Mumsnet Talk

Hi there....i am looking for some advice.

My husband and I are trying to conceive out first child. I am 27, he is 37.

We have been trying since May but my periods have been irregular, and my acne has flared up again since stopping the pill.

The length of my cycles have been as follows: 53 days, 50, 36, 37 and 43 (31st December 2011).

My doctor sent me for blood tests (Hormones) which needed to be 2 weeks before my period came...which is hard to judge! I went on the 31st Jan and got a call today from surgery to go in, despite not having my period yet and knowing whether or not these bloods will be 'valid'.

I asked for my results over the phone in the meantime (appointment not until next Tues) and everything was OK apart from progesterone which was a level 10 "unlikely to Ovulate - see doctor?"

I have no idea what this means for us and am worrying - and as i have to wait a week to see the Doctor, i wondered if anyone here could provide some insight?

Many thanks.

Sounds like the symptoms and cycle lengths I had before I was diagnosed with Polycystic Ovaries from a blood test.

Think there are many things they can do to help women with PCOS conceive if it is that.

I have PCOS and have 2 children, both conceived without any treatment at all, although the youngest it did take a while to happen x

Hi ladybe - I'm not sure why you were told to go in 14 days before your period. Unless I am missing something, progesterone tests should be done 7 days after ovulation. With such long cycles this will be quite difficult for you to pinpoint. Do you chart, or use OPKs? Are you still on a long cycle now? Because it sounds like you did the test at the wrong time,I.e before ovulation.. I would push for a referral to a gynae because you should try and find out why your cycles are So long. Clomid/metmorphin (sp) are often prescribed for ovulation problems. Don't panic though, there is so much they can do now!

Also I echo Reggae - didn't want to diagnose you but I have friends who had similar cycles and they were told they had pcos. If it is you should also look into diets as my good friend controls her through diet.

Thanks for the responses - i also have a friend with PCOS and i am worried it might be that. I'm afraid I don't know what charting or OPK's are??

The doctor said that my period needed to be within 14 days after the blood test, appointments are only ten minutes long so there wasn't much time to go into details unfortunately.

Thank you for responding Joycep - generally I do try to eat healthily, i enoy fruit and veg every day, and as I am 6ft and come from a tall family, I struggle to gain weight and am technically underweight at 9st...but I have never managed to get above 10st despite trying with build up drinks etc.....i don't know if that could be a contributing factor??

Your dr sounds like he/she doesn't know what he/she is talking about. A progesterone test to confirm ovulation should be taken 7 days after ovulation, or if you don't know when you ovulate, 7 days before you think your next period is due. The level at 14 days before, roughly when you ovulate is irrelevant for confirming ovulation. 10 would be too low to confirm ov if it had been taken at the right time. Most labs say over 30 is indicative that ovulation has taken place.

The irregular cycle lengths could be indicative of PCOS. Exerising regularly and eating a low GI diet should help. If you are at all overweight, losing the excess in a healthy way should also help.

NB OPKs=ovulation predictor kit, you can buy them in chemists or online. They detect the hormone that surges just before ovulation. Charting=temperature and other signs charting on a site like Fertility Friend. If you ov, you should get lower temps pre-ov and higher temps post-ov. It's helpful for getting to know your cycles.

As eurochick says sounds like GP has done day 21 progesterone but is likely to be the wrong time. Usually say 7 days before period due. Also should have day 1-5 fsh lh TSH testosterone. Other half needs sperm analysis and you prob should have pelvic ultrasound better to get these test on the way before referral so they have them appointment

Both OPKs and temp charting are of no use at all if the menstrual cycle is this irregular. It may be that PCOS is to blame here; it is a common cause of consistently irregular periods.

The GP should do a day 3 test to test your levels of LH and FSH; I would put money on it that your LH level if tested is higher than your FSH (again this could indicate PCOS if this is the case). As periods are irregular as well the blood tests can infact be done according to calendar days so if your day 21 is low they should and can do a day 3.

GP should refer you to the subfertility unit now and do not take no for an answer. Do not let GP further muck around in ignorance; PCOS if it is present is outside a GPs remit.

Thank you Attila for you response, it's a relief to know that charting wouldn't have helped much because I wouldn't like to think I might have missed out for not researching properly etc.. (I hadn't even heard of charting - especially as we were trying not to put too much stress on ourselves).

It is a concern that my GP may not approached this correctly - is there really no benefit of the blood test that I had (other than to rule out diabetes etc.. that I was also tested for).

I'm afraid I don't know what a day 21, or day 3 are...but i will be sure to push my GP for the referall next week. We also have Bupa, but I suspect this is not covered??

Most health insurances don't cover fertility-related stuff. You might get a cooperative dr who will refer you for non-fertility related investigations. For example, my friend had huge amounts of pain due to endometriosis. She got this dealt with under her health insurance. She was ttc at the time and this should help fertility but it was a problem in its own right, if you know what I mean.

Attilla and I have a difference of opinion over OPKs and charting based on our own experiences. We both have PCOS and OPKs and charting work well for me. I assume they didn't for her. I used to post over on the Verity PCOS boards too and lots of women over there also have success with them. But if you have very long cycles or are not ovulating at all I accept they are useless.

It is a good idea not to put too much stress on yourself if you have time on your side. I am 36 now and don't!

P.S. Day 3/21 are talking about days of your cycle (day 1 being the first day of your period).

Eurochick's first para certainly applied to me at the time as I have endometriosis as well and that was diagnosed under the private healthcare system.

I also have PCOS too and was not ovulating at all (had practically non existant periods) so in my case temp charting and OPKs were and would be of no use whatsoever. I would save your money and spend it more wisely on nicer things for either yourselves or your home. Also OPKs and temp charting can add more pressure to what can be an already stressful time. They are indeed as eurochick suggests useless when it comes to long cycles.

I would ask/insist on GP referring you on now to a specialist; if PCOS is the root cause of all this then it is outside a GPs remit.

NHS subfertility unit at that time made me go for blood tests almost every week throughout the calendar month. Regular blood tests such as these and done over the coming months confirmed non ovulation and an ongoing LH/FSH imbalance; it was a very thorough series of tests that was done. They also did regular internal ultrasounds.

I was hoping that my cycles were becoming more normal with the 36 and 37 days, but then at Christmas they went back up and i'm also at 40 days and counting now....so no such luck. But at least when they do arrive, they are what I would call 'normal'.

What can I do to try and conceive in the meantime? (as i imagine it could take a long time for referal to fertility clinic?) Is there anything I can do to improve our chances?

If i were to go to Bupa for diagnosis of PCOS, would that mean restarting the process again with the NHS if the time came for fertility help?

thanks

Well my period has started today - I don't know whether to laugh or cry!

It means I'm not pregnant...again

but, on the other hand it means the end of another cycle, and an opportunity to try again.

Onwards and (hopefully) outwards.

Just wanted to update following my doctors appointment and to get your feedback.

Between my blood test and my period starting it was 10 days (within the two weeks I was advised by the doctor)....and as you all predicted, when I got to the surgery today, she proceeded to tell me that it had been done too early, and I should have another and get it done within 1 week of my period starting.

I tried to tell her that she had previously told me 2 weeks and that now i'll have to wait another month 40 days or so before my period, but she wasn't having any of it.

I said that I had been told online that it was usually taken on day 21, to which she said this doesn't apply to women who have irregular or long cycles.

My scan appointment is still being processed.

Feel sad about having to wait even longer to get an idea about what might be going on....and annoyingly there isn't really anything she can give me for the acne that is suitable when TTC...and it's getting worse each cycle...any tips? (lots of tea tree and aloe vera gel at the moment!)

Thanks x

She's right about day 21 not aapplying to long cycles. The progesterone test should be done to catch the peak level of progesterone released by a corpus luteum (the bit from which the egg pops out). On a textbook 28 day cycle with ovulation on day 14, this will be day 21. If your cycle is longer, it will be later, ideally 7 days after ov (or if you don't know when that is, 7 days before you expect your next period).

Don't know if it helps, but I was blood tested on day 21 of my cycle and had low progesterone, which they told me meant I probably hadn't ovulated, I had a scan and whilst I had no cysts on my ovaries on the 3 scans they did, the other blood tests they did were consistent with PCOS.

I too had long irregular cycles. I was put on Metformin, which regulated my cycles perfectly, and am now on Clomid to encourage ovulation.

It is annoying when you have to wait and wait, it feels like it's time wasted that you could be using to TTC, I feel exactly the same.

Althoughh I have been given the Clomid for 3 cxycles they are not blood testing or follicle tracking, so I don't even know if they are working

Apparently in my NHS trust area they don't follicle track etc until you've finished the cycle and didn't get a BFP.

So between finishing my 3 cycles of Clomid, I then have 3 months of waiting for my next OB/GYN appointment for either higher ndose Clomid or something else, so I can really empathise with you about the waiting thing.

Reading this with interest... I had the day 3/ day 21 tests and the results all came back fine, except I had a very low progesterone result. However I have very regular periods (always 27-29 days) and just started charting my temps and it seems I have the rise and falls in temperature that indicate ovulation has happened. My doctor said that due to my age (37) I may not ovulate every month and has just prescribed Clomid for the next 4 months. Reading up about Clomid it seems that it is used a lot for women with irregular cycles/PCOS, which doesn't apply to me. Anyone else taking Clomid even though they have regular cycles?

I'm taking Letrozole (similar drug) even though I have regular cycles and ovulate each month. My consultant refers to it as "superovulation". The aim is to get out more than one egg for the swimmers to target. Apparently Clomid results for non-ovulaters are good but the results are much less good if you are oulating already (I guess because there is some reason other than egg production why you are not pregnant).

Thanks eurochick, that makes sense...this is all very new to me and so I am trying to get my head round everthing and be as informed as possible

saretta, it's new to me too, this is my first month charting and on Clomid and sometimes it can all be quite overwhelming wondering if you're doing everything "right" iykwim?

ladyk9, the acne could be because you have a hormone imbalance and are producing too many androgens or testosterone.

This could be another symptom of PCOS, another is a "peach like fuzz" type hair around the chin area on your face, also weight gain that is nigh on impossible to shift is another common symptom.

I had all this and Metformin has regulated my cycle (your GP can give you Metformin) and the hormone imbalance, but still was not ovulating so hence the Clomid.

I think if you do go to Bupa for help, then decide to go back to the NHS, then you have to start at the beginning again with the NHS, as in they'd want to do all their own tests again, even if Bupa had diagnosed PCOS.
Plus for things like IVF there are waiting lists, so better to get onto a consultants list as soon as you can, then you have the options open to you should you ever need them (I'm not implying I think you will at all), and then you won't have to start at the bottom of the list, iyswim?

It does sound like your GP isn't really being as helpful or quick at organising things as she could be, does your GP practice have another GP you could see, sometimes it makes the world of difference.

I went to a different GP and within weeks was on Metformin and getting hospital appointment letters.

Good luck, I hope you can get things sorted.