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Tuesday, June 03, 2008

Barren Advice: Seven

This is the seventh installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.

Dear Mel,

I have just found out I am pregnant (naturally after IF!) but am wondering what to tell the doctor about my cycle dates.
You see, I didn't ovulate until CD25. So the typical week count from Day 14 will not be accurate to measure growth and predict due dates. But we all know how well doctors listen to what we have to say. In my experience they usually decide (in a somewhat patronizing way) that I am mistaken but I know I'm not. I temp every day and am very aware of when I ovulate. Also, I use TCOYF software.

I suspect that the Doctor will still want to count my 40 weeks from my CD1 which was April 19. This will throw off calculations by almost 2 weeks.
Should I fudge my dates? Should I tell them that CD1 was April 29 in order to reflect CD14 ovulation date which is how they calculate the 40 weeks? Would there be any harm in this? I just don't want to go through the next 40 weeks explaining to every nurse and ultrasound tech that I actually ovulated on CD25. (Assuming that my pregnancy lasts that long.) I know that this seems like a trivial problem to have but I really don't want to have miscalculated times the whole way through.

--Skygirl at
Chasing Blue Sky

My gut says to work from a place of utmost honesty. State the start date of your cycle and the date you ovulated. A doctor who is not willing to work with you to calculate the correct due date and trust that you know your body is not a doctor you want to remain with during the duration of the pregnancy. Switching doctors is easier said than done, but problems can actually arise that go beyond the panic you'll feel when you hear your embryo is measuring behind.

Not using the correct date of ovulation can throw off all testing that is time sensitive--CVS, amnio, AFP tests (alpha-fetoprotein). You may be induced early believing that you've reached your due date--and induction does carry more risk and a higher chance for a c-section than natural labour. It's one thing when induction is unavoidable, it's another when it's being done simply because a doctor will not listen to you when you know your ovulation date.

Back up your words with evidence such as the TCOYF software and a copy of your chart. And truly, a doctor who is rigidly set on Naegele's Rule and can't listen to facts or wishes is giving you a sign that they most-likely will be inflexible later on when you decide you do or do not want other changes to standard protocol.

Another route is to ask your doctor to do a series of ultrasounds early in pregnancy to help determine the correct due date based on growth. The ultrasounds are most accurate before 12 weeks. There is a margin of error as there is with any ultrasound, but you will still be able to get a better sense of the correct due date once you bring together all of the information you have on hand (LMP, the ovulation date, and ultrasound findings).

Stand your ground and put on some ass-kicking shoes before that first appointment just in case you need to kick a little ass in order to have reality heard.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

Leave a comment in the reaction box below--only keep in mind that conflicting advice is embraced and rudeness is not. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday's installment of Barren Advice


Jess said...

I agree with Mel!! If your doc is too bullheaded to listen, you don't want him (or her) treating you in other areas. I recently dealt with a doc with a decent God-complex and it was hard butting heads with him throughout my pregnancy when I KNEW I knew what I was talking about.

(ALTHOUGH as a SIDE, if you really honestly want to remain with your doc and really don't think he or she will listen to you, I can't see harm in fudging the dates to make the correct in his or her mind. If you feel safe and trust your doc, and think this is just one time that he or she will not listen, I say go for it. But I'd rather get them to see logic, like Mel said, and it seems to ME that with a chart and evidence, there's no way they can't see the O date!!)

Good luck!! I'll be following, of COURSE...I'm sooo excited for you!

Anonymous said...

I agree with Mel, and thank you for asking this question! My cycles range anywhere from 39 days to 110 days (my personal world record!) so I've always known that if (and when! :) I do get pregnant and it's an un-monitored cycle, it's not because I ovulated on CD14. I've always pondered what to tell the doctor regarding CD1. It's that annoying thing from our parents again...honesty is the best policy. Lots of luck!

Jess said...

You know, I was just thinking of this (too much time on my hands, see? And I have two 6 months apart, you will be FINE) and maybe you could ignore the CD1 question by hedging and telling him when you ovulated. Just say you don't know for sure when your period started, but you DO happen to know when you ovulated...THE LUCK!

Ellen K. said...

That's a good question. I am currently PG after IVF and as such do not have a real LMP date, but I say at each appointment, "My egg retrieval was X date, so please subtract 14 days to get the last menstrual period date." And I think you could do something similar based on ovulation date.

Kathy V said...

Well coming from a person that ovulated on day 21 of a cycle, I have had this same problem a number of times. When I called and they scheduled the first ultrasound they did it during week 5. I told the us tech the ovulation date does not match with the lmp. she wrote it down but they wanted to check after 6 weeks when they could detect the heartbeat. They did and ultrasound tech confirmed dates of pregnancy matched with ovulation and not the lmp. They told me to call and schedule an appointment. I did. They asked me for the lmp. I told the receptionist that the lmp did not match ovulation and was greeted with a "Whatever that means." I figured she was just the receptionist and only knew about scheduling and not pregnancy week dates. The doctor confirmed the ultrasound tech was correct and pregnancy did match with ovulation and not lmp. However, I have had to double check all prescriptions for timing to make sure they used the correct week count instead of lmp. I had one for bloodwork that was almost a week and a half off of when they really needed it. Plus they have already given me a script for a necessary shot of rhogam that has the wrong date on the top. I have had to answer this question and explain this everytime. If I had to do it all over again, I would have fudged the lmp so that the ovulation date matched and told only my doctor the real information. Cause putting in the true lmp has caused me nothing but hassle with nurses and receptionists.

Kathy V said...

The other thing you can do like somebody else pointed out is tell them the ovulation date and tell them you can't remember when your lmp was. They will calculate based on ultrasound progress then and you don't have to fudge. You can just say you can't remember.

sky girl said...

Thanks everyone!

It's not so much that my doctor won't believe me, but you know for every ultrasound you get a new tech and they all ask the same thing. LMP? So, it gets so frustrating to explain it over and over again and often I find a patronizing look coming my way.

Michell said...

I agree, if the doctor won't listen to you, it's time to find a new doctor. It may be difficult or a pain in the hiney but a doctor like that doesn't have your or your babies best interests at heart. Good luck and congratulations.

kate said...

I only have one thing to add, and really it's just an emphasis, but I spent the better part of my teens and 20s under the care of miscellaneous doctors who either didn't take me seriously or who were neglectfully undereducated about what is normal or not, and it set me back substantially in my physical health journey. First and foremost, obstetrician or otherwise, FIND A DOCTOR WHO BELIEVES YOU. Period. It is one of the most important things a woman can do for herself is to develop a good relationship with a doctor who believes them.

Jen said...

I vote that you tell the doctor the whole story, but just give the simple answer for everyone else, like nurses and technicians. It will give them the same answer and it saves you having to go through the whole spiel each time. I mean, I've gotten tired of explaining a short cycle, so I've just given up and I am nodding along with what they say. Also, my practice has six different doctors and one of them absolutely refused to believe that I actually knew when I ovulated. I gave up and just discussed it with a different doctor the next time I came.

ms. c said...

I like the idea of telling the Doctor and U/S techs the day you ovulated.

I ran into this problem particularly at the END... my IUI was on cd 16, so my due date by my LMP was 2 days earlier. All along it did not matter (also, it was of no worry to any U/S tech as the baby always measured big). However, I feel if I had been insistant with my dr from the beginning about the 2 day discrepency it would have bought me 2 more days where my dr wasn't "forcing" an induction on me. (and yes, with this dr, sadly 2days really made a difference...)

In summary: please just make sure that your chart really reflects your dates!!

Tracy said...

We actually ran into this because we did IVF with an egg donor, and they coasted me for a few days, so the date of my LMP and the retrieval (ovulation) date did not match up.

When I told my doctor, HE actually fudged the date of my LMP for purposes of determining a due date for their paperwork...

My OB's office never looks at the LMP date; they strictly work off the due date that my OB calculated at our first visit. The little wheel they all whip out works off that due date, so my LMP is never an issue.

Karen said...

It's not the doctor believing you I'm worried about. I had this problem with my triplets. My due date was off by a week because I triggered a week late and had my IUI on CD 22 or 23.

So while ALL of my DOCTORS agreed with me throughout my pregnancy as to what my actual due date was and how many weeks pregnant I was, when I was admitted to the hospital, the nurses entered my LMP into their computers in addition to my EDD.

Unfortunately, this meant that when I delivered my triplets at 33 weeks exactly, the NICU recorded their births as 34 weeks. Not a big deal, right? Au contraire. This actually posed a problem with insurance for coverage for some care for them, because sometimes HOW premature a baby is will dictate how much care the insurance decides they need. It also dictates whether a baby is "small for gestational age", etc.

If I had my life to live over again, I would have lied about my LMP when I got admitted to the hospital, or at least told them that I could remember when my LMP was, even though I was completely honest with my team of doctors.

Just my $0.02

Rachel said...

I'm going to go ahead and disagree and say fudge the numbers. Although it is important to have a doctor who listens to you, the receptionists, techs, and nurses have a fixed list of questions and they are usually too rushed to pay attention to your answer. By all means tell your doctor when you see him or her, but don't use the real date in your answer. Since I am completely anovulatory, except when induced with a large dose of drugs, (an answer nobody ever believes), I have taken to answering 1992. At least it gets their attention that they cannot precede as normal.

sky girl said...

Well I went to my doc yesterday and told her that the date of my LMP wouldn't matter much because I ovulated around CD25. She went ahead and ordered an ultrasound to determine dates so that there wouldn't be a question. I still don't really get why they can't take my word for it and count 38 weeks from my ovulation date but whatevs. What can you do?

Thanks everyone. I appreciate all your thoughtful advice.

Liza said...

My LMP/OD discrepancy is only two days, but using LMP gave me an EDD of 9/11.

Um. No. Not ok with me.

I fudged the LMP date to make them align. New EDD 9/9.