helps anyone else.

jcohen721 · March 2012

Thanks everyone for your responses. It really helped. I did talk to my doctor and I have an apt. scheduled for June 18th. She wants to see if we can get pregnant again, and if it doesn't happen by June we will begin testing. It felt good to stick up for myself. Thanks to all of you

britny08 · March 2012

So glad to hear!! I caught myself doing research on laws in different states on when testing can be done!! I felt my heart aching for you knowing that my doctor in TN told me up front that testing would be done if this happened again and you were being told you needed to wait and see if a third m/c was to occur!!! make sure to keep us updated!! Praying for a BFP test before then if it's meant to be!!

MomLovesWine · March 2012

According to my OB, it used to be standard to wait until 3, but now many OBs feel that emotionally, it's better to start testing after 2 vs. waiting for 3 and risking yet another miscarriage.

I have had a chemical pregnancy before DS, and two first trimester losses since him and we're starting testing next month. I would push for testing if you're having a hard time moving on to TTC again.

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