Appointment update - January 3rd

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Registered: 06-27-2006
Appointment update - January 3rd
10
Mon, 01-03-2011 - 6:02pm

I feel much more relaxed and calm. The doctor pulled out his diagram he drew for me back in August and showed it to my husband and then also added some things to his drawing (we called it his "masterpiece" - a very crude drawing of the brain and the ovaries/uterus and how the brain sends hormone messages to the ovaries to create follicles and so forth...LOL!). He then talked about my low progesterone levels. He was NOT happy with my levels (obviously) and said that he wants me on Prometrium for the remainder of this cycle. He also is going to put me on Femara for cd3-7, he wants me to take mucinex from cd8 until after my peak-type mucus is gone, take the Prometrium after O next cycle from 3dpo until 12dpo (or we'll discuss continuation if I get a BFP), and then he wants me to continue taking my 81mg baby aspirin. I am to do this for two cycles and if we haven't gotten pg, then on the 3rd cycle of Femara, he wants me to go for a follicle study from cd10 through whenever I happen to ovulate (and they said they would trigger if I needed that). If, after that 3rd cycle things don't work, then he wants to see me to discuss what we'll do next. We did talk about endometriosis and I asked him if it's something we should be looking more into. He said, we can, but he wants to try this first. If, after 3 cycles on the Femara/Prometrium/Mucinex/Aspirin combo, we don't end up pg, we can meet again and discuss potential endometriosis. But, he thinks that we can just push this over the edge with the med combo right now.

As for the insurance coding issue. I talked to him about it and he thought about it for a minute and said that because I had had testing for progesterone levels (which insurance covered), he would code it as a consult to go over those results and to tell me that I have Luteal Phase Defect. I thought that insurance would have a fit about that and question things since he was putting me on fertility meds, but I took the meds to the pharmacy and remembered that my Rx plan has nothing to do with my medical insurance plan. Medical insurance won't know at all that I was given fertility meds. They will just get a bill from the doctor's office stating that I was seen for LP defect. So, hopefully they will cover it without needing to get office notes or anything.

I think it's fantastic that I thought that I was going to have to pay 100% out of pocket for the meds, but I'm only paying my $25 copay for non-generics and DH's employer is picking up the rest of the cost. SWEET! It's what I hoped for and more!

I doubt that this cycle worked for us because we only had one chance to DTD before DH got horribly sick (he finally went to the doctor today and got himself some meds...it's been a great day for the pharmacy with meds dispensed to our family). I never got my completely positive OPK either, so I think this cycle is a bust. But, the Dr wants me to take the prometrium anyway because their philosphy is that anything that happens in one cycle affects the next, so if I start the prometrium tonight, hopefully it will knock out the pre-AF spotting I usually get and then maybe it will help my next cycle to start out well and with the Femara added to the mix, hopefully it will make for a very healthy cycle.

Can anyone share what their experiences are with Prometrium? I was told that it can make me feel a little nauseous, which is why they want me to take it at night. Help! Does it cause daytime queasiness too? Any other input on Femara, too? Any side effects I should be forewarned of?

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Registered: 07-28-2009
Tue, 01-04-2011 - 5:37am
When my dr prescribes Prometrium, he also tells me to administer it vaginally. He says greater than 90% of the drug is destroyed in the stomach long before it gets to where it needs to go. I would ask about that if I were you. I had no side effects with the Femara but I don't think I am the one to ask as I never have any s/e at all! Not with Clomid, not with Progesterone, not even on injectables. I guess I'm lucky that way but it always makes me paranoid that the drugs aren't working!
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Registered: 12-21-2010
Mon, 01-03-2011 - 11:41pm
Glad you're appointment went so well! Its nice to have a plan. And having a Dr u actually trust in.
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Registered: 06-27-2006
Mon, 01-03-2011 - 10:38pm
Thanks Jen!
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Registered: 06-27-2006
Mon, 01-03-2011 - 10:38pm
Thanks Dustie! I hope I don't find any side effects of the prometrium either! :) I'm finding it very encouraging that the warnings on the side of the bottle may just be a CYA warning rather than "the norm". :)
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Registered: 06-27-2006
Mon, 01-03-2011 - 10:36pm
Thanks, Aubre! I'm supposed to take the Prometrium gelcap things at night, too. They didn't give me enough in the script to cover the rest of this cycle AND next, so now I'm not sure what to do. The doctor wanted me to take them the remainder of this cycle, so I guess that's what I'll do. If I run out of the meds toward the end of that 3rd cycle, I'll just have to call the doctor's office and tell them that they didn't have enough to cover this cycle PLUS 3 more cycles. LOL! I guess we'll cross that bridge if we need to.

I'm sorry that Metformin has been harder to adjust to than Prometrium for you. I hope you get your BFP really soon!
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Registered: 06-27-2006
Mon, 01-03-2011 - 10:33pm
Thanks Chouli! This doctor is absolutely fantastic a 180-degree turn from the doctor I left after my miscarriage. He has wonderful bedside manner and is willing to take the time to listen and then explain anything we don't understand. My husband was beyond impressed, especially after the cold, clinical feel of the stupid doctor I had before.

Thanks for the input on the Femara. My doctor didn't say anything about the Prometrium being used vaginally, so I'm assuming he wants it taken orally. I'll try that first. LOL! The bottle says it may cause dizziness and may make me sleepy, but I guess that's ok since I'll be taking it right before I go to bed anyway. No better time to sleep, huh? :)
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Registered: 06-29-2010
Mon, 01-03-2011 - 10:07pm
Glad your appt went. Well!!!!
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Registered: 05-12-2008
Mon, 01-03-2011 - 8:57pm

Yay, Tee, that's great!

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Registered: 08-07-2007
Mon, 01-03-2011 - 8:47pm
My RE has me insert the prometrium vaginally both morning and night. It does give me gastric side effects. Not queasiness, but gas and bloat, and some constipation. Femara gives me almost NO side effects...only about 1-2 hot-flashes per cycle that lasts a few minutes.

It sounds like you have an excellent plan in place and I like the rapport you have w/ your Dr.
Chouli, 34; DH 45 Lilypie Pregnancy tickers
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Registered: 05-04-2006
Mon, 01-03-2011 - 7:59pm

I am SO happy that your appointment went well!!!