Clear Blue cont.(long)

[Guest guest]

Dr. Fehring,

In regards to the client of mine with PCOD and her combined use of CrM and the Clear Blue Monitor, thanks for your response below. Here is my attempt to learn more about this as I have a feeling that I will see more clients with it.

"What might the fertility monitor tell you and her":

that her ovaries are producing enough estrogen to trigger a high reading on the monitor (i.e., a threshold of E3G) Assuming I guess that the PCOD, or the residual aldactone, or a diet too high in soy didn't give the reading. And what about stress, her wedding is in 10 days. How does that factor into readings? As well as how the urine was collected in the first place, stream vs. dip. There just seems to be a lot of things that could effect the results. I would have a had time trusting the machine but I certainly don't have the experience or knowledge to feel confident about it.

that for her first two cycles – she did not reach a threshold of LH – and probably did not ovulate – i.e., 2 anovulatory cycles. OK, so the first 2 cycles of being off the aldactone did appear to have an anovulatory mucus pattern with no clear peak day and no peak reading (3 bars) on the monitor.

that for her third cycle she reached a threshold of E3G (high reading) and then a Peak (LH). Will wait to see the length of the luteal phase to see if this was probably an ovulatory cycle--- I will be interested in knowing. She did say she emailed you and so you are aware that her 3rd cycle off the aldactone did show a peak, that she was very confident of, and the monitor appeared to correlate well with her peak day. That is, a 3 bar reading on the day she saw the days of the greatest quantity and quality of peak type mucus and then on P+1 it dropped to 2 bars and Peak +2 and +3 it was down to 1 bar. (She is charting these bars right above her observation recordings, enough to make a CrM teacher go batty dealing "extraneous markings"!) I still think that her LH was suppressed by the Spironolactone until it cleared her system (I could be wrong about that) Was it 2 weird cycles due to her PCOD or the aldactone, who could say for sure. She was on the aldactone for several cycles and in most cycles, 8 out of the 11 , you could identify the peak; although the pattern and type of mucus did fluctuate which was confusing to her as a new user. I don’t know why she could not use the monitor with post (monitor peak LH) HCG treatments -- since the HCG would not affect the E3G and LH testing post LH Peak. She is starting the HcG 2,000u IM this cycle for P+5, 7, and 9; she missed P+3. They want to continue cross checking with the monitor and hope the HcG will help stabilize the cycle and relieve her PMS symptoms- hot flashes, insomnia,cramps, breast tenderness, etc. But they were also concerned about the cost of the Clear Blue monitoring; a $1.00 per stick each day to check the urine? You could call Dr. Machelle Seibel – the medical affairs person at Inverness Medical -- Dr. Seibel is Professor of Obstetrics and Gynecology and Director of the Complicated Menopause Program at the University of Massachusetts Medical School and Editor-in-Chief of Sexuality, Reproduction, and Menopause -- a journal of the American Society for Reproductive Medicine. Tel: and ask him about use of the monitor – he has written a number of textbooks on infertility Thanks, the fiance is an Internal Medicine resident so I will pass this on to them if they want to dig into this deeper. I do not why she cannot use the monitor along with charting mucus changes if she wishes – my experience with charting mucus with PCOD is that the cycles are very confusing as well --- with a lot of estrogen stimulated mucus unrelated to ovulation. If everything is working right – the LH and mucus peak will correlate. Yes, it looks to be correlating so far but I am already concerned that this is effecting her CrM observations. She had some big changes on her routine of checking mucus this follow up that she felt were due to her reliance on the monitor. I encouraged her to try to get back on track in case of problems with monitor, running out of sticks, forgetting to take it on a trip etc. Comments? This year the president of Ireland will be at Irish Fest. Bono?! ( Sorry friends from Ireland, no offense, I just see him all over in the press.) Thanks for the web site on foreign car parts --- will look at it when my Subaru needs a new strut! Happy to oblige.....but what I meant was www.aafcp.org !

Thanks for you help!

Theresa McGuire RN, CFCP

[Guest guest]

Nurse McGuire:

Bono? The president of Ireland is McAleese!

As mentioned in a previous e-mail the use

of the Clearblue fertility monitor is not recommended by the manufacturers (Unipath

or Inverness Medical) to be used for somebody with PCOD or with hormonal therapy.

Our experience and that of other NFP teachers who have used the monitor in

teaching NFP find that once the PCOD is treated effectively – the monitor

can be used with little problem.

I was just trying to point out even if the

monitor is not recommended it “might” give you or the client some useful

information. Furthermore, NFP charts with cervical mucus and BBT are often

confusing with a person with untreated PCOD – or during hormonal treatment

– but the charts do provide you with information.

If you are not confident with the monitor

and the client/couple find it too expensive and confusing --- it probably is

best not to use it. But is the information from the monitor

confusing or is the menstrual cycle from the woman confusing and the monitor

just reflecting that confusion? As Dr. Zinaman (Chair of Reproductive

Endocrinology at Loyola

University Medical

Center) mentioned at one

of our NFP conference several years ago, the monitor provides a direct measure

of the hormones (E3G and LH) – whereas, cervical mucus and BBT and electrical

resistance are reflections of those hormones. Typically the monitor will ask

for 10 tests per cycle – which will cost from $18-25 dollars/cycle –

about the same as use of the birth control pill.

I would point out that at Marquette we teach the use

of self-observation of cervical mucus, the use of the hormonal monitor, and

BBT if desired. Many of our couples choose to use mucus only, some use both,

some only use the monitor, and some BBT, Monitor, and Mucus and some use SDM

with Cyclebeads.

Do some couples get careless with mucus observations

when using the monitor – yes – we encourage consistent observation

of cervical mucus with these couples. Do some couples who use mucus only

get careless – yes – again we encourage consistent observations. I

find it hard to comment on one client’s use of the monitor without knowing

the whole picture.

I heard that when the Billings were first

teaching NFP – that the women used both BBT and mucus – but eventually

the women found the cervical mucus sign sufficient and accurate and stopped

using BBT. I suppose that is the same for women who use both mucus and

the monitor – some will find the use of the monitor sufficient and

accurate.

I wish you well working with your

challenging but NFP faithful couple.

Nurse J. Fehring

Marquette

PS – Nurse McGuire – how much

does HCG injections cost?

From:

nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of datmcg@...

Sent: Friday, July 08, 2005 8:39

AM

To:

nfpprofessionals

Subject: Clear

Blue cont.(long)

Dr. Fehring,

In regards to the client of mine with

PCOD and her combined use of CrM and the Clear Blue Monitor, thanks for your

response below. Here is my attempt to learn more about this as

I have a feeling that I will see more clients with it.

" What might the fertility monitor tell you and her " :

that her ovaries are producing

enough estrogen to trigger a high reading on the monitor (i.e., a

threshold of E3G) Assuming

I guess that the PCOD, or the residual aldactone, or a diet too high in

soy didn't give the reading. And what about stress, her wedding is

in 10 days. How does that factor into readings? As well as how

the urine was collected in the first place, stream vs. dip. There

just seems to be a lot of things that could effect the results. I

would have a had time trusting the machine but I certainly don't have the

experience or knowledge to feel confident about it.

that for her first two cycles

– she did not reach a threshold of LH – and probably did not

ovulate – i.e., 2 anovulatory cycles.

OK, so the first 2 cycles of being

off the aldactone did appear to have an anovulatory mucus pattern with no

clear peak day and no peak reading (3 bars) on the

monitor.

that for her third cycle she

reached a threshold of E3G (high reading) and then a Peak (LH). Will

wait to see the length of the luteal phase to see if this was probably an ovulatory

cycle--- I will be interested in knowing. She did say she emailed you and so you are aware

that her 3rd cycle off the aldactone did show a peak, that she was very

confident of, and the monitor appeared to correlate well with her peak

day. That

is, a 3 bar reading on the day she saw the days of the greatest quantity

and quality of peak type mucus and then on P+1 it dropped to 2 bars and

Peak +2 and +3 it was down to 1 bar. (She is charting these bars right

above her observation recordings, enough to make a CrM teacher go

batty dealing " extraneous markings " !)

I still think that her LH was

suppressed by the Spironolactone until it cleared her system (I could be

wrong about that) Was

it 2 weird cycles due to her PCOD or the aldactone, who could say for

sure. She was on the aldactone for several cycles and in most cycles, 8

out of the 11 , you could identify the peak; although the pattern and

type of mucus did fluctuate which was confusing to her as a new user.

I don’t know why she

could not use the monitor with post (monitor peak LH) HCG treatments

-- since the HCG would not affect the E3G and LH testing post LH

Peak. She is starting the

HcG 2,000u IM this cycle for P+5, 7, and 9; she missed

P+3. They want to continue cross checking with the monitor and

hope the HcG will help stabilize the cycle and relieve her PMS

symptoms- hot flashes, insomnia,cramps, breast

tenderness, etc. But they were also concerned

about the cost of the Clear Blue monitoring; a $1.00 per

stick each day to check the urine?

You could call Dr.

Machelle Seibel – the medical affairs person at Inverness Medical --

Dr. Seibel is Professor of Obstetrics and Gynecology

and Director of the Complicated Menopause Program at the University of

Massachusetts Medical School and Editor-in-Chief of Sexuality, Reproduction, and Menopause

-- a journal of the American Society for Reproductive Medicine. Tel:

and ask him about use of the monitor – he has written a

number of textbooks on infertility Thanks, the fiance is an Internal Medicine resident

so I will pass this on to them if they want to dig into this deeper.

I do not why she

cannot use the monitor along with charting mucus changes if she wishes

– my experience with charting mucus with PCOD is that

the cycles are very confusing as well --- with a lot of estrogen

stimulated mucus unrelated to ovulation. If everything is working

right – the LH and mucus peak will correlate. Yes, it looks to be correlating so far but I am already

concerned that this is effecting her CrM observations. She had some

big changes on her routine of checking mucus this follow up that she

felt were due to her reliance on the monitor. I encouraged her to

try to get back on track in case of problems with monitor, running out of

sticks, forgetting to take it on a trip etc. Comments?

This year the

president of Ireland will be at Irish Fest. Bono?! ( Sorry friends from Ireland,

no offense, I just see him all over in the press.)

Thanks for the web

site on foreign car parts --- will look at it when my Subaru needs a new

strut! Happy to

oblige.....but what I meant was www.aafcp.org !

Thanks for you help!

Theresa McGuire RN, CFCP