Using progesterone suppositories immediately after getting BFP

[aprilshower]

We are TTC again after a December miscarriage.  I tend to have low progesterone levels, both when pregnant and when not.  With my m/c baby, I had low progesterone that was not noticed soon enough, leading to the progesterone suppositories being too late.  (Of course, no one knows if low progesterone was the cause of my m/c, but I'm not going to take any chances iykwim.)  Although I miscarried at 7w2d, my baby dated 5 weeks.

My plan is to begin progesterone suppositories as soon as I get a BFP.  I have a prescription for 100mg 2x/day.  (My prescription is from my family practice doc). 

My cnm wants me to wait until at least 5 weeks to start the suppositories.  (Since 5 weeks is also the time my baby dated, I have a big problem with this.)  She has some crazy idea that she needs to monitor both my hcg and progesterone until that time, without suppositories.  She thinks it will be inaccurate info if I'm using the suppositories.

We left this discussion with me agreeing to call her when I get a BFP and then we'll talk about the suppositories.  She is super sweet and really wants to help me hold on to my next baby, but I think she just doesn't have a lot of experience with (1) post-m/c moms ttc again and (2) moms who educate themselves and just don't do what the doc says, etc.

I am planning to stand firm with my plan to start the suppositories when I get a BFP. 

Do you guys think that this makes sense?

If so, do you have ideas about how I can explain this to my cnm, so that I don't alienate her when I start the suppositories without her being in agreement?

Thanks so much!

Julie

[mamaforever]

Hi Julie,

I'm so sorry for your losses.  I'm certainly not an expert with this, but I agree with you completely to start taking the suppositories immediately after a BFP.  Would she have your progesterone tested immediately after your BFP?  I guess I don't understand why she has to monitor the level for a week or more from when you get a BFP until 5 weeks.  If you test for prog once right away, and it's low, then start the supplement!

I guess just be as direct with your cnm as possible (in a nice way).... that you don't want to take any chances and that you are willing to be put on progesterone supplement even if she doesn't think you need it.  This is YOUR baby and don't let her talk you into something you're not comfortable doing (such as waiting until 5 weeks to take a supplement).  If she still says no, then I say start taking natural progesterone cream immediately and try to find another dr. who will prescibe the suppositories for you.

I suspected that I had low progesterone because of my short LP and my m/c in Nov.  So after my BFP this month, I had my progesterone tested immediately and it was a good number at 24.  So maybe you won't need to the progesterone supplement anyway.  But definitely get it tested right away and definitely start taking a supplement right away if it comes out low.

[aprilshower]

Thanks so much for replying, mamaforever :)  I really appreciate your validation of my decision to start the suppositories immediately after a BFP.  Its good to know I'm not crazy in all of this :)

I can easily/quickly do bloodwork thru my family practice doc.  So, I think that I will test my progesterone (plus hcg) on the AM of getting a BFP.  Then, I'll start the suppositories later that day - unless I can get the progesterone results stat (otherwise it takes a week). 

I think that my cnm will be okay with this, as it is a bit of a compromise :)  She'll still get one pre-suppository result.  And she does really mean well.  She mentioned that she was going to try to talk to a maternal fetal medicine doc re the progesterone suppositories, so I hope she does that soon (leading her to find out that taking them with a bfp is normal!)

My family practice doc prescribed the suppositories when I was pregnant with my miscarried baby, and I have a good supply left on that prescription - so good that I'll never need a new prescription for my next pregnancy :)

Now to get the BFP! 

Congrats on your BFP :)

Julie

[mamaforever]

Sounds like a good plan, Julie!  Good luck this cycle!

I would love to get your opinion on my situation since you have done a lot of research on progesterone too.  I had my second beta and progesterone test today.  These were my results Tuesday and today:

Tuesday (4 weeks 0 days) - hCG 297 and progesterone 24

Friday (4 weeks 3 days) -  hCG 1482 and progesterone 19

First of all, that means that the hCG more than quadrupled in 72 hours, right? I have heard that hCG rising too quickly can be a sign of a problem, but I'm trying my best not to worry about this since it's out of my control.  But what I'm concerned about is my progesterone dropping.  My dr. wasn't concerned because it's still above 10 and she says that it is expected to go down when my hCG level goes up (NEVER heard this- actually have heard the opposite that it should increase as hCG increases!).  She doesn't seem to think that progesterone supplements would do anything and she thinks I'm worrying too much.  So I have taken matters into my own hands and started natural progesterone cream today.  I feel better about it and I really don't care what my dr. says anymore.  I think I will try and find a new doctor.

I am using 40 mg/day (20 mg twice a day) of natural progesterone cream.  I'm hoping this will be plenty to keep my level up.  Do you have any knowledge on natural progesterone cream?  Or should I try and find a doctor who will prescribe suppositories?  Thanks in advance for your help!