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Conception

When's the best time to get pregnant? Use our interactive ovulation calculator to work out when you're most fertile and most likely to conceive.

Original poster

Short luteal phase - referred to fertility clinic - what next?

86 replies

kennetrose · 01/02/2021 10:03

Hi. I've been TTC with my fiancé for a few months. I track my cycles with OPKs and a TempDrop so I'm confidant I'm pinpointing ovulation each cycle. My LP is consistently 8 days. I was not on HBC - I had a copper IUD.

Because of my consistently short LP, I went to see my GP who ordered CD3 bloods (all normal) and CD21 progesterone. The first time I was 7DPO and the result was 4.1 nmol/L. Second time I was 8DPO and the result was 4.6 nmol/L (I think 12-49 nmol/L is what they're looking for). Because of this, my GP referred me to the fertility clinic, pending my fiancé's sperm analysis (we're just waiting for the results of that - he did it last week).

I've been taking vitamin B6 and vitamin C supplements since the beginning of October but they don't seem to have had any effect on lengthening my LP so far.

I've read research that suggests short LPs with no other issue can delay the time to a positive test but there isn't a significant difference in birth rates. I understand the reasons behind this now. I had a private gynaecologist remove my IUD and he said not to worry about short LP.

However what I don't understand is whether or not I have an issue. My GP said my CD21 results suggest I'm not ovulating, but that contradicts my data. What I think it shows is that my body isn't producing much progesterone, but does that mean the test is missing my peak or I'm just not producing much after ovulation? And will that prevent pregnancy or not?

So I have a lot of questions and no way of answering them until I finally get to the fertility clinic, and who knows how long that will be. Spending so much time on Reddit I see a lot of Americans get treated straight away for anything but I know UK doctors don't like overtreating and I don't know what the NHS approach normally is.

My questions are

  • has anyone been in a similar situation to me, and what was the outcome?
  • what normally happens when you get to the fertility clinic?
  • do things like Clomid and letrozole get prescribed much in the UK to treat what might be 'weak ovulation'?
OP posts:
Original poster
kennetrose · 16/02/2021 13:36

and to add - short LP is such a controversial area. Some doctors believe in it and some don't. I suspect that it depends on individual. Short LP alone doesn't prevent pregnancy in everyone, but maybe it prevents pregnancy in some people? And the research hasn't quite reached that conclusion yet?

OP posts:
Original poster
kennetrose · 16/02/2021 13:34

@Debs726 thanks for sharing your experience! Sounds kind of similar to us. Waiting for NHS referral right now but looking into private options. Would you mind sharing the name of the Harley St doctor you've been seeing, via private message if you prefer? What treatment are you starting?

I get cramps 4/5DPO too. I know that prostaglandins cause cramps but I don't know how the correlates with progesterone. I've bought a home progesterone kit that I'm going to do at 4DPO this cycle just to see if my progesterone ever rises, or if it rises and falls quickly.

OP posts:
Kitte321 · 16/02/2021 12:40

Hi @Debs726. I commented also as I have a similar issue to the one you described.
I’m on letrozole days 2-6 and then progesterone from 2 DPO. Is it the progesterone that your consultant was recommending?
Good luck with the treatment. I’m in the TWW so hoping for at least a longer luteal phase x

Useruseruserusee · 16/02/2021 11:40

My LP has always been 9-10 days. I conceived DS1 after a year of trying. DS2 was conceived on the first month.

Debs726 · 16/02/2021 11:38

Hi ladies :-), New to mumsnet, but wanted to join to share my experience with short luteal phase in the hope that it may help any others struggling with this issue.

My other half and I have been TTC for 10 cycles now, in tracking them since starting to TTC I noticed that I have a short LP of only 6-8 days with cramps at 4-5DPO and spotting at 5-6DPO. I have 25-27 day regular cycles with confirmed ovulation at approx. day 18-20. Spoke to my NHS GP about this, who initially told me that we simply hadn't been trying for long enough, however referred me for initial tests after considerable pushing on my part and I only think she did so in the end as I was over 36. Had day 3 FSH, LH, Thyroid and Estridol etc.testing and progesterone test at 5 DPO, all came back normal (progesterone at 5DPO was also normal and showed ovulation at 34nmol/L - should be over 30). They also sent me for an ultrasound scan, which came back normal and showed no issues.

NHS GP was still dismissive of short LP issue, but finally agreed to put me on the referral list for further fertility investigations only due to my age and that it was coming up to 12 months TTC. Due to COVID first appointments for this on the NHS aren't until May / June, so I booked a private consultation with a fertility specialist in Harley St London. We had the online consultation with the specialist consultant, who was brilliant, she listened to everything and immediately said that my short LP was an issue, that my corpus luteum and progesterone levels were falling too soon (despite normal progesterone levels at 5DPO) and anything shorter than 10-12 is too short for conceiving and that I need simple hormonal support in the LP of my cycle to sort this out, I am due to start treatment next month (costs for this were also surprisingly reasonable too).

This is of course only my experience and I fully appreciate that this will not be the case for everyone with a short LP, but the message I wanted to convey is that if you notice a short LP of anything less that 10-12 days after ovulation then please get it checked out ASAP, don't wait. I hope this helps in some way.

Rose2108 · 08/02/2021 19:15

@LondonladyTTC just wanted to say thanks so much for sharing your insight from the specialist.

I'm 31 and have been ttc for 9 cycles; they are normally 28 - 30 days and I normally ovulate 18 - 20 so my LH is very short indeed. I have been trying to vary my diet to promote progesterone and have been taking Agnus Castus. Nothing so far but hoping it will happen for us naturally. From my many hours is scrolling online, it seems you can definitely get a BFP with a short luteal phase don't give up hope ladies đź’•

Original poster
kennetrose · 07/02/2021 09:56

Thank you @LondonladyTTC! It’s interesting to hear what he thinks causes it. I had my AMH tested when I did my fertility MOT so I know I’m a little below average for my age (which didn’t surprise me given my cycle length) but not massively, but of course that test was a snapshot in time and the real question is how quickly do those numbers drop.

So he does think it could be a problem then?

What is his aggressive treatment vs less aggressive treatment?

I did actually send his office an email last week. Going to follow up with a call tomorrow. Sounds promising from your experience. Thanks for sharing :)

OP posts:
LondonladyTTC · 07/02/2021 09:43

Hi @kennetrose , the appointment went well thanks! Sorry for monster message below but wanted to include everything.

He wants to essentially track my cycle before trying any treatments as could be one of two things which causes a short luteal phase. Progesterone or lining. He also was a bit concerned about my long term egg reserve given how short my cycles are and said that knowing my long term fertility prospects will be helpful for family planning for future as I may have more limited time. I didn't realise that long term egg reserve could be checked by a simple blood test, so got one done yesterday, I was also 7 dpo so got a progesterone test.
Another interesting thing is that he was very sceptical about the accuracy of home ovulation tracking, which is why he wanted to track my cycle by the below plan before treating anything. He said clomid would by his least preferred option as my ovaries are already on overdrive with my short cycles and could just need a simple progesterone suppository.

Plan:
Progesterone and egg reserve results will be back Tuesday, if low progesterone I will get suppositories but to be honest no doubt AF will have arrived due to my short LP so will be on to next cycle.
Assuming I get bfn this cycle and progesterone ok, I need to call the clinic on CD1.
Start tracking ovulation as usual from CD9.
I will get a scan CD 10-12 to check the short term egg reserves (the eggs which have started maturing for the next 12 ish months and the one which is ready to be released) and my lining. This will very accurately tell him when I will ovulate and my shorter term viable egg count.
Basically egg reserve blood test will tell me how 'urgently' He would want to get pregnant which would help determine which treatment option e.g. if I have a long time I could opt for non invasive but if I only have a few years and want 2 kids in that time I should choose the more invasive but higher chance of it working route.
The long term fertility thing was something I had not considered since my mum had a baby at 42, I just assumed I had a long time left. This blood test will apparently estimate how many years I have left which will be either reassuring, or worth while knowing!

Maybemay123 · 07/02/2021 08:24

Yes medicated iuis.
The clomid unfortunately didn't do anything unfortunately for me but as I said I did meet ladies at the clinic who it did work for.
I had 1 nhs round of iui followed by 5 private rounds.

Original poster
kennetrose · 06/02/2021 16:17

Thanks for sharing @Maybemay123! Who knows how things have changed in that time. So did you have medicated IUIs? Did the clomid increase your LP? Did you have the IUIs on the NHS? I know they don’t do that these days usually but you can do it privately.

OP posts:
Maybemay123 · 06/02/2021 15:34

This may be of no help at all as it was 2002. I had treatment under NHS fertility clinic for same problem.
After initial tests I had 6 months of clomid and progesterone suppositories. This didn't work for me but I did meet two ladies it did work for.
I then went on to have iui (which worked). The drugs were given and my levels shot up and whereas insemination normally takes place at around 14 days and they'd monitor ladies alternative days till they got to the optimum, I was monitored daily and in 6 rounds of iui never had insemination after day 9. I also had a longer course of progesterone once I conceived. I did overstimulate twice which I was told was more common.
It took 4 years to conceive but now have 3 dc and worth the wait (even as teenagers!)

Original poster
kennetrose · 06/02/2021 14:41

How was the appointment @LondonladyTTC? I hope you were able to come up with a plan!

OP posts:
Original poster
kennetrose · 03/02/2021 09:09

good luck @LondonladyTTC! That sounds really promising.

I've been looking at the Fertility Plus website. I'm glad they're so transparent with their pricing but it does make my eyes water a bit! I've had a look at more local fertility clinics in Berkshire and Oxfordshire but they seem to be IVF only, so I think my only options are in London. Please let me know how it goes. As soon as we get our SA results I'm going to start reaching out to clinics.

Woke up to my period today, 8 day LP like clockwork again, which just motivates me even more to get this sorted. Who cares if we haven't been trying a year yet, I'm going to be on cycle 18 by the time we get to a year at this rate! Sad

OP posts:
LondonladyTTC · 02/02/2021 20:26

@kennetrose the fertility doctor I am seeing (Mr Gudi at Fertility Plus on Harley Street) is apparently a bit of a short luteal phase specialist- if you search him he has some YouTube videos where he also mentions the importance of strong ovulation. Wanted to let you know since location is probably quite convenient for you, and I will give an update when I have met him on Saturday. He has fantastic reviews so my hopes are high!

beth821 · 02/02/2021 20:17

I had a progesterone test by gp which showed i didn't ovulate but actually got pregnant that month so I wouldn't always say they are that accurate. I had a short luteal phase and took agnus cactus that month too. From day 1 to ovulation and I swear that helped. Good luck.

beth821 · 02/02/2021 20:14

I had a progesterone test by gp which showed i didn't ovulate but actually got pregnant that month so I wouldn't always say they are that accurate. I had a short luteal phase and took agnus cactus that month too. From day 1 to ovulation and I swear that helped. Good luck.

Original poster
kennetrose · 02/02/2021 19:59

@Kitte321 @Crazydoglady123 thanks both. That has long been my suspicion but it’s been a struggle getting doctors to take me seriously. Two specialists already told me they don’t treat short LP but would they say the same knowing my results? Who knows.

My fiancé and I have decided that when get the results of his SA next week we’ll approach some local clinics just for maybe an initial assessment to see what they recommend while going on the NHS waiting list. I’m sooooo impatient though!! I’d approach doctors now but I think it’s a good idea to wait til we have SA results so I can give as much info a possible.

@Cams50 the first time I went for CD21 I went on CD24 as it was 7dpo and my GP told me off. Next time I went on Cd21 which was 8dpo. I think the proper time is 7dpo but GPs aren’t specialists and just follow very narrow guidelines. The test should always be repeated if you get a poor result. Hope you get somewhere with it all!

OP posts:
Cams50 · 02/02/2021 19:28

@kennetrose I’m not sure what will happen with these results. I’m hoping he may refer me straight to the fertility specialist but might want to do another round of blood tests or referral for the scan. I’m not sure they’ll show ovulation anyway as I don’t ovulate as early as day 14 but he insisted they need to be day 21 regardless which seems conflicting to other things I’ve read. I totally agree with you about the American/UK differences. American doctors seem way more likely to give progesterone cream etc as well as the clomid. Hoping you’re getting your appointment (or better yet bfp!) soon x

Kitte321 · 02/02/2021 19:08

Yeah exactly what @Crazydoglady123 said. It’s more a question maybe of treating the ovulation (or indeed getting you ovulating) and that would correct the LP. God it’s a minefield!
Massive luck

Crazydoglady123 · 02/02/2021 18:50

I agree with @Kitte321. I'm not a doctor but it may be that you're not ovulating properly therefore you're progesterone drops causing you to bleed (AF). I had similar discovered on my blood tests. My third round of letrozole I had my 21 day bloods which came back as 23 (should be 30 plus) and the next day CD22 I started spotting and then a couple of days later AF.

Original poster
kennetrose · 02/02/2021 18:42

@Kitte321 thanks! I saw a private doctor for my fertility MOT and she was of the opinion that short luteal phases weren’t something to treat. The gynaecologist who removed my IUD privately (because I was too impatient to wait 3-5 months for the NHS to do it) is also the local specialist consultant so I’m likely to see him again now I’ve been referred and I know short LPs don’t concern him. I mean it might be short LPs aren’t a problem but in my case there is a problem with progesterone so I might be prejudging? But who knows. Obviously I am very impatient! Unfortunately Manchester is a bit too far for me but if I heard of a doctor in London or Oxford or somewhere in this general area who believed in treating short LPs I would make an appointment.

OP posts:
Kitte321 · 02/02/2021 18:08

Hello @kennetrose.
Ah I may be mixing up with some other results then. Sounds like exactly what my consultant said.
I started exploring tests at about month 7 - I’m 37 (36 then!) and knew time wasn’t on my side. I also felt something wasn’t quite right.
Got initial bloodwork done on NHS but COVID meant Appointments kept getting cancelled so I went private. Not the fault of the NHS but I needed more control (and speed!).
It was the best decision and he prescribed Clomid straight away. You also get more monitoring when private so it tells you more about what’s going on. In addition, after my miscarriage he quickly suggested changes to improve outcomes so on the whole I’m more confident I’ll get there eventually!
I’m based in the North West so Manchester Fertility but sure a lot of private clinics would take a similar approach? x

CharityRoyall · 02/02/2021 18:03

Hi everyone, this is all really interesting reading. I’ve been off the pill 6 months with a consistent 8 day LP in a 30 day cycle Sad I keep reading such conflicting info about it - lots of conceptions despite a short LP but then some info like this where people have been referred for investigations. I think I’m going to contact my doctor as it’s something I’ve been worried about but this thread kind of confirms!

Original poster
kennetrose · 02/02/2021 17:50

@Kitte321 thank you so much! That is really helpful to know. Would you share the name of your private consultant? Obviously as a private message if you're comfortable. I am west of London. I am very open to seeing a private consultant depending on NHS wait times.

How long were you trying before you saw a consultant and before he prescribed Clomid? Were you told to try 6/12 cycles first? Why did you go private rather than NHS?

I've just double checked and my progesterone results were definitely nmol/L. It said they were looking for 30+ to confirm ovulation.

Good luck with letrozole! Thanks so much for responding - exactly the kind of experience I was looking to read.

OP posts:
larrythelizard · 02/02/2021 16:44

Thanks @Xxdxx2020 I was also considering acupuncture but it's all closed at the moment!

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