HSG and Progesterone levels

MNturnsVA · October 2015

Hi ladies,

I just had a question about how all this works as I'm going to get my blood drawn today for a week post O to check progesterone levels. I had asked my OB about the possibility of doing an HSG because I will more than likely have met my deductible by the end of Oct and I want to do any testing necessary this year if possible. She said that we would wait until we got the results back from this blood draw before talking about the HSG. So how do these 2 relate to each other? Or do they even relate to each other?? I have an appt set up for an RE for the 1st week in Nov if we dont get a BFP this month and my DH is doing a SA the 1st week in Nov also if no BFP this month.

I'm 35 and this is our 6 month of TTC and my DH will be 43 in just a few days.

Thanks for the help!!

jnissa · October 2015

They don't relate to each other at all. I'm just going to say that this is a reason that many women on this board will caution using an OB for fertility concerns rather an an RE. An RE is going to consider an HSG a standard part of pre-treatment testing before they make any assumptions on fertility.

Progesterone obviously has a lot of implications for things like proper hormone levels, uterine lining (the biggest thing) and the ability to keep a pregnancy post-implantation. But it doesn't have anything at all to do with whether your tubes are blocked or not. It's possible she's waiting because if your progesterone is low she'd expect to see a thin lining on the HSG and that could inform that - but you need the information regarding your tubes regardless of your progesterone level before you proceed with any treatment plans. All the extra progesterone in the world won't matter if your tubes are blocked.

Hopefully you get your bfp this month and it's a moot point! But an HSG is a necessary part of fertility testing regardless of the results of hormone tests (unless you're DOR and going immediately to IVF)

bsckgb7 · October 2015

^^ Please skip the OB and get to an RE. Did they confirm O will bloodwork? Your HSG is typically done early in the cycle as to not mess up a potential cycle. So, you wouldn't do an HSG until this cycle is over anyway.

MNturnsVA · October 2015

Well the OB is the one saying they are hesitant to order the HSG. I'm not sure what the blood work is for,but I don't believe its to confirm O though. I was supposed to go on CD 21, but after reading some previous stuff on here about blood work done on CD 21, that is if you O on CD 14. I typically O later in the month, like on CD 20. So I waited until today to go get the blood drawn because the 7th day would be tomorrow and they are closed on Saturdays.

My appt with the RE is on Nov 6th and if I were to get AF this month I would guess then it would probably be too late to do the HSG this month and not mess anything up because I'd be on CD 9 when I go to see the RE.

Which is fine, unless there's more stuff/testing that should be done or could be done because I'd really want to do as much as I can without going to extremes anyways before January.

KidShrink · October 2015

I think it'd make sense to get it done early next cycle (before seeing the RE), as they'll be wanting to do one anyway and depending on how things work for you, it might be too last minute to schedule one before O during that cycle. I think she's hesitant to do it now in case you're pregnant/getting there, as the HSG would likely flush it out (hence doing it early in the cycle). So not too sure how the bloodwork will change anything except for letting her know you ovulated, and therefore shouldn't play in there until you know if something caught or not.

bsckgb7 · October 2015

^^ Right. No one is going to do an HSG AFTER ovulation because you flush the floating ball of cells (if you were pregnant). I think there is also something with the status your cervix (low/soft/high/etc) that's better at the beginning. You should be able to do the HSG with the RE in December and still make your cut-off this year. I think my doc does HSG on CD 5-10 or 5-12 somewhere in there. Depending on the doc and availability, you may have a chance for November.

Have you called to try and get on a wait/cancellation list so maybe you can go in to the RE a few days early and may have a chance for the HSG in November?

MNturnsVA · October 2015

@KidShrink That makes sense. I'm going to call and try to talk to the nurse for the dr ordering the blood work next week and see what they say the levels are. If its questionable I'll see if they can maybe schedule the HSG for early in the week that I go see the RE. I'm going to see the RE on a friday afternoon, so maybe if they can order it and get it done on the Mon or Tues of that week or something.

MNturnsVA · October 2015

@bsckgb7 I haven't tried to get on a cancellation list because next week is really not good for me and I could get a BFP next week. I could call to see if I could get in earlier in the week of Nov 2 though instead of at the end of the week.

MNturnsVA · October 2015

I hate this......and I REALLY don't want to jump to any conclusions and would LOVE for something to just happen naturally for us......I also feel like I'm "rushing" it too much because I've only been taking my temps for 4 months, one of which was anovulatory,(but we've been TTC for 6 months now) so it doesn't count for a TTC month really because it didn't make a difference anyways. So of the 6 months we've been TTC, we've only had 3 that have had "good timing"......ugh

bsckgb7 · October 2015

Yep. That's what I mean, earlier in that week. So you might could get in on say Monday and still make the cut-off for an HSG.

jennamarie05 · October 2015

I just had an HSG today, and my doctor ordered blood work to be done a couple of days ago, checking my progesterone as well as estradiol. Their largest concern was to make sure there was no way I was pregnant. HSG can't be done during pregnancy, so my guess is with you, they just wanted to cross their t's and dot their I's :-)

Good luck!!

MNturnsVA · October 2015

@bsckgb7 I moved the appt to Monday nov 2nd so if they can do the HSG that week I'd still be under CD 10 I believe or right @ it. Thanks for all the input ladies!!

MNturnsVA · October 2015

Oh, I had another question, could doing the HSG next month cause me to not ovulate???

BrightenMySky · October 2015

I am not sure why having the HSG would cause you not to ovulate and don't think it would be likely. It is not hormonal, it is injecting a dye into the uterine cavity (through the fallopian tubes).

MNturnsVA · October 2015

Because it may make me stressed out or anxious?? While it's not a "medical procedure" per say, I know stressors like being sick or just super stressed can cause an anovulatory cycle.

HBamama2B · October 2015

It will be unlikely to delay ovulation. It's not particularly stressful, just very uncomfortable. Thankfully it's also very fast, 5-10 minutes. Take Advil before and make sure to call and get them to schedule as soon asAF arrives if it comes before your apt. The HSG has actually been correlated to increased pregnancy rates (PR) just from the procedure as it has the benefit of flushing the tubes and some older uterine lining (you'll have spotting afterwards). FYI: My office required you to have it on cd 6-10. GL!

bsckgb7 · October 2015

I had my HSG in conjunction with a medicated cycle. Thats part of the reason they do it early, in hopes of NOT messing up O. FX they can get you in this cycle.

BrightenMySky · October 2015

I did not find the HSG that painful (I took 800 mg ibuprofen an hour beforehand, per my RE's instructions), but I know it can vary quite a bit. I like my RE (he is the one that did the procedure), and I got the results right away, during the test, and I think it was wondering what the results would be was the most stressful part of it.

PCOSbaby · October 2015

@BrightenMySky We have have the same RE! I had the same instructions and received my results immediately.

My friend didn't take her ibuprofen and she was too crampy to work the following day.

FX it all falls into place @MNturnsVA

KLake42 · October 2015

If you are in your 6th month of TTC, it may be just a hair too early for insurance to cover an expensive test like HSG. Blood work, however, is a much easier and cheaper way to start to check out your reproductive health. Your insurance company might want to get the cheaper tests done first, and to wait until you have been TTC for 6 months to a year, before covering the test.

(My insurance company excludes all fertility stuff, so this is just an educated guess on my end.)

I do think that when it's time to see a RE, the HSG is a fairly standard part of the work-up, but it does happen before you ovulate, so you don't interfere with a possible pregnancy. They also do a pregnancy test to make absolutely sure you're not pregnant.

For what it's worth, the HSG was very painful for me. But I had either a blockage or spasm on my left tube, which opened up after more dye was pushed. So the process took longer and was a little more involved than some women experience, which may be why I found it so painful.

MNturnsVA · October 2015

Hey ladies,

So I just got my results back from my CD 25 blood draw (although they wanted me to go on CD 21 but I didn't because I O on CD 19 this month) and I my progesterone level is a 7.3.

Isn't that pretty low??? Like I would have a hard time getting and keeping a pregnancy low??

Correct me if I'm wrong please.....

Wicked4589 · October 2015

If your progesterone is low they will just put you on meds. For IVF you are on progesterone anyway. I had daily injections for the entire first trimester.

KidShrink · October 2015

How was your ovulation confirmed? If no bloodwork showing rise in LH was done, it could be that you ovulated earlier and it was on its way down? Otherwise, you could be put on progesterone supplements. PIO seems more common in those doing IVF. When I was doing TI and IUI, I was put on Prometrium suppositories from a day or two after ovulation and I was on it until 12 weeks. It does seem to show up in blood though, as my progesterone level at 8 weeks was as high as someone in their third trimester (from taking 400mg of Prometrium per day for 6 weeks at that point).

MNturnsVA · October 2015

@KidShrink I had a blood test done on CD 3 and then they wanted me to go in on CD 21 for the progesterone but I don't O usually until CD 18, 19, 20 so I went in for the 2nd blood draw on CD 25 and I O'd this month on CD 19. I'm going to see a specialist on Friday. But I've heard that progesterone levels can vary from cycle to cycle??

bsckgb7 · October 2015

On my first cycle of Letrozole doctor did a Progesterone check as 7dpo. On my second cycle of Letrozole, NO progesterone check. Same thing when I switched to Follisitim, progesterone check on first round and nothing on second. When asked about no progesterone check, I was told "you were good last month". So my RE only believe in checking Progesterone when meds change, so he must be pretty confident that Progesterone stays fairly constant.

Sure it may a few points, but if your have 20 one cycle and 24 the next, its still plenty high enough. I suspect you will get progesterone based on that one low number.

MNturnsVA · October 2015

That was going to be my next question.....are they going to want to do 3 separate cycles to test the progesterone levels without meds first to determine whether or not I actually need to be put on a supplement of some sort?

And are the progesterone meds going to make me a crazy person?? I've heard that Clomid can make you super crazy/irrational/emotional.......

riveridgional · October 2015

@MNturnsVA My RE has you take progesterone (prometrium) orally for TI or IUI no matter what. He actually doesn't even test progesterone after because you take the supplements. Don't even worry about this since your RE will treat you appropriately. If he doesn't automatically put you on progesterone (doubt it), ask to be. My 40 prometrium pills cost $50. Since I've never been pregnant, each prescription has lasted me over 2 cycles. The progesterone supplements can't hurt you, only help.

riveridgional · October 2015

@MNturnsVA Also, I don't believe they will turn you into a crazy person except if you symptom spot. Progesterone will cause minor cramping, sore boobs, constipation, fatigue, and pretty much a bunch of the early pregnancy symptoms. It's really not bad at all.

bsckgb7 · October 2015

^^Both of these all day long. Slow down. Take a deep breath. The doctor will see your previous labs and treat you accordingly. With IUI, my RE gives Progesterone automatically (even if you don't have Progesterone issues). Progesterone will give you pregnancy symptoms though.

MNturnsVA · October 2015

I Knew that was probably going to come across the wrong way.....I just want to know what to expect. Especially as I feel most of the information I've learned on this board has been consistent. But only one person has said that progesterone levels are "subject to change" on any given cycle, which I'm sure is true. I was really just wondering though if that is true, and say my cycle is 7.,3 this time. Would they maybe want to wait another cycle and see what happens next month?? If they can really change that much (the PP poster, not in this thread) said her levels were 1.2 on one cycle and a 12.9 or something the next. That's a pretty big difference. So I guess if I were a dr, I'd want more evidence that progesterone supplements are necessary before just advising them to be taken. So can the levels really vary that much on a non medicated cycle? Also, I've seen on line on a few different web sites that the blood should be drawn first thing in the morning and that the patient should be fasting before the blood draw. I just am looking for other's experience so I know a little more of what to expect. And I know your experiences really mean nothing on how mine will go. Again, just looking for information.

I'm just ready for this to happen, so I'm really hoping that they will not want to do additional blood work to determine what they think needs to be done because or whether supplements are needed.

bsckgb7 · October 2015

But as PP said, it's not going to hurt to give you Progesterone. As one my my friends said, they pretty throw EVERYTHING at you hoping something will help and make a pregnancy stick. They added Metformin to my because my insulin was high-normal. Still in the normal range, but just higher. My RE adds Progesterone with injectables and IUI no matter what previous Progesterone levels where. My levels were over 50 with the supplements and I had to continue taking them. He also switches your meds after 3 cycles with no BFN, even with good response to the previous meds (hence the "throwing everything at you, hoping something will stick").

So it really depends on the doctor. Some give them out regularly, as PP said, no mater what the levels are. Others wait and test your levels. Its really up to doctor. All that being said, you do have one instance of a low Progesterone.

MNturnsVA · October 2015

@bsckgb7 Thank you, thats pretty much exactly what I was looking for in an overall general answer and what to expect in general. I'm fully prepared to just ask to be put on the progesterone at this point anyways if they don't just advise me of that, especially based on what you've said that it can't hurt.

bsckgb7 · October 2015

Just know that you get pregnancy symptoms and it will delay AF. Most people have to stop taking it for AF to show up (some start anyway, but generally you have to stop them). I went from a 13day LP to a 15 day LP.

MNturnsVA · October 2015

Hmmmm.......well.....I guess they'll cover all that right? How and when to take it?

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