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I thought Clomid was supposed to correct luteal phase defects, so why is mine even shorter?

(18 Posts)
Brokenbits Thu 18-Nov-10 12:23:32

A hideous and long-winded miscarriage in Oct 2009 left me completely infertile. I've had all the hormone tests, scans galore and an HSG and the upshot of it all was that everything was normal - except my progesterone level which was 6. I was told it should have been in the high 30s or even in the 40s. It was taken later than day 21 (around day 25-26 I think) as I explained that if I ovulate at all, it's very late in my cycle.

No one seemed interested in whether or not I was actually ovulating - they just assumed I wasn't given such low levels. I thought I might be - just later than I should be given the length of my cycle. I reckon my progesterone problem occurs a few days after the temperature spike, as I always begin spotting about 5 days before AF is due. My cycles have been fairly normal in terms of length - between 28 and 34 days if I count from the first proper day of bleeding. Since I don't see any sign of ovulation until at least day 22, it would suggest that my luteal phase is a bit dodgy.

I finally got clomid and I've just taken the first month of 50mg. I was carefully monitored throughout. My temping and OPKs correlated with what we saw on screen and I appeared to ovulate on day 20. On days 25 and 27 I went for my version of the day 21 blood test - both of which came back perfectly normal.

I phoned for the results yesterday, but I'd already started spotting at 9dpo. I was hopeful because, despite the weird brown sludge, my temp had shot up. Today however, I've had more of the usual brown gunk (sorry TMI I know) and my temperature has plummeted below the coverline. I'm a little concerned that even if we do everything right and time conception perfectly, there is no time for a little bean to stick when this is happening at 10dpo.

Can any clomid experts enlighten me? Will this get better? Are the effects of Clomid cumulative in terms of helping LPDs? It's so depressing when everything looks so positive and then the stupid spotting starts again. I know temps etc can be inaccurate on fertility drugs, but it's hard not to pay attention when everything else this cycle has correlated. It would almost be easier if AF arrived in full force, just so I could start another month of clomid instead of moping around wondering and waiting, but I am concerned that this may not work for me now.

ceebie Thu 18-Nov-10 12:56:33

Sorry I'm afraid I don't have anything like the technical expertise you seem to be after. All I can say is that I too ovulated late with Clomid (day 21 test negative, day 28 day test positive), but I don't really know what my luteal phase was like or what it was supposed to be like. All I know is that I conceived after I gave up thinking about conception and doing all the monitoring, reading and posting etc and even worrying about DTD at the 'right' time. However I don't think I decided to give up and let go of the stressing - I just got to the point where I couldn't continue any more. If you can, TRY to let go a bit and TRY to trust your body to do its thing. I feel for you, it is miserable. (I too had a miscarriage which was horrible although not anywhere near as awful as yours I suspect). Best wishes

gardenpixie Thu 18-Nov-10 13:03:14

Hi Brokenbits,

Did you have a trigger shot to stimulate ovulation? The only reason I ask is that I was given an HCG trigger shot on clomid (currently on my third cycle) when a viable follicle had developed - partly to stimulate ovulation but also to help lengthen the luteal phase.

Do you think you could have ovulated before CD20? Did they monitor the thickness of your uterine lining as well as the development of the follicles?

Sorry for so many questions ... I'm not an expert in any of this but these are things that my consultant went over with me so I thought I'd ask.

I was told that clomid can make odd things happen re spotting (and I had issues with it last cycle) but that unless and until you get the full AF flow, implantation is still possible and beans can still stay put.

Fingers crossed!

Brokenbits Thu 18-Nov-10 13:17:09

Thanks very much both of you.

ceebie If only I could relax! I know it would help, but I've been TTC for 2 years now and it's awful, particularly because my DS was conceived on the first month. Makes me terrified to think that a mc can cause such upset to the system.

garden I don't have a trigger shot, but I did have scans ever other day (5 appts in total). They started scanning me from cd10 and then monitored me until the egg popped. I'm pretty sure I ovulated when they said give or take a morning/ afternoon and FF would agree as did the only + OPK I got.

As it's only the first month, I was told that the clomid hadn't affected my lining too much and it was a good thickness.

It certainly can make odd things happen in terms of spotting. I also spotted on 1, 2 and 3 dpo which struck me as very weird. When I queried it, the specialists didn't seem very concerned at all. I can't work out if this is because they don't really understand what's happenening or because it's not that uncommon, but I can't find much info on it.

Spotting has now calmed down a bit. Just a little bit whenever I go to the loo, but not sufficient to use anything. Tbh the same thing happened last month when I wasn't on clomid, so I don't know what to think. Fx that you're right about implantation being possible, though if my temp is an indicator of low progesterone, I think I'm out this month.

AttilaTheMeerkat Thu 18-Nov-10 13:20:02

Hi Broken,

I am very sorry to read what has happened to you.

Clomid's main and only job however, is to make the ovaries work harder. LPD is a controversial area; some gynaes think it is a problem whilst others do not. If your progesterone level is really low then chances are your LH and FSH levels are awry too. These levels should be tested early in the cycle around day 2. Normally LH and FSH are the same; if for instance there is an imbalance of LH to FSH then this can be indicative of a condition called polycystic ovaries. This can cause periods to become irregular and thus make ovulation less likely to occur. Clomid is usually given to women who present with such problems. I know you write you have had all the tests but some do get missed out; did you ever have a day 2 test?. Apart from anything else you need up to date test results, anything over 6 months should be discounted.

What was the result of your most recent progesterone test number wise?.

Temps can rise in the second half of the cycle when an egg has not been shed; this may be why you had a spike in temperature. OPKs can also be misleading particularly if taking clomid as the OPK will read the increased level of LH that the clomid is producing and thus will give you a misleading result.

Spotting should always be investigated further to ascertain the underlying cause; this should be reported to the people who prescribed the clomid. You should be monitored every month you are on this; it is quite powerful stuff.

I would keep asking them questions and ensure that you are both adequately investigated. You need a diagnosis first and foremost.

Brokenbits Thu 18-Nov-10 13:36:32

Hi Attila,
I think you've been my guru before on this subject, so thanks for your time - and patience - again!

The only diagnosis I've ever had - and very vaguely mentioned in passing - is that I'm not ovulating properly.

I've literally just had FSH and LH tested, so I know they're okay. Anatomically, there is nothing wrong. Several internals/ ultrasounds and an HSG have confirmed this.

Prompted by your question, I've just phoned - and badgered - the ACU (who were their usual abrupt and annoyed selves and very reluctant to give me numbers for fear that I might question my treatment - guess they don't like people who ask questions! grin) and been told that my progesterone levels were 62 on day 25 and 64 on day 27, so clearly there wasn't a progesterone issue at that stage and I definitely ovulated. Certainly a little better than the level 6 I got last time!

They've fobbed me off and told me the spotting can be caused by any number of things and that I shouldn't be worried at this point. Easy for them to say, eh? hmm

AttilaTheMeerkat Thu 18-Nov-10 13:49:03

Hi BB

That's quite alright.

I think you really ought to be seeing the cons gynae here at another hospital unit; to be just told that "you're not ovulating properly" is not really any sort of proper diagnosis at all. Something is causing this problem.

Sorry to read also that the ACU were unhelpful.

What were your most recent LH and FSH levels, I ask this as you need to compare the two. It is no point looking at these separately; it is only when they are compared than any abnormality could be seen.

I would be looking at getting a second opinion from another hospital unit. You will need to be persistant in order to get answers.

Brokenbits Thu 18-Nov-10 14:09:57

They were both the same. 3 I think? These people are very reluctant to give you numbers, but I seem to remember that's what I was told when I badgered them again! grin I believe that's good if memory serves? Estradiol was also perfectly normal.

I'm quite a boring case really. I've got to the point that I'd rather have a problem to fix! As far as I know all hormone tests were fine and there has been no sign of polyps, fibroids, scar tissue, blocked tubes, cysts or anything else untoward since I started the tests! The only annoyance is the spotting and, er, obviously the lack of baby!

I will see how things go in the next few days and make a decision as to finding a second opinion elsewhere. I've researched all this to death, which tends to make them less helpful. They don't like a know it all!

AttilaTheMeerkat Thu 18-Nov-10 14:41:14

BTW I had a congenital polyp in my uterus (that also interfered with ovulation as it was pumping out hormones). It was not detected on any internal ultrasound I had (and I've had more of those than I would care to mention) until laparoscopic surgery was performed.

LH and FSH should ideally be the same so that seems good.

Good luck to you BB, keep us posted as to developments.

Brokenbits Thu 18-Nov-10 14:52:45

Thanks Attila - for all your helpful advice and for asking the right questions. I'd ask your advice any day over any so-called fertility specialist or gynaecologist.

Will let you know of any positive developments! smile

uggmum Thu 18-Nov-10 18:10:24

I always had a 30 day cycle, I was prescribed Clomid for unexplained infertility (ttc 2.5 years). On the first 2 cycles my af came at about 21 days. I found this really frustrating. It did settle down though and returned to the normal 30 days.

Therefore, it may just take a couple of months for your body to get used to the Clomid.

On a brighter note, I had Clomid 11 years ago as I was diagnosed with low progesterone, I was told I would never get pregnant naturally as I did not get the rise in progesterone to sustain a pregnancy. It did work and I became pregnant with dd, (now 11).

3 years later (no contraception during this time) I did become pregnant naturally with ds (now 7).

I am now trying again and I have now had 4 rounds of Clomid, I think my age is now against me to be honest. I can have 12 rounds of treatment on the nhs.

I also had spotting with both my pregnancies, therefore, if your af does not arrive fully I would test just to be sure.

I know it's really stressful and that 2 week wait each month is really difficult. My consultant said not to lose hope as Clomid can take up to six months to be effective.

Brokenbits Fri 19-Nov-10 11:07:21

Thanks ugg. That's really interesting. I'm just worried because spotting is actually normal for me, but I figured it would improve.

I've already tested against all common sense, if only to rule it out before I do another round!

I'll try and be patient and give things a bit of time. I suppose the fact that I only get 9 chances makes me want to rule out all the problems immediately. I've never been very patient!

uggmum Fri 19-Nov-10 15:06:55

I am with you, when you are given a set timeframe it makes it even worse. I count down every month that is left and it can make you panic.

You could discuss a slightly higher dose, even if you ovulated on 50mg your levels could still be borderline, if you have no success in the next couple of cycles I would discuss this with your consultant.

absentbump Sat 20-Nov-10 18:48:13

Hi Brokenbits I just thought I would let you know that i have similar spotting to you...I ovulate fine on day 14/15 but then start spotting from 5 post ovulation but then dont get my full AF for another 6-9 days so think I have a short LF however but then if I dont count AF till full flow is not to bad on some months but I just want to find out why im spotting so much. Sometimes 3 days after ovulation I bleed after sex. Ive had clamidia tests, tested for infections and had my progesterone tested and all fine and my day 2 blood tests and they are fine - im hoping my scan helps to see if there is a fibroid or polp or something to explain...will let you know how I get on...im wondering if they will try me on clomid even though i do ovulate. I hope your spotting gets better and it is just your body getting used to the clomid.

Brokenbits Sat 20-Nov-10 20:53:51

Thanks absent it's the fact that it raises my hopes about possible implantation bleeding that really gets to me! But, I'm also a bit freaked out about what the problem might be. I've had loads of scans and nothing showed up. I'm resigning myself to it being the clomid, but I'll be spotting more days than I'm not soon.

It's now day 4 of spotting and it's just brown discharge. Doesn't look remotely like blood. Anyway, thanks for helping me feel less isolated. Keep me posted as to how you get on and I'll do the same. Best of luck to you. X

Brokenbits Mon 29-Nov-10 23:03:31

Just wanted to update and say that, despite the 7 days of spotting (3 days just after ovulation and 4 days from 9-12 dpo) I got my BFP this month after a hellish couple of years and am hoping and praying it's a sticky one. Thought I'd post this in case anyone else finds themselves in a similar situation.

Thanks to all the lovely ladies here for your support.

Miffles Tue 30-Nov-10 09:08:20

Congrats BrokenBits (need to name change now!) - that is great news on your BFP grin

I read your post with interest, as am starting my first course of clomid at the mo. And even better to hear a positive outcome!

Here's to a sticky bean.

Brokenbits Tue 30-Nov-10 09:29:00

Thanks Miffles. I'm too scared to name change in case I jinx it! Best of luck to you with Clomid. Ask away if you have any questions and fx that you get your BFP very soon.

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