Confused about what the consultant said - any advice.

[Thistledew]

Decided to start ttc end of Jan 2014 and came off the pill.

Periods didn't return until Aug 2014 and cycles were all over the shop - 33 -37 days to start with, then settled at around 22 - 25 for several months.

Since the middle of this year they have settled at around 25 - 30 days, although some are still a day shorter or longer.

I have had a trans-vaginal scan, which showed everything was in order, apart from a thin womb lining, but this was before my periods had returned properly.

I have had a HSG scan - this is all fine.

Day 21 tests are inconclusive. Due to my uneven cycle length it has been difficult to get them on day 21.

I have been using a basic OPK test for the last three months. In August, I got one which was probably a positive result on day 20, and had the 'day 21' test on 20 August (day 28). This produced a reading of 19. My cycle was 31 days long.

In September, I did not get a clear positive OPK result.

In October, I got a very clear positive OPK result on day 12. My cycle was 24 days long.

Before I started using the OPKs, I was tracking my cycle based on EWCM and cervical positioning. I got clearer indications on some months than others. It started off with a very short time between when I got these signs and when my period came - only about 7 days to start with, but has gradually increased to 11 - 12 days.

I have seen the consultant today, and have been left quite confused by some of the things he has said:

• He thinks that based on my day 21 progesterone test, I am ovulating. He said that ovulation is a yes/no answer, so with the result from the last test, it is likely I ovulated, just not on day 20 as suggested by the OPK.
  

• Based on this, he does not think that the OPK is helpful in terms of predicting when I ovulate. Likewise, he has said that tracking EWCM and the position of my cervix is not a good indicator of ovulation.
  

• He has given me the option of a Lap and Dye test, or going straight for IVF. The waiting list for either is about 4 months, and he does not recommend one over the other.
  

I am left with the following questions:

1. Is it correct that getting a reading of 19 on the progesterone test indicates that ovulation has occurred, just not 7 days before the date of the test?
   

1. Is it really right that a positive OPK test, EWCM and position of my cervix are not good indicators that I am, or am about to ovulate?
   

1. The consultant does not seem to be concerned that I (may) have a short phase between ovulation and the end of my cycle, but prefers the explanation that I have ovulated before the date on which I saw signs. Is this plausible?
   

1. In my shoes, would you go for the lap & dye examination or straight for IVF, or ask for some other investigation?
   

Other information of relevance - I am 36 (tomorrow), healthy BMI, no other health concerns, never been pregnant. DH got the smug git award for having 'excellent' results on his sperm test.

Thanks for reading all of this, and many, many thanks for any advice.

[mascaraisamust]

Really interesting thistle that he has jumped to such a conclusion without considering other things such as:

1. Your cycles are irregular - have you ever considered PCOS? Or other investigations to find out why? Ultrasound?
   

1. Day 21 tests (no matter what your cycle length it needs to be done 7 days before AF) - I do agree they can give false readings and be unreliable if this is the case. I got a pg level of 1 and another of 9 and I got a BFP that month after I was told I hadn't ovulated by my gp.
   

1. An opk might give a positive reading but doesn't mean you have ovulated, it just means you have had a surge of hormones.
   

1. Have you tried temping to pinpoint ovulation? Much more reliable if you can do it regularly (I forget)
   

1. What other blood tests have they tried? Thyroid? LH? FSH? I've just had a full blood work done and found I'm very vitamin D deficient, is something like this being checked?
   

1. I have a short luteal phase and my private consultant is trying Clomid to bring on ovulation/produce a stronger egg and progesterone from ovulation
   

Hope this helps x

[Thistledew]

Thanks, mascaraisamust - I very much appreciate the reply.

1. I think PCOS was ruled out with the trans-vaginal scan. I have no symptoms that would fit this.
   

1. Do you know if it is right that a reading of 19 on the progesterone test means that I must have ovulated at some point? The consultant said that he would expect readings of under 5 if I had not. However, I really think that this is a hormonal issue more than anything, as my cycles have changed and are still changing so much since I came off the pill.
   

1. The consultant mentioned clomid last time I saw him, but didn't seem today to think it was worthwhile trying it.
   

1. I haven't tried temping yet. I think I might give that a go.
   

1. I had a full range of other bloods done - Thyroid etc all fine. I take a vit D supplement in the winter and spend a lot of time outdoors in the summer.
   

As I said, my gut feeling is that this is a hormonal issue, but the Consultant seems to be straying away from this conclusion. I don't want to say I know better than him, but at the same time, I would rather find out why my cycles are still not quite right, rather than go for the final option of IVF.

[stealthbanana]

Hi - a couple of thoughts

1 as PP said, have you had full blood work? You might have PCOS but not have ply cystic ovaries right now (weird and counterintuitive but possible)

2 having a prog result of 19, esp 3 days before your period, does seem to indicate you ovulated. BUT if you had a period at cd31 it seems unlikely you ovulated on day 21 (you get the LH surge 24ish hours before ovulation) - you might have multiple LH surges (again that's very PCOSy)

3 alternatively it might be you have a (very) short luteal phase which together with the womb lining I would definitely want to explore before ivf- no point doing it if you can't sustain implantation!

Conclusion: get a new doctor

[mascaraisamust]

I also think my issue is hormonal, namely a progesterone issue. My private consultant agreed with me also due to the short LP and I also miscarried and was spotting on and off when I was pregnant. He said clomid doesn't always worked but can initiate a stronger egg and progesterone levels can be boosted as a result.

I read the average pg level is 30 but anything above 15 can mean you have ovulated.

I would try temping and use CB dual hormone indicator OPKs for a month (expensive but tell you high/peak fertile times). Pop your temps into FF and it will do the hard work for you.

I'm no expert though!

[beakybeak]

Thistle, I'd say try temping, it's probably the most reliable way of tacking ov, albeit it doesn't tell you before the event but over a few months you might see a better pattern to your cycles.

Are you NHS? I have found they are very much for papering over the cracks rather than fixing the cracks iykwim. I'd say get a lap & dye since you've been offered it, if you go ahead to ivf and it didn't work you may wonder whether that would have thrown anything up that you could sort.

I always have spotting and short lp's too but the consultants never seem too concerned. I was told progesterone should be over 30 7days before af to show ovulation. You'd also get progesterone during your luteal phase with IVF which can address this in some cases.

[Marchgirl]

I would agree with the others (and your own gut feeling) to try other things before ivf. Temping works because your temperature is driven by your progesterone levels, so this should give you a better idea of if and when you're ovulating, although sounds like you are from your numbers.
I would also suggest trying acupuncture. I was a total cynic before I started, but it really sorted out my cycles, which used to vary from 30 to 38 days and settled at bang on 28 after a month of acupuncture once a week. I know so many people who swear by it helping sort out their hormones and helping them fall pg

[Kwick709]

What is temping?