The score: 4 doctors think my level is fine and doesn't require additional support, 1 suggests additional support for a week, and 1 potentially suggests additional support until 20 weeks. You would think that having 2/3rds of them solidly on one page would put my mind at ease, but no.
The 4 who think things are fine: Both of the perinatologists in the practice I go to, my RE, my RI.
The peri who isn't the one I see was the first to respond to my call over the weekend. She doesn't think I need additional progesterone support but said it would be fine for me to take 2 suppositories a day until Friday if it would make me feel better. My peri called about 5 minutes later. It was clear she was annoyed that I was calling her about something we've already discussed and was very blunt in saying she absolutely would not order progesterone for me nor would she order any tests to monitor my levels. (To her credit, she also did her very best to try to reassure me that everything looks perfect and that she doesn't see any reason for me to worry.)
I haven't had a chance to ask the nurse why my RE is fine with my level being below 20, because it came in a voicemail.
And really surprisingly, the RI's office says anything above 10 is fine at the end of the first trimester/start of the second, even though their website says immune patients should continue progesterone support until 16 weeks. 10? Seriously??
The 1 suggesting additional support for a week: The RE who was on-call for the clinic this weekend.
The surprise of this one is that the nurse had told me on Friday that there was no point in asking him what his recommendation was, because that particular RE requires all his patients to be off all progesterone support by 12 weeks, regardless of their levels, no exceptions. But then she decided to go ahead and ask him anyway on Saturday since my RE hadn't responded yet. And the one who never recommends supplementation past 12 weeks told her to have me continue taking a suppository until this Friday, which will be 14 weeks.
The 1 potentially suggesting additional support until 20 weeks: Another RI who I had consulted with last fall but decided not to work with because the additional treatment he recommends for some tough RPL cases is a drug I won't take. One of the risks of it is an increase in the likelihood of developing leukemia, and with my dad's and grandfather's history, I'm not going there.
But he has a forum on his website where you can post questions. And while he didn't directly answer my question about what he likes the level to be at the end of the first trimester or directly comment on my particular level, he did say that for women who have had low progesterone levels and a history of losses, he keeps them on supplementation until half way through.
If I was already his patient and he was already involved in managing some aspect of this pregnancy, I'd just go with his recommendation. But I'm not actually his patient (we only did a brief consult about a year ago), and I think it could potentially create an uncomfortable relationship with the peri if I bring in another doctor who will do what I want because she won't.
If she was an average ob at a typical practice, I would shrug off that concern and find another ob if need be. But this is a fantastic practice in every other respect - they get what we've been through, they let me come in as often as I need to put my mind at ease, and I know I will get really careful and frequent monitoring. (Most likely weekly until 32 or 36 weeks, then twice a week at that point.) My friend who recommended this peri can't say enough great things about her c-section experience.
I'm supposed to get my levels re-checked again on Friday, and I see the peri that day as well. I guess we'll see how it goes.



