Question:
Hello Dr. Ramirez,
I am turning 34 later this month and have been trying to get pregnant for the past 4 months. I never have any spotting during the first half of my cycle, but have had light spotting usually for 3 - 5 days before my period starts (as long as I can remember except when I was on the pill). About 7 years ago my doctor did some tests and sent me for an ultrasound and when he found nothing wrong, put me on the pill to regulate this. I stopped using the pill about 3 years ago and have lived with the light spotting (starts very, very light and gets a bit heavier each day until my real period starts - usually starts on Day 27 to 32 of my cycle).
Over the last 4 months, I've been recording basal body temperatures while trying to get pregnant. I've noticed my temperature only stays high for about 8 days. It drops usually on the 9th day and the day after that very light spotting starts. After doing my own research, I'm concerned that I may have a luteal phase defect and need some sort of progesterone to help get/maintain a pregnancy. I went to my doctor and he said I would need to try for a year regularly before determining I have a fertility problem and he doesn't think testing is necessary yet even thought I think my temperature readings and spotting indicate there may be a problem. I understand it may take a while to get pregnant, but if there is a possibility of a problem that could be helped with progesterone, I would rather find out now than wait until next year when I'll be almost 35. Especially if I do need a referral to a specialist at some point, it could be a 6 month wait to get an appointment.
Does it sound like I may have a problem (hopefully treatable) or should I continue trying for another 6 or 8 months before undergoing any testing?
Thank you very much for your help, L. from Canada
Answer:
Hello L. from Canada,
I have had many letters from Canadians lamenting the fact that their Physicians are uncooperative and it is a long wait to see a specialist. You certainly have not tried long enough on your own to warrant an infertility evaluation, but I am surprised that you doc won't give you progesterone supplements. It is such a simple thing with no side effects and potentially helpful.
Yes, the BBT findings and pre-menstrual spotting are consistent with LPD. The diagnosis is made with an end cycle endometrial biopsy for dating. Since your doctor won't do that, we can make the assumption and you should go on progesterone supplements. There are many sources of natural progesterone. I believe you can even get natural progesterone creams in health food stores. I will usually prescribe the pharmaceutical versions such as Prometrium, Endometrin, Crinone or Prochieve. You have to take them starting from day #16, but the problem is that the supplementation may prevent your natural menses from starting because it is the dropping of the hormones that leads to a menses. So, you would have to do a pregnancy test to see if you are pregnant then stop the meds if you are not (you would continue them if you are).
For now, I would recommend that since none of this is easily obtainable for you, you should continue trying on your own for the next six months. If you should become pregnant, the pregnancy will produce the hormones that you require via the corpus luteum cyst that forms from ovulation.
Follow-up Question:
Thank you. I really appreciate your response and think I will go to a walk in clinic next month to at least get a day 21 progesterone test to have some idea of my levels.
I started taking a B50 complex vitamin this month as some women have reported B6 helps with the luteal phase (contains 50 mg of B1, B2, B3, B6, Pantothenic Acid, Choline and Inositol; 50 mcg of B12 and Biotin; and 0.4 mg of Folate.) Would there be any known problems with these vitamins if I were to become pregnant? I am also taking a prenatal vitamin that contains very low amounts of the above noted vitamins (except for Folate which is 1 mg in the pre-natal). Again, thank you very much for your help. It is very much appreciated.
Answer:
Hello Again,
It is okay to continue those vitamins for now, but discontinue them should you become pregnant and stick with the prenatal vitamin only.
Good luck with your treatment!
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.
She shouldn't assume that CD21 is the right time for the progesterone test... I thought you wait till 7dpo? I mean, if she normally O's later, like after CD14.... I am interested if I understand this correctly! Thanks!
ReplyDeleteHello Georgette,
ReplyDeleteTechnically you are correct for the patients that have a longer proliferative phase. But that would require a little more sophisticated monitoring and being followed by a competent infertility doc. The majority of patients have cycles within the 30 day range so a CD#21, 22 or 23 progesterone would be sufficient.
Dear Dr. edward, Thank you for your blog. i love it is helpful. am writing from Uganda.
ReplyDeleteQuestion.
i have had ivf 6 times, one resulted in a pregnancy 3 year old now in 2008, and have since been on the roller coster ride of ivf since with no success. in the follow up ivf, i have used gonal f, always produce 6-9 eggs, did amh, this year and levels were normal, we have severe male fact and always do the ICSi, however this time round got 12 eggs but only 4 fertilized, and throughot after transfer use 50mg, or gestone since its the one i had a success on after failure with utrogestan. am wondering can i continue taking the 50mg of getone injection in the morning aand maybe add200mg of utrogestan at night, as i have on the last 4 cycles bled before test day. now Re added progynova 2mg twice a day.
many thanks for your fast response.
Yes. I use both injectable and vaginal progesterone.
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