Concerned about progesterone levels - spotting 3 days before AF with low temps

[lisaf]

Yeah, there are many doctors who have trouble wrapping their heads around the LPD. (heck, I had the nurse at my GYN's office tell me some total crap about how I might only get a faint line on a pregnancy test because the egg was still traveling down my fallopian tubes... ummm.. yeah right )
I think its because many women with a LPD may not have too much trouble getting pregnant. Implantation can happen as early as 5dpo, so just statistically, some women are going to have implantation happen then before their corpus luteum stops making progresterone.
Again, I do think the HSG might have helped clear things out so the egg could travel down faster and implant earlier than it might have for my 2 suspected chemical pregnancies.

An IUI could help even if its just a tilted cervix etc. Depends on your financial situation of course, IVF was never going to be affordable to us, even IUI was going to be a stretch (of course if you were guaranteed success, then finding the money would be easy, its just so hard to spend that money and then possibly face failure).

My acupuncturist told me that with chinese herbs and acupuncture she got a girl with PCOS and 60 day cycles down to a perfect 28 day cycle. So it really can work for some issues.

 

[DaisyQ]

Hi Lisa,

I think you are exactly right - because some women with short LPs do get pregnant, LPD gets discounted. I am reading two books at the moment - The Perfect Balance by Robert Greene (RE), and Making Babies by Sami David (RE) and Jill Blakely (?) acupuncturist. In Greene's book he says progesterone under 20 a week after ovulation warrants progesterone support. Mine was 17. In David's book, he recommends iui (x2) with progesterone support. I am going to lobby hard for progesterone support, whether its with natural cycles, medicated cycles, or iui cycles.

Of note, I do have a tilted uterus. I'm not sure about my cervix specifically.

I do intuitively feel that iui would help us bypass any cervical or uterine positioning problems, and also dh's suboptimal sperm morphology. I guess what I really want is iui with progesterone support... Maybe unmedicated first, then medicated, as I seem to be ovulating normally, unless I have LUFS.

I'm glad to hear that you feel the HSG helped. Perhaps I should just give it a few more natural cycles after the HSG? Getting impatient though!!

 

[lisaf]

you may have better success at combining the HSG benefit with another treatment, so don't 'put off' any treatment plans to give the HSG alone a try

Also... there are 2 different ways of measuring progesterone. In the US we use one method where the 'normal' 7dpo progesterone level is 10. In the UK they use a different method where the 'normal' 7dpo progesterone level is 30. In the UK measurements a 20 would be considered the equivalent of about a 6.5 in the US levels (which is about where I was hitting). So you have to be careful when comparing levels and make sure you know what method of measuring they use.

My GYN admitted that my levels were low, but said they indicated ovulation so the clomid was working and upping the clomid wouldn't do anything else for me. He turned out to be wrong.
A 17 is actually really good for US levels. A 10 is considered normal for an unmedicated cycle, a 15 is normal for a medicated cycle.

The highest I ever got before my BFP cycle was an 8 and I suspected I had a chemical pregnancy on that one.

I have a friend that had good luck with vitex... I don't think she had low progesterone like me but she did have an LPD. Different things work for different people, you know?

 

[DaisyQ]

Thanks Lisa. I will move forward I think with treatment to take advantage of the increased fertility after the HSG.

The doc who wrote the book is American and practices in CA. I know that my progesterone level is considered good, and a definite indication that I'm ovulating, but according to this RE, it is possibly low enough that progesterone support might help implantation. He is basing this on research, but I don't know of the specific studies... I think I'm going to have a very hard time convincing the RE to go for it. But I really feel that it can't hurt and especially if I'm going through the expense and stress of IUI etc., I'd like all the help I can get to nudge implantation along.

 

[lisaf]

Well, my RE did tell me that the number 10 was arrived at by testing women's progesterone levels on day 21 and seeing who got pregnant. Those who got pregnant had levels 10 or above or something like that. You do have to figure that the cd21 may not have been 7dpo for all the women so there would be some fluctuation.
I would be interested in the newer research that author has referenced... and if its been duplicated etc

 

[DaisyQ]

Me too! I am reading the book on my kindle, so I'll look at the appendix when I'm done to see if there are references listed.

Also - just talked to my friend who referred me to the RE I am seeing. She is due on April 5th, and got knocked up on her first round of IVF. She had been trying for 4 years previously, and had tried clomid and IUI without success. Anyway... it was very reassuring. She said that our doctor is very flexible and willing to let the patient direct the course of treatment, and is willing to be as aggressive or nonaggressive as we like. Nonaggressive being natural cycles with or without monitoring, and aggressive being meds and IUI or IVF. She said that at least with IVF, progesterone IS given, no matter what. In talking to her, and you, I feel like I want to move forward sooner rather than later. She said her biggest regret was waiting SO long to go to IVF (4 years of trying). She said there was no obvious problems for either of them except her husband also had suboptimal morphology (5%, and my husband is at 6%). Personally, I'd like to try IUI and/or meds before jumping right to IVF, so my tentative plan right now is:

Cycle 7 (current) cycle - HSG and natural cycle, with progesterone support if the doc agrees to let me try it.

Cycle 8 - Medicated (clomid) cycle OR unmedicated IUI, hopefully with progesterone support

Cycle 9 - Medicated IUI with clomid, with progesterone support

Cycle 10 - One more try - medicated IUI, with progesterone support

Cycle 11 - IVF...

That's my plan for now... Hopefully I will be prego by July! I realize this sounds a bit aggressive, but my friend made me feel reassured that the fact that I've never been pregnant, never even a chemical, suggests that I really may need some help. She was in the exact same boat and they never found a problem with her, and her husband's only problem was his morphology, which is very similar to my own situation.

 

[lisaf]

yeah, nothing wrong with being aggressive! The only reason to wait or be less aggressive is if your financial situation is limited.

I do actually know a girl from here who did several clomid rounds, IUI etc, and while waiting for her IVF cycle she got pregnant naturally (she had already paid for her IVF treatment too, lol... got a refund)... so there is an advantage to taking a break here or there too.

 

[DaisyQ]

There are so many stories like that! My husband and his ex used clomid to conceive their first child. With their second child, they tried IVF and it failed. They took a break, and during their break, she had the HSG and conceived my youngest stepdaughter. So I guess the moral of the story is that there is always hope.

 

[DaisyQ]

So a mini update on me - had the HSG, no blockages. Still bleeding though 4 days later (grr). Saw the RE today and next cycle we are going to try IUI with Clomid and trigger shot. We'll try a few rounds of that (2-3) before considering IVF. If the IUI doesn't work, I may take a break and do a few more natural cycles before going to IVF. We'll see. Hoping the HSG has me primed and ready to go, and that I get knocked up this month or next!

 

[lisaf]

good luck! so glad everything is clear! Keep me posted

 

[Renee413]

So I am hoping someone still checks this thread. I am just looking for some advice and/or suggestions.

I had a m/c in 2009 after our first round of Clomid. It was really early. Got a BFP, bloodwork showed hcg at 31, started bleeding 5 days later and my hcg was already down to a 3.

Fast forward to September 2011. I had an infertility appointment and left with a prescription for Clomid. 6 days after that appointment, I realized I was late for AF, tested BFP! (we had been trying naturally since the m/c in 2009). Bloodwork was indeterminate at a 21 progesterone at a 2.5 (yes 2.5), repeat test two days later, hcg 42 progesterone 2.1! Start bleeding a couple days later, hcg at a 55. m/c right? Dr monitors my levels, bloodwork the following week shows hcg at a 380, then 740, ultrasound Oct 3 reveals pregnancy in my right tube. Methotrexate did the trick, hold off on TTC for 3 months.

January 2012. Green light to TTC again, start the Clomid. + OPK on CD16, CD21 (yeah not 7DPO) P4 shows 8.3, not terrible according to my doctor. February 4th I get a BFP. Bloodwork two days later shows an indeterminate level hcg at 18 progesterone at 9.5. I am feeling good...repeat bloodwork 3 days later. hcg 39 progesterone 6.9?!?!? My DH picked up 200mg compounded suppositories last night, I got to put one in, brown spotting. I still put it in. Wake up this morning, light brown spotting still. No cramping though and no red blood <knock on wood>

This is my 3rd pregnancy and no children! I am frustrated and feel defeated. I go in for just hcg on Monday but I am not sure that will be any good...my doctors view on my progesterone levels seem idiotic. An 8.3 after O, on a medicated cycle, seems ridiculously low! Even with my hcg 39 p4 6.9 bloodwork on Thursday, the nurse said he doesn't think I need suppositories but I demanded them! I need to know I am doing everything I can...

any insight??

 

[DaisyQ]

I'm so sorry for your losses. This must be incredibly frustrating. not a doctor, but those progesterone levels do seem low, and possibly too low to sustain pregnancy, which sounds like what you must be thinking as well. The suppositories sound like a great idea, and if this one doesn't stick (FX it does), I would chart, and take them immediately, once ovulation has been confirmed. I'd also look into getting a second opinion from a different fertility specialist.

 

[lisaf]

WSS^^ Sorry for your losses, that is so rough
You're doing everything you can right now with the suppositories. They are the strongest thing you can do and the only 'harm' they can do is prevent you from miscarrying even if the pregnancy is no longer viable, so ultrasounds and/or HCG bloodwork are a very good idea (not necessary, but it would at least keep you knowing everything is going well)
I agree though, if this doesn't work out (knock on wood!) then you should see someone else. My progesterone was always low until I got a higher dose of Clomid - my GYN said there was no point to giving a higher dose of clomid but my fertility doctor said that increasing the dose would be his first choice to give me a bigger follicle to give me a bigger corpus luteum.

 

[Renee413]

thank you so much for posting! I would like to say that I started those suppositories Friday night (with the brown spotting) and haven't seen it since Saturday afternoon! They stopped testing my progesterone but have continued to monitor my hcg. I think we got off to a slow start...

18 --> 39 Doubling time = 60 hrs
39 -->143 Doubling time 50 hrs
143 --> 408 doubling time 33 hours!

I am praying the suppositories are the key to this turning out successful. I find out tomorrow when I get my early ultrasound (need to make sure its not in my tube), its either Friday or Monday so I am hoping for the best and preparing for the worst...thank you both so much!

 

[DaisyQ]

Congratulations!!

 

[ttcsince2009]

Congrats!

 

[lisaf]

What happened with the ultrasound?

 

[Renee413]

Unfortunately, this story did not have a happy ending! betas were rising great, 1st u/s, no sac seen anywhere. 2nd u/s, no sac in uterus, mass attached to my ovary, suspected ovarian ectopic, sent to hospital for methotrexate. Doctor didn't give it to me, said he wasn't convinced it was ectopic, possibly a cyst. 3rd u/s, no sac in uterus (levels 5000) confirmed tubal ectopic! sent for the MTX that day. 4 days later (Tuesday 2/28) first blood draw after MTX showed my levels went from 5,000 to 7872, a slight rise is expected, this was too big of one. Doctor has us come in last Wednesday, tells me he is worried and wants to take my tube. Had surgery that afternoon where once he got in there, it was starting to rupture and was bleeding (thank god we did the surgery when we did!). So, now I am left side tubeless, right side damaged from 1st ectopic. Out Dr. recommends IVF at this point, because I apparently look like I have thousands lying around, lol 2 back to back, opposite side ectopics, how unlucky can I get?!

 

[DaisyQ]

Oh man, I am so, so sorry. This is really terrible news.

Does your insurance gave any infertility benefits?