Advice please - GP appt tomorrow

[Sylva]

Hi everyone.
I've posted about my low progesterone fears in other threads and got some great advice but wanted to start a new thread to prep me for my GP appt tmw. Hope that's ok.

Last month my luteal phase was 7 days and I've just got AF today so this cycle the luteal phase was 8 days.
I had a progesterone test on Monday and seeing the doc tmw. She reluctantly gave me the test but said even if it shows a problem they're unlikely to do anything to help until I've been trying a year, at which point I'll be almost 36.
My opinion is that if I have a proven short luteal phase and test shows low progesterone it is clear there is an issue, so why wait to treat that? I think she'll say it's too soon.

So advice please - how can I get the best from my GP appointment tmw? What have you done when speaking with GP? She made it sound like I was wasting her time...

(To those that have suggested alternative methods I am going to try acupuncture, soy isoflavones and maybe progesterone cream and I'm currently going mad on the B vitamins, vit C, Omega 3 & magnesium)

 

[snowbee]

If it helps at all once you are over 35 you are entitled to tests after only 6 months. Might be worth finding that on your nhs trust website printing it out and taking with you.

 

[Princess81]

Hiya hun, good luck for tomorrow.
I feel your pain, i had to go without a period for a year to receive treatment when I was TTC my first. I needed fertility treatment but still, they say I will need to try for another year for any more babies even though they are aware that I have a problem.
In my case, I will be going private as I am also 36 and don't have time to waste. x

 

[Sylva]

Thank you @snowbee & @princess81. It's good to know it's just 6 months once you're 35, but that does still feel like so long!! It does seem unhelpful to wait for a year when the problem is already clear - I understand waiting a year and then doing tests for people who are TTC without any known issues, but it seems risky to wait because by the time a year has passed I'll be older and with more risk of a difficult pregnancy, so it could end up even more difficult to fix and more NHS time wasted!
I'm hoping she can help tmw or at least make a plan with me. I just don't want to get confused and say the wrong thing.

 

[1sttimer]

Hi Sylva, my advice would be to not expect too much from your appointment. I know that's not what you want to hear but the reality is that they have to operate according to the guidelines - point out what snowbee said about it being 6 months not a year after 35, and then just crack on with the progesterone on your own. I know that's not helpful but having butted my head against that brick wall for some time, I would have appreciated someone being straight with me at the beginning. If it is a simple progesterone issue, all the things you've listed doing yourself will potentially sort it without any requirement from them... they won't prescribe you progesterone, its just not a done thing with GP's. My GP didn't even know what I meant, he said 'are you sure you don't mean folic acid' errrm no!

 

[Sylva]

@1sttimer thank you so much for your honesty. It's good to know where to best focus my energy. What's crazy is they prescribed me progesterone in the past but on the phone she did say they wouldn't prescribe it to me - that it isn't procedure, which is just what you described. I so hope it is something I can fix by myself. I just fear that I could be making it worse if they're not involved and monitoring the progesterone... It seems really crazy that this is the route. But let's see what tmw brings and thanks so much. I won't be too disappointed now if she can't help me, as I'm kind of prepared for that.

 

[MoominGirl]

It's so difficult with GP appointments. Some are a lot better than others but they usually don't know all that much about fertility as they're not specialists. Sorry if I'm reading your posts wrongly but I think a fertility referral/further testing is what you're after as you already know the GP can't prescribe anything? Apologies if I've got this wrong but I'll try and be helpful

In my experience, the fertility clinic will specify what basic tests need to be done by the GP in order for them to accept a referral. So if you get them to agree to a referral than you will need to get the tests if you see what I mean. Does the GP know how long you've been trying? I second what the others have said about being referred after 6 months if you're over 35. I'm under 35 but still manged to get referred after less than a year as I'd had previous hormone issues. I was completely honest as they knew how long we'd been trying and the GP was happy to do the referral on that basis. I really did just ask nicely and she agreed but I know it depends hugely on which doctor you get.

 

[Sylva]

Thank you @moomingirl that does help. To be honest I'm not really clear on what I want or need! I just know I've had previous hormone issues (progesterone), I can see a pattern emerging with my progesterone which is making it hard with TTC and I want to try to work on it as soon as I can.

I will be totally honest with the gp - they already know how long I've been trying because they took out my Mirena and I do hope they take my age into account. They've already done the progesterone test too. I suppose I'll just see what it is she says she can do and take it from there. I will however ask for a referral to the fertility clinic though, the worst thing she can say is no and it sounds like this is what I really need, rather than the gp. I worry I'm always too polite and don't push things hard enough and then come home and regret it later.

I did do a Google today and saw that there is a private fertility clinic near me that does £90 initial consultation followed by £40 per progesterone test and £20 per progesterone prescription if I do need that, but follow up appts are £120 so I'll need to do some budgeting if I do go down that route.
I think I'll come back on here tomorrow to report back and get some advice then. This is all quite new territory.

 

[MoominGirl]

Thank you @moomingirl that does help. To be honest I'm not really clear on what I want or need! I just know I've had previous hormone issues (progesterone), I can see a pattern emerging with my progesterone which is making it hard with TTC and I want to try to work on it as soon as I can.

I will be totally honest with the gp - they already know how long I've been trying because they took out my Mirena and I do hope they take my age into account. They've already done the progesterone test too. I suppose I'll just see what it is she says she can do and take it from there. I will however ask for a referral to the fertility clinic though, the worst thing she can say is no and it sounds like this is what I really need, rather than the gp. I worry I'm always too polite and don't push things hard enough and then come home and regret it later.

I did do a Google today and saw that there is a private fertility clinic near me that does £90 initial consultation followed by £40 per progesterone test and £20 per progesterone prescription if I do need that, but follow up appts are £120 so I'll need to do some budgeting if I do go down that route.
I think I'll come back on here tomorrow to report back and get some advice then. This is all quite new territory.

It's really difficult when you're starting out. We've had a few bumps in the road so I have no issue stamping my feet if that's what I feel I need to do!! Remember though that you can be polite as well as assertive. My OH has exactly the same issue but he's a changed man after some of the issues we've had!! I'm always polite (I'm not one of those mad women that storms in guns blazing!) but it's really important to know what you want and present your case. A lot of the time, GPs are so pushed that they're happy for you to do their job for them if it means getting you out the door faster!! In a lot of cases, I think of the GP as the means of getting to see someone who can fix my problem. I don't want that to sound like I'm disrespecting their role - much the opposite. It's like you wouldn't want a heart specialist doing your hip replacement. There's a time and a place for GPs and in my experience, fertility isn't one of them.

Also, just my experience, but I'd be cautious about paying privately if you are entitled to NHS help. Yes the waiting can be tedious but we had a lot more investigations and procedures than we initially planned for. If we had gone private after the first issue we had, it would have cost us a fortune and that's long before we've even got to IVF.

 

[Sylva]

That's all really good advice - thank you so much @moomingirl. I definitely couldn't afford to go private long term if the costs were to escalate.
I will be polite but assertive tomorrow and set out what I have experienced, what I know so far and why I believe a fertility clinic referral is the right way to go and hopefully she'll be willing to hear that. She did say on the phone that when we get the results we can put a plan together - I know she doesn't want to be a barrier, she has said that - but I also think she has certain restrictions on what she can / can't do. I have made a list of things to say in the appointment so I don't get flustered and forget and hopefully that will help and I will be able to get her to see the reasons why I think a referral is the way to go. Fingers crossed.....

 

[Sylva]

Hi everyone. So my progesterone result was 10. On one of the other threads someone told me it needs to be 30 to sustain a pregnancy. I'm feeling really down, obviously. The doc was lovely and told me not to worry too much about what I read about progesterone, because she knows of loads of people anecdotally that have conceived without medical intervention. I didn't find that very useful advice as what I've read tells me that it's very unlikely I'll conceive with progesterone this low and if I do, I'll probably miscarry.

She said it's too soon to refer me to a fertility clinic but what she has done is referred me for ultrasound and blood tests for thyroid, FSH, full blood count, luteinising hormone, prolactin, sex hormone, testosterone & urea. I have no idea what these are but at least I'm getting more tests so that when I can go to the clinic I have some information. She was lovely and really helpful and it's great she's got me these tests - I can see she wanted to help. I just hope that when the results come back she won't just say I have to still wait for months and months.
Any thoughts from anyone??

 

[millielaura]

Any chance you could of been out a day or two? Not being exactly 7dpo could change the result a bit xxx

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[Sylva]

Any chance you could of been out a day or two? Not being exactly 7dpo could change the result a bit xxx

Sent from my SM-G928F using Tapatalk

I don't think so - I am pretty sure it was day 21 but it may have been day 22.

 

[snowbee]

Do you ovulate on day 14?

 

[Sylva]

Do you ovulate on day 14?

According to the LH tests it is day 15, which means I had my progesterone test on 7 days past ovulation - however I do temping and can't really see a pattern or obvious rise in temps, but think that happens with low progesterone?

According to my cycles my luteal phase is 7 or 8 days usually (between ovulation and period)

Are you thinking maybe the ovulation day is wrong?

 

[MoominGirl]

As snowbee has said, a progesterone test on day 21 is only relevant for a 28 day cycle and assumes ovulation on day 14. You said you got the test done on Monday and af came yesterday so only 2 days before. Are you sure you have your ovulation dates correct as if you haven't then it would be normal to have a low result at that point in the cycle. I hope that makes sense.

I'm glad you're making some progress with the tests. Make sure you get the other bloods done early in your cycle (days 2-5) so you get accurate results. It's good you're getting an ultrasound as well as they'll be able to see if things look normal depending on what part of the cycle you're in.

 

[Sylva]

As snowbee has said, a progesterone test on day 21 is only relevant for a 28 day cycle and assumes ovulation on day 14. You said you got the test done on Monday and af came yesterday so only 2 days before. Are you sure you have your ovulation dates correct as if you haven't then it would be normal to have a low result at that point in the cycle. I hope that makes sense.

I'm glad you're making some progress with the tests. Make sure you get the other bloods done early in your cycle (days 2-5) so you get accurate results. It's good you're getting an ultrasound as well as they'll be able to see if things look normal depending on what part of the cycle you're in.

Ahhhh.... Ok... So my cycles are 23 days. So I would actually need my "day 21 test" on day 16? Presuming it needs to be 7 days before AF. With that in mind, it could be quite different?

I only get about 7 or 8 days between ovulation and AF, so it's the 2nd half of my cycle that is short (the luteal phase). I will talk to my GP about that next time, that perhaps it shouldn't be on day 21.

I had my other tests done today (day 2) so it's within the right time (day 2-5).

I can only go on LH tests to get my ovulation but they are pretty clear. I can't tell by the temps (unless of course I'm not actually ovulating and it's just an LH surge).

I think you're right re: 28 day cycle. Mine definitely isn't that long, so it makes sense that the day 21 isn't right

 

[snowbee]

If you are sure of ovulation day then 7/8 days after ovulation is correct for bloods. I was wondering if you were ovulating much earlier in your cycle. If you are oving cd14/15 with a 23 day cycle I would say you have a LP defect as you think but I would try and see if there is a possibility you are oving much sooner, you may be mistiming dtd and then bloods if so.

 

[Sylva]

If you are sure of ovulation day then 7/8 days after ovulation is correct for bloods. I was wondering if you were ovulating much earlier in your cycle. If you are oving cd14/15 with a 23 day cycle I would say you have a LP defect as you think but I would try and see if there is a possibility you are oving much sooner, you may be mistiming dtd and then bloods if so.

Thank you for this - I have got a new thermometer to see if that helps me to nail down the ovulation. The LH tests are always pointing to cd 14/15 but I think getting the temping sorted will help to either confirm that (and know for sure it's luteal phase defect) or show that ovulation is earlier.

Thanks so much for your thoughts on it