Suggestions for P4/E2 monitoring?May 22 2012 at 11:07 AM
|Erin (no login)|
So, I found out that C.ornell wants to start tapering my P4 at 7wks (and I'm going a bit rogue already with continuing my E2 that they don't seem to think is necessary after implantation). I am not comfortable with this. My E2 makes me nervous- it's been between 175 and 265 on a Climar.a patch. P4 has been between 42 and 62, but I'm on 1cc PIO + 100mg Endometrin 2x/day.
Does anyone have any advice on how to continue E2 and P4 support and get monitored for it? I have extra PIO, Endometrin and Climara available, so I can just keep using it on my own and hope for the best, but that makes me nervous too. I'm in MA but don't have an OB yet, but I doubt any of them will know much about this. Has anyone dealt with this? If it wasn't too expensive I'd be willing to pay a third party to keep up the monitoring and refills. Thanks in advance!
|May 22 2012, 11:16 AM |
I was in the exact same boat at C.ornell a few weeks ago - C.ornell likes to release you at 8 weeks, which I think is the reason for the tapering at week 7.
I was extremely nervous and stayed on my p4 and went back to C.ooper for pg monitoring. C.ooper has been weaning me off my p4 slowly (I am almost at week 12 and have cut my p4 dose in half at this point).
When I pushed back a bit with C.ornell about coming off p4 cold turkey so early, they did say I could just stay on until I saw my OB and have my OB wean me. (My OB herself wanted me to stop the p4.)
You could have your OB run frequent p4/e2 tests, if you have no other monitoring options, although you may have to push your OB a bit to do this.
I know how nerve-wrecking this all can be!
Thank you and f/u question-
|May 22 2012, 11:33 AM |
Thanks so much SMRC! I'm sorry but I can't remember- did you use C.ornell for this cycle? I did consult with Coop.er and have been thinking about calling them to ask them to monitor me from here, but I feel awkward asking since I ending up going to C.ornell instead for my cycle. I also worry about using an OB since they tend to be a bit conservative in MA and I fear I won't be able to find one that will know what they're doing. Thanks so much- it totally is VERY nerve-wrecking!
|same anon again|
there are "lots" of MA ladies on the board
|May 22 2012, 12:18 PM |
maybe do a spearate post. Meg is one, Holleigh, karma, newbie, maybe kristen?? Oh and of course JulesM (she's a nurse herself too!). And PhoebeMass. maybe they happen to be near you and can make good recommendations for an OB sensitive to IF.
Thanks! Posted above... n/t
|May 22 2012, 1:31 PM |
I did use
|May 22 2012, 12:29 PM |
C.ornell for my successful cycle but had been with C.ooper previously. C.ooper was willing to take me back and pg monitoring with them has not been too costly so far - and preserved my sanity (which is priceless!).
My OB has actually been helpful too, and I think she would have done the monitoring/weaning if I had asked, although I don't think all OBs are as sensitive to p4/e2 requirements.
Thanks so much again!
|May 22 2012, 12:57 PM |
I will give Coo.per a call and see if they are will to do OOT pg monitoring for a fee. I think I'd also feel much better having them watch over this, since everyone else I've talked to seems to say that E2 doesn't matter. I guess the worst they can do is say no.
I forgot to say earlier- congratulations on being 12wks! That is wonderful! Hope you're doing well and thank you so much again.
I can't write much now
|May 22 2012, 11:25 AM |
but please continue with E2 support. Your P4 is looking good. But E2 is usually higher at this point. Can everything turn out fine with the levels you have? SURE! But please do wait a bit longer until your placenta has taken over before doing anything with the E2.
I agree with you-
|May 22 2012, 11:37 AM |
I will not stop the E2 support. I do seem to be a low estrogen person- my E2 I think barely got to 600 on my last 2 cycles, with 4 and 3 mature eggs and about a 10mm lining on each cycle. So it seems maybe my body does more with less estrogen, but I am in no way willing to risk it, and I wish it were higher. One way or another I plan to keep up the E2, but would like someone to follow it. Thanks so much for your input!
how many refills do you have?
|May 22 2012, 12:50 PM |
You could just keep taking it and not do the monitoring. If your levels have been good on the dosages you have been taking then I wouldn't worry too much. Or aren't there those independent labs (labcore or something?)
I'm not sure what E2 levels are supposed to be in pregnancy, i don't think docs know much about that.
Glad things are going well, are you having an u/s soon?
I have available:
|May 22 2012, 1:07 PM |
One month's worth of PIO at 1cc/day, 2 refills of 42 Endometrin supps (though need to start using the first refill tomorrow), 3 more Climara patches + 1 refill of 4 of them (changing about every 5 days b/c the E2 of 175 was after almost a week on the patch) and 30 tabs of estrace. I agree that most docs don't seem to know much about E2 in pg or think it's an issue, but reading this board has made me think it does. Ugh.
I am currently 5wks and 3 days and actually had my 1st u/s yesterday! I have one little bean with a gestational and yolk sac growing in the right place measuring 5wks 1 day (of course being 1 day behind made me nervous, but I was told it was within the margin of error...). So I guess things are going well. I don't have tons of symptoms, which also makes me nervous (are you detecting a theme?
). In any case, thanks for asking! Next u/s looking for a HB is 5/31. Hope you're doing well!
glad to hear!
|May 22 2012, 1:41 PM |
That you have a little bean in the uterus. Don't worry about the dates, I think it's +/- 3-4 days, I would only worry if it differed by a week or more. The measurements are not accurate, especially at that age because it's so small.
I understand worrying about the E2, I was worried mine was low for a previous pregnancy. I don't even have levels for this pregnancy. But my point was, I'm not sure what level you would even want it to be since there is no info on this.
Sounds like you have refills that would take you to 10 weeks or so?
You should start interviewing OBs and see how they respond to your questions--obviously you are going to want one that understands this is stressful pregnancy for you, you want one that is totally reassuring.
I just made my ob appt and couldn't get it until 11 weeks! I'm really annoyed. I don't even love my ob and would like to see another in the practice but that is awkward. So it's good to find one that you like right off the bat.
Good luck on your appt next week, that one is stressful but everything looks good!
|May 22 2012, 7:19 PM |
That they can't see you until 11wks! Doesn't anyone get how important this is to us?! Ugh. I hope you have a good visit despite your lukewarm feelings for your OB. I am sure that I'll be stressing about the next u/s, but it seems so far away since the days are moving slow as molasses lately. In any case, thanks for the positivity- it is much appreciated these days! Wishing you lots of good luck as well!
|May 22 2012, 1:55 PM |
Is a good guy who you can talk things out with. His office admin is a bit, well, unpolished around the edges, but a giant sweetheart.
Marc Kobelin with Beth Israel - Lexington. Don't know if Lexington is outside your traveling zone though.
We had a great experience with him. But you have to talk with him.
Erin, I'm so sorry, I've been on/off the boards lately. Did you do IVF or IUI? Who is your RE - Cornell? Do you have a local place that your monitored?
|May 22 2012, 4:21 PM |
Hi PhoebeMass- Thanks for the recommendation! Assuming I get there, I think I would like to delivery at Newton-W.ellesley or Mt. A.uburn (I'm hoping for a more natural delivery if possible and that seems difficult around here), but I don't know if I could consult with your doc as well. Honestly, I'm so new to this whole thing- it's weird to be so out of my comfort zone after knowing so much about IF. In any case, no worries about your question- I did IVF at C.ornell but monitored at Fer.tility So.lutions in Dedham. They're very nice, but I asked and they didn't understand why I'd be monitoring E2. I've actually followed your story a bit b/c your cycle in February was almost identical to mine- I think you were just a couple days ahead of me! I wish you luck and thanks so much for the referral.
|May 22 2012, 5:11 PM |
You could call Dr. Cardone's office. Just ask them if they would do the b/w. You know what numbers you need. You have a lot of meds available.
What are you looking for? I'm so sorry, I hate to sound moronic. Someone to draw blood. Or someone to interpret results? Or the meds?
Ha! If anyone sounds moronic...
|May 22 2012, 6:01 PM |
...it's definitely me!
I'm looking for someone to order the labs and give me an rx for more meds if I need them. I think I could probably interpret the results myself (although I'm sure I'd be more conservative than anyone who didn't have my child growing in their belly...). I was actually looking at those online sites where you can order labs yourself, but they're wicked expensive and apparently MA law doesn't allow their use, so that's a no-go. I think I just really need to find a good OB at MAH or NWH, but that's proving difficult. The fun never ends! Thanks so much for your help PhoebeMass!
You'll find someone, definitely
|May 22 2012, 6:37 PM |
I would think Mt. Auburn definitely. They are known for being a bit more holistic and easy to work with. We go to the ER at NW and they are terrific. They have a women's practice, I think.
Good luck, Erin. You'll find the right person to help you.
You sound like you have a good supply of meds.....?
Thanks for the confidence!
|May 22 2012, 7:15 PM |
I'll keep searching and hopefully I'll find someone who fits my criteria at one of those hospitals. Unfortunately I don't have any good friends with kids in the area, so it's hard to get a personal referral. I'll figure it out... eventually...
And yes on the meds- I'm kind-of stock-piling them to break out in case of emergency. Hopefully I have enough! Thanks again and hoping for all the best for you as well!
Reach out if I can help
|May 22 2012, 7:40 PM |
on both the ob front and the other front.
Kobelin is a good guy. But I still think you'll find your match at Mt. Auburn or NW. Go interview them. I did that with our pediatrician - who is a legend at Harvard Med School - it was a good chuckle for us both. But, heck, it's your medical health.
From MA too.
|May 22 2012, 2:49 PM |
But I had my GP/endocrinologist do some extra monitoring, as he is a family friend. When I mentioned to my OB that I was continuing with it, she offered to write the scripts, but I felt my confident with my GP.
I would ask potential OBs if they would be able to monitor these for you. They should and I can't imagine you might need a third party to help with it.
Are you close to Boston? If so, consider using an OB at a hospital that also has an IVF practice- The Brigham, MGH to name two.
|May 22 2012, 4:26 PM |
As for hospital, I think I'm leaning towards using Mt. Au.burn or NWH over BWH and MGH, as I'm hoping for a more natural childbirth experience which I'm gathering might be easier in those hospitals. I'm still figuring out how to ferret this information out of OBs since they don't seem to want to see me until I'm 8wks... I guess I'll figure it out. I hope you're right and an OB will follow the E2/P4, as obviously that would be much easier. Thanks so much for your response!
|May 22 2012, 6:10 PM |
I delivered at NWH and really liked every nurse I came in contact with. I used a birth doula and from what I could tell, she was fine with the staff...or they were fine with her being there. I do hear that Mt. Auburn is the most open to midwives and doulas. BTW are you using one, as they would be the best source of info on that. We found ours through our local yoga studio, she taught pre and post natal yoga...might be a good spot to 'shop for one' or to pick the brain of one on information like natural childbirth friendly hospitals, OBs and such.
Sent you an email...
|May 22 2012, 2:57 PM |
Glad to see you on here my friend!
I JUST today saw the email you sent me last week! I am so sorry, I'm bad lately with checking email and that email isn't linked to my phone.
Curious, what happened when you called Cooper? Did they tell you that you had to come in before they would monitor you? Just curious.
This will all work out. Thinking of you!
I replied to your reply! ;)
|May 22 2012, 4:29 PM |
As for Coo.per the receptionist was nice, but I think the issue was twofold- I am OOT and I've never completed a cycle with them. I think if I met one or both of those criteria it might have worked out. Oh, well. I really should be able to figure this out!
Thinking of you too!
|May 22 2012, 5:38 PM |
I agree with a couple of the other ladies on asking your ob/gyn about monitoring it. My ob was very responsive to my wishes after I was realeased by Dr. check at 8 weeks because of the circumstances. I actually weaned myself off at around 12-13 weeks, and E2 is not nearly as important as P4 so a couple checks of that should be fine.
|May 22 2012, 6:04 PM |
It seems like that's the consensus, which makes me feel better. I also appreciate your comment on the P4 being more important than the E2- that's what every doctor seems to tell me, but it's not in my nature to believe them.
Now, if I can just find a good OB... Thanks again!
another post from me....
|May 22 2012, 6:28 PM |
I see you are really looking around for an OB. I used one affiliated with NWH, it was about.womenbywo.men. I was drawn to the practice because it was convenient to both my home and the hospital. They have around six doctors and they rotate. I actually liked some of the others in the practice better than the one I went there for and in the end was delivered by one who did a fabulous job. Not to push the doula point at all, but they really help to keep the delivery as natural as you want it. I in the end was induced early and it all worked out just fine for me. I wish I knew someone at MAH to refer you to...but maybe it is time to hit the yoga studios and chat with the instructors and other yogis!
Women by Women
|May 22 2012, 6:47 PM |
Okay- you are maybe the 5th person I've heard recommending this place. I was not sold b/c they don't have midwives, but I hadn't thought about the doula option... I've read some good things about Dr. Cla.rk? I made an appt with a doc at MAH, but I was just reading a few reviews that said she spends about 5-10mins in her consults... Not good. This is tricky business!
As for yoga, it's been pretty embarrassing when I've tried it before (I tend to be the participant that gets the most "special attention" due to my complete lack of coordination) but I guess I should start going to the yoga studio (or at least participating in some form of physical activity?). Thanks so much for the referral. I may give them a call tomorrow if I can get over the midwives issue.
Booked an appt with them!
|May 24 2012, 3:51 PM |
And spoke to their NP who was incredibly nice and helpful and said they would monitor my E2/P4 through the 1st trimester. I wish they had midwives, but what can you do? Thanks so much for the recommendation!
So glad it seems like a good fit
|May 24 2012, 6:55 PM |
So I guess you will deliver at NWH. I don't think you will regret it. I did a childbirth class there too.
Funny for us, but when we checked into deliver they apparently had been really busy and then we got in it was calm.
While in early labor I was walking the halls and noticing all these empty rooms, nearly 3/4 of them. So post partum we had nurses hanging in our room answering any and all questions. I would say 'hey, i don't want to take all of your time' and several nurses said no one was on the floor- just a fluke. Hopefully the same for you!
As for AWBW, I never had any issue with booking appts or talking to nurses via telephone...they seem pretty quick to respond.
|Current Topic - Suggestions for P4/E2 monitoring?|