Arguing with Healthcare Professionals.... Namely.. my OBGYN

Remember when I told everyone how much I just LOVE my new OBGYN?
Yeah well... not so much anymore...

She was so easily willing to give me Clomid... and wanted to test my progesterone when I got a positive pregnancy test and also to do a beta in her office... SO... I did some research on progesterone because I had seen it mentioned a couple of times regarding PCOS and what I found was shocking...
It turns out women with PCOS are often deficient in progesterone...

I'm not sure if you can read this, but it says "Woman with PCOS always have low progesterone levels, the best solution is to begin supplement with progesterone, and not synthetic progesterone, rather bioidentical progesterone"

It gets better...

The reason woman with PCOS are deficient in progesterone is because many woman with PCOS do not ovulate. Low progesterone levels are because woman with PCOS are not ovulating. What a coincidence? That is what Clomid and Femera do... they make the body ovulate?

See, the thing is that doctors are supposed to TREAT conditions such as PCOS, not aggravate and make it worse. Not tell patients to pretty much go fuck ourselves...

Which brought me to another point... Why has no doctor EVER brought up progesterone levels? The ONLY doctor who brought it up was my current OBGYN and she mentioned doing it after a positive pregnancy test, which to me was fine at first, but after my research, not so much...

It turns out that woman with PCOS often do not ovulate, and so even if they get a positive on the OPK, because the hormonal imbalances are there, the LH Surge detected is often false, or fake...

For those TTCers, we know how delicate the balance of hormones are for trying to become pregnant... and things like progesterone deficiencies, make it that much harder...

In my research, I found out that one of the main reasons woman are progesterone deficient is because they are estrogen dominant. In PCOS, the case of estrogen dominance is that much more real... because we are not in check, and we often are fighting with our bodies to get our hormones in check, and our bodies to do what they need to do...

Now, you would THINK that a doctor who prescribes Clomid to one who does not ovulate would understand PCOS and the delicate hormonal balance that needs to occur...
I approached my doctor about getting tested on CD21 to confirm ovulation... and to do this with progesterone lab, and she refused.

Her response actually made me chuckle a bit...

This was the conversation between she and I:

07-23-2013:

Spoke with the fertility specialists. They do not check progesterone levels when patients are on clomid and do not put patients on progesterone while using clomid. . If you get your period on the clomid, then you ovulated. The clomid works to make your cycles more regular and to make you ovulate.. If you miss your period, then a home pregnancy test can be done. If you have a positive pregnancy test at home then we can order a progesterone level and beta hcg.

Sincerely,

Adili Shay, MD

----- Message -----

From: DRIESSE,APRIL M

Sent: 7/20/2013 6:38 PM EDT

To: ADILI SHAY, MD

Subject: Appointment Follow-Up Question

Hi Dr Shay,

I called My Insurance and spoke to them today, regarding you saying your not sure if progesterone lab is covered service and they said "as long as a doctor puts it in as medically needed, they will cover the blood test as diagnostic" I do not have a regular 28-30 day cycle. My cycles range. (see photo) each month, due to my PCOS and hormonal imbalances. I read that based on this, I should do a progesterone lab instead of at CD21-23, at around 7DPO, which for me on average is CD24-28. Monday is CD29, could you order a progesterone lab, and a beta hcg (to see if I am pregnant) please? Can you send this to CMC McGregor St so I do not have to go all the way to Dartmouth Hitchcock in Manchester? Thanks.

Also: I was reading on progesterone and its importance following ovulation in woman with PCOS, since you mentioned starting progesterone following positive pregnancy test. Woman with PCOS often are deficient in progesterone, or have too little of it, or just barely enough, and so I feel that In conjunction with Clomid, I should be on progesterone following positive confirmation of ovulation via OPK and then check labs on the aforementioned above dates. Could you order progesterone please? If possible. I read there are 3 kinds, oral (pill) cream, or suppositories. Which do you feel is best? I feel suppositories is best because it goes directly to the source per say... I am wondering if the low progesterone is the cause of my miscarriages, since other specialists brush off my MTHFR, Thyroid, PCOS and clotting issues. What are your thoughts? do you think they all play a role?

Thanks Dr Shay,

April-

SAY WHAT??

First of all...

When I read that, I was going WTF, where did she go to medical school?

Then I thought about it, and I sent her this response:

----- Message -----

From: DRIESSE,APRIL M

Sent: 7/23/2013 9:12 PM EDT

To: ADILI SHAY, MD

Subject: Other

Regarding your response:

There are some things I disagree with in the above response. I am not being pissy, but I've had far then great care at Dartmouth. I have concerns, and I want you to know that I understand your opinions on this, but I also feel like your not understanding mine.

I spent today following your response researching, and I researched for hours, now I'm not disagreeing with you, but I am not agreeing with you either..

Dr, I've had 5 miscarriages, 1 chemical, and 1 stillborn at 23 weeks gestation. I've been given every excuse in the book. I've been told that there is simply no explanation. I was told by several doctors, not just your office, that I didn't have PCOS (previous OBGYN in Bedford who was high risk through Dartmouth), my clotting disorders didnt cause my losses (RE's, Endo's, OBGYN's, Internal Medicine Doctors), and there was nothing they could do to help me get pregnant. You were the first willing to help me, by giving me clomid, and so I am asking you to hear me out on this.

I'm not trying to tell you how to do your job, but I'm 24. I am otherwise healthy, other than my PCOS, MTHFR and clotting disorders. I am NOT going to experience another loss before someone helps me... and I think doing everything in my power to prevent losses is feasible! 7 children... thats 7... 7 of my babies I could have brought into this world, but no one gave a a damn. I'm not going to sit back and just let it continue to happen...

I'm sick and tired of my concerns being brushed off because this specialist says one thing, while the other says the other. I'm not dumb. I'm going to school for nursing, and begin in January. My point is... I feel like, yet again, my concerns are being brushed off... and I don't appreciate it... I'm sick of being treated like I don't know what I'm talking about because I'm a patient...

Its not that patients on clomid need progesterone, because not all infertility patients have PCOS. Some have unexplained infertility, others have other conditions. Woman with PCOS often need progesterone, following their periods. You can't treat me like I am dumb, because when you mentioned progesterone, I went home and researched for hours about it... and was shocked no one had mentioned it other than you before...

And I quote, an article from a Reproductive Endocrinologist at Boston Brigham and Womans

"PCOS can be worsened or caused by a progesterone deficiency. Progesterone is important, not just for implantation and sustaining pregnancy, but also for keeping our immune systems healthy in our gut."

"If you have a deficiency in progesterone, you may have difficulty getting an embryo to stick (chemical pregnancies), have early miscarriages because you’re not producing enough progesterone to sustain the pregnancy, or even quasi ovulating (you’ll have to look up something called luteinized unruptured follicular syndrome), where it looks ovulation occurs, but the luteinized follicle never releases an egg, but does release progesterone. Bottom line, a lot can go wrong on the way to pregnancy with progesterone deficiency. For those of you who chart your BBT, another sign of progesterone deficiency is a luteal phase (the phase that begins the day of ovulation until the first day of your period) that is less than 12 days long"

My Luteal Phase on average is between 8-11 days, with 12 being average. Read that last line again out loud. Almost ALL of my losses have been before 14 weeks... with them often occurring between 8-12 weeks. I've also experienced a chemical pregnancy. I've charted for 13 cycles... I'm far from dumb with my fertility... and my conditions...

No one has tried progesterone following ovulation. I have multiple conditions against me, why not try? My goal is to get pregnant... and your in it to help me correct? Having my clotting disorders, MTHFR, and PCOS against me, why not treat progesterone on top of it. You were all for Clomid and helping me get pregnant...

Also, from another article, taken from PubMed:

"In some women the ovaries do not make enough progesterone or the lining of the uterus does not respond well to normal amounts of progesterone. If this happens the lining of the uterus is not able to thicken or prepare for implantation of the fertilized egg."

I could go on and on, but the point is I disagree and why not try? Why not? No one has tried it yet, and if it achieves pregnancy, why not?

Also, I must correct you, in saying your wrong... just because you get your period, doesn't mean you have ovulated... I've gotten my period over 13 cycles, and I didn't ovulate 8 out of 13 of those, even with my period... and several other woman will tell you the same. period DOES NOT = ovulation. Especially in PCOS.

Also, Clomid is meant to induce ovulation, not regulate my cycles. Thats what Metformin does... I'm still insistent upon the progesterone following ovulation, and if you wont do it, I will order the labs myself, and I will order the cream myself...

She responds with:

April,

You have a very complicated medical and ob history. I am not a fertility expert and when I saw you we discussed your multiple issues and told you that I am not a fertility expert. I agreed to put you on Clomid for 3 cycles since you did well with that in the past. Since I am not a fertility expert, I will not be ordering more than clomid for you. I recommend you see a fertility expert- Reproductive Endocrinologist - to discuss your fertility further. We have fertility experts here at Dartmouth that I can assist you in seeing or there are fertility experts in Boston as you quoted in your articles.

Sincerely,

Adili Shay, MD

SAY WHAT????

So... let me see if I understand this correctly...

I'm too high risk to treat...

But yet you treat me with Clomid on a trial basis...

I'm too "complicated" to bother with because I've had so many losses, but you won't even try...

Your willing to give me Clomid to ovulate for my fertility but you won't check my progesterone...

Your willing to check it once I get a positive Home pregnancy test...

But at that point its probably already too low?

This is HUGE to me... HUGE...

I'm 24... everyone else thinks that my clotting disorders, and mthfr are NOT the reason why I've miscarried... so why not TRY to check my progesterone?

She won't even freaking bother! That bothers me...

It doesn't take a fertility expert to be knowledgeable in PCOS...

it doesn't take anything but common sense to help a patient...

And SHE WONT EVEN BOTHER!~

Here is what gets me...

Clomid thins the lining of your uterus...

Clomid works by blocking certain receptors and tricks your body into thinking you have not gotten enough estrogen and thus causes it to think there is NOT enough estrogen in the body, causing it to produce MORE... If Clomid works, your body produces more LH and FSH causing you to ovulate...

Where does progesterone come into play with this?

Well... Estrogen and Progesterone must have that delicate balance to sustain life...

Progesterone has two works in it PRO and GEST... to promote and to gestate...

Progesterone is HUGE in allowing a pregnancy to flourish and not miscarry...

it is WHY people get their progesterone checked in pregnancy to ensure they can carry life...

I'm not dumb... but I do think that an OBGYN should know that woman with PCOS often are deficient in progesterone because they do not ovulate... and that is also the reason why woman with PCOS often miscarry... I'm greatly bothered by the fact that I could have this deficiency and no one cares... and to answer the question I've been asked a lot lately, NO, I won't be going back to this doctor, namely because I'm moving, and I feel that I need to have better treatment...

Point in blank, yet again, ANOTHER Dartmouth Doctor trying to tell me stuff I know is wrong...

And Yet again, another battle to try to get my appropriate healthcare... and treatment...

So I will be ordering my own progesterone tests...

There are tons of labs that can allow you to order it yourself...

Namely...

Any Lab Test Now: $49.00

Direct Labs: $54.00

Order a Test: $59.00

MDLabTests: $40.80

LabsMD: $43.49

So because another doctor won't help me, I'm back in battling myself...

Back in hoping that I can find a doctor knowledgeable enough in getting this treated and treated properly...