I need your advice on…progesterone suppositories

I forgot to mention in last night’s post that there was one hiccup at the RE appointment. I don’t know if I mentioned it here but when my beta number came back at 10,475 my progesterone also came back… at 12. This is obviously lower than the 25 or so that is expected (or at least desired) at almost 5 weeks. My OB was nonplussed (also her reaction to my high beta) and my RE didn’t seem too concerned but when I met with him on Friday he brought it up, saying it wasn’t necessarily a cause for alarm but also that it wasn’t what he would hope to see. He suggested progesterone suppositories since this is a “highly desired pregnancy” (damned straight!) and “it’s better to be safe than sorry.” He wrote me a prescription and the nurse was all set to fill it but when I asked how much it cost she told me she wasn’t sure but she thought it was expensive. I asked her to just give me the Rx and the list of pharmacies and said I would deal with it.

It’s not that I’m against taking progesterone in the first trimester and I recognize that my levels are lower that would be expected. I’ve always had low progesterone and I worried about it with my pregnancy with Isa. Unfortunately I never got my levels checked then (if I had and they were similarly low I would probably assume that is just how my body works and not worry). The biggest thing is I don’t want to spend a lot of money. Just the ultrasound on Friday was $300, which for us is a massive amount of money. I’m not sure I can afford another blow of those proportions in the next two weeks.

In the end I know it comes down to one question: if I don’t use the suppositories and something goes wrong, can I live with the possibility that the suppositories would have made the difference? For me, this choice is really about regret management and I’m not sure what to do.

So I need your wisdom and advice. First of all, are progesterone suppositories expensive? Is there a generic brand I can request even if my doctor ordered the more expensive name brand (probably what he did)? Is it as horrible shoving progesterone up your va-jay-jay for 6+ weeks as it seems like it would be? Do you think, with a 19DPO level of 12 it’s very necessary. Please know that I know none of you are medical professionals and I will not be taking your advice as such (that is meant to take pressure off not disregard your suggestions), but I also know that you’ve all done this shit before and you’re pretty well versed in the ins and outs of “highly desired pregnancies” and you have great advice that I’m hoping you’ll share.

Thanks in advance!

PS I should add that I have Kaiser and my OB there will not write this Rx so I will be filling it without insurance. If anyone knows how much it costs out of pocket, I’d appreciate it.

19 responses

  1. I was on the supp for the first 10 weeks of my pregnancy with Chloe, and if I remember right, a box that would last a month was $20. I don’t know if it was generic or not, I’m assuming it was. I used them twice a day, once in the morning and once at night. The night one wasn’t bad b/c I would just do it right before bed and lay down. The morning one was a bit trickier and I started setting an alarm for 4 or 5 am, putting it in, and laying back down for a couple hours to let it do it’s trick. I wore a liner during the day though because they can get kinda messy. My RE wants to see the prog over 20 so as long as you think it’s feasible, I would suggest taking the prog just as one less thing to worry about.

  2. You are smart to weigh your options. I’m dealing with massive medical bills right now for C’s hospital stay and my surgery, andwhile I didn’t know either of these would happen, I am regretting choosing a high-deductible insurance plan to save on monthly costs.

    I know nothing about progesterone, but is it the kind of thing people might have leftovers of?

  3. Actually, I am a medical professional (a women’s health care nurse practitioner) and it is my professional opinion that there is no place for progesterone supplementation outside of IVF. Progesterone levels are extremely hard to accurately measure, they fluctuate up and down constantly and are effected by everything- eating, drinking, sleeping, stress, etc. There has never been a single study that shows progesterone supplementation will prevent miscarriage in a non-IVF pregnancy (with IVF the medications used suppress natural progesterone activity making it necessary to supplement). The use of progesterone in non-ivf pregnancies is outdated and is more of a legal issue (I.e. so docs don’t get sued if they didn’t give you progesterone and you miscarry). You can research this topic, you’ll find all the evidence based guidelines recommend not doing progesterone testing or supplementation. Also, it makes you feel crummy. It just amplifies all the early pregnancy symptoms (fatigue, constipation, nausea, breast tenderness) and makes it harder than it has to be.
    On a personal note, my first pregnancy, I went through the same thing. My first progesterone level (which I was annoyed they even ran) was low and my old-school ob told me I was crazy not to supplement. I insisted on another level and it was great. I had a perfectly healthy pregnancy.
    Hope that’s somewhat helpful. Congratulations and good luck!

    • I appreciate what you are saying here about side effects, etc. Every medical intervention has typical risks and costs that must be weighed against typical benefits. However, you seem to acknowledge here that there is some low level beyond which pregnancy success is affected by lack of progesterone, because IVF drugs lower the levels and result in the need for supplementation. Why not also consider then, there are individuals with chronically very low levels that might also benefit from supplementation. If you study “all non-IVF moms” then the benefit to this group from supplementation would be masked, as the majority of moms with naturally adequate levels would numerically swamp the statistical signal you are looking for in the low prog, high risk moms.

      Taking the fluctuating levels comment to heart, what I would do (as I also have Bay Area kaiser) would be to go to your kaiser OB with this test result. The squeaky wheel gets the grease at Kaiser. Demand that they either treat you in network based on this test result (meaning in-network drug access), OR use this out if network test result as evidence to request an in network diagnostic test. My 2 cents.

  4. I’m on the suppositories now. My levels have never been super low but after 4 miscarriages we’re doing everything to try and make this one stick. I would hate to not do it and then lose this one too. I think they cost about $20 for a month supply and I’m pretty sure it’s generic. Putting it up there isn’t so bad but the leakage is horrible! Wear a panty liner!

    • Oops, I just checked and it’s not generic. Also, remember that insurance varies. Mine covers the whole cost with a co-pay of $30 (checked that too to make sure I had the right price) but your may not.

  5. I just got done taking mine. With insurance, my co-pay was $125 a box and a box lasts 15 days. My RE had coupons for $50 off – maybe you can ask and see if they have any? There are no generics.

    Also, if you do get them, take them at night. Use a pantyliner – there is a, um, discharge, that is rather unpleasant and it’s much better to use at night then to do it in the morning. Just sayin’.

  6. First, fight your insurance company for the cost of the ultrasound. It’s considered an OB ultrasound and should be covered by your maternity coverage. It shouldn’t have cost you anything.

    Secondly, I’m a huge proponent of P4 supplements. It saved my cousin’s only successful pregnancy. There are generic options available. Also, does your clinic have a donation policy? I’ve donated all my old meds to the out of pocket patients. OR you can head to a forum and see if anyone has any left overs. I wish I had some left overs I could send you!

    At this point, my P4 levels dropped below 20 and my RE added an extra oral dose on top of my suppositories. Prometruim was ordered and I got the generic “progesterone capsule.” Incidentally, what I’m taking orally can also be taken as a suppository and the total cost without insurance would be $102.29 for a 30 day supply. It’s a tough place to be, but as it is not a ‘fertility” medication but a pregnancy supplement, check with your insurance to see if they’ll cover it.

    GOOD LUCK! And take care of you!

    • See if there’s a compounding pharmacy around your area that makes them and see if the RE would write for a slightly unusual strength (that the pharmacy makes in bulk so it’s cheaper for you) if you want to go with it. It could save you a lot of money over the chain pharmacy price.

  7. My first pregnancy, I asked for progesterone suppositories (I had low progesterone levels in my IF work-up, so I was worried). The OB kind of shrugged and was like ok, if you want, won’t hurt. I can’t remember now what I paid for them, or whether it was covered by insurance (I don’t recall any sticker shock so I’m thinking probably not too expensive). What I do remember is freaking out one day because I couldn’t remember if I’d missed the dose the night before or not. Counting pills and all that. Then nobody told me when to stop and I took them longer than I needed to (to 13 weeks) (if I even really needed to… which I can’t know either way. In any case, I don’t think it had anything to do with my complications later on.)

  8. You know, I think my SIL has progesterone suppositories from when she was pregnant with my nephew. I’m going to ask if she has them and if she’s willing to donate.

  9. When I got pregnant with my daughter, following my missed miscarriage, my doctor put me on progesterone for the remainder of my first trimester. It was a pain in the butt and messy. I paid about $335 or so for my supply.

  10. I am currently on progesterone suppositories. i go to a compounding chemist and they make them for around half the price of the off the shelf ones the only draw back is that the compounded ones have to be refridgerated. so not as good if you have to travel but are $110 (Australian) for 30 as oppoased to $90 for 15 of the off the shelf ones.

  11. I used Crinone after I graduated off of the injectable PIO. But obviously, mine was a post-IVF pregnancy, so the necessity of my circumstance is different than yours. Like Laurie said above, I’d recommend checking out peer-reviewed research (in addition to your regret-management!)– I did extensive checking on this topic since I was looking for a way to convince my RE to switch me from injections to inserts. And what I found is that there is questionable connection between low serum progesterone levels and any sort of positive outcome when “resolved” with supplementation. BUT, if any supplementation is given, the theory is that vaginal suppositories are better than PIO injections or oral doses, because they put the progesterone where it’s needed. Again, this is what *I* found when I was looking at the research, and granted, my research was geared more toward PIO vs other forms AND regarded post-IVF pregnancies, but still. Do some research and then add that in to your feelings regarding worst-case-scenario-what-ifs.

    And maybe ask around for leftovers. I think I paid $20 co-pay for a month’s supply, because mine was not considered an IVF medication, but a pregnancy medication. Have you double-checked that your insurance won’t cover it (or will they flatly not cover anything prescribed by an RE)? Anyhow, I had a box left over after my cycle and I sent it to another IFer who needed it. Surely there might be someone out there who has some to pass along, if you decide you want it!

  12. I second the recommendation to get the suppositories through a compounding pharmacy — after my first miscarriage following test results that included low progesterone, my OB/GYN put me on them during the luteal phase of each subsequent cycle, and she prescribed them through a compounding pharmacy. She didn’t do so for financial reasons — we’re not the Rockefellers, but we could and did throw some money at our fertility issues as needed — but they were cheap. (Success rate: I got pregnant again, only to have an early miscarriage. I noticed no difference in pregnancy-related side effects from my first pregnancy. Third pregnancy also involved progesterone supplements, but that was because IVF was involved.)

    And yes, they are messy. But they’re not horrific. If you can lay your hands on some relatively inexpensive ones, I’d give them a whirl — you know they’re not going to hurt at the very least, and using them will probably make you feel better.

    Good luck!

  13. I used Crinone after my IUIs because I had a short luteal phase and low progesterone. My insurance didn’t cover it for my 3rd IUI so the boxes that I would have needed had I gotten pregnant were $520 (or around that).

    If I were you, knowing that this pregnancy was a miracle pregnancy based on your recent tests, I would take the progesterone supplements. If you do miscarry and there was a way for you to prevent it, that will haunt you. Who knows if you guys are going to get lucky again? And although $500 is a lot, I would think for a miracle baby the progesterone would be priceless.

  14. This is my first time taking the progesterone vaginally. I paid 55.00 out of pocket bc my insurance wouldn’t cover it. I’ve only had 3 doses of it so far. I’ve had 3 miscarriages and my dr thought this would help me. He is a really great dr and I trust him. He took over my case after my third loss. I would rather know that I did everything I could for my baby. If not it would haunt me and I wouldn’t forgive myself.

  15. Pingback: Progesterone suppositories cost

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