Day 21 and day 28 blood tests for infertility with an irregular cycle - please help if you have experience in this area

[BlueMoon1981]

My fiance and I are currently going through some fertility tests. I have had 2 miscarriages just over 2 years ago but not have not been able to conceive again since. I have had scans, swabs, blood tests, a hsg and everything is looking ok so far. The fertility clinic want to repeat my day 21 and 28 blood tests because of my 'low normal' progesterone results. My problem with this is that my cycle can vary anywhere between 28-35 days, so accurately getting day 21 and 28 is difficult. I can usually tell when I ovulate, but the time between ovulation and af varies. I have just had my day 21 test done on Thursday, basing it on a 32 day cycle, and sodding af has arrived this afternoon, so where my day 28 blood test should be taken next Thursday, I'm now all out of sync. I'm really upset now because I've missed it, and I'm guessing I'll have to ring to cancel my consultant appointment because the results will be useless? I wish I had a regular 28 day cycle. Feels like I cant even get the basics right :(

Should I attempt another lot of day 21/28 tests next month? If I always get them wrong I could be doing this forever. Should I just go to my appointment anyway (not til a few weeks time but not enough time to fit in more tests) or should I call and ask what to do?

Any advice would be gratefully received.

First of all I'm very sorry for your losses.
I'm in a similar boat with irregular cycle (24-29 in last year). I'm at the gynae stage too after ttc 18 months. I seem to ovulate quite early (cd8-13 since temping). Doc has told me to do cd17 in case its a 24 day cycle and cd20 because my average is 27! It is almost impossible to get it right with irregular cycles.
My GP said ideally it should be 7 days after ovulation/7 days before your period, so your 21 test is too late for a ?24 day cycle. I would call up the reception of the gynae and ask to speak to someone rather than cancelling.
It's probably worth having another go next month but as you say potentially it could go on forever!

Thank you havealittlefaithbaby for your reply, I love your name :)

Sorry to hear you are in the same boat, but also glad you are seeking help. I think I will call in the morning and see what they say. Its all so frustrating!

I hope things work out for you and you get your much deserved baby.

They ought to be doing a day 3 test to check and importantly compare your LH levels against that of your FSH levels. LH and FSH kickstart the whole ovulation process; if these two levels are awry then ovulation can be affected.

Day 21 is a standard test done to measure progesterone; am wondering however, why they want a day 28 test done too?.

If your cycle is irregular (and this may be why the progesterone result is low, "signs" indicating ovulation can also mislead) the blood tests can be done according to calendar days so you can go on the 21st and 28th of the month. I'd also be asking them about the day 3 test.

Talk it over with the cons/subfertility unit by all means but do not cancel your forthcoming cons. appt, you need to see such a person anyway.

atilla thank you for replying. My gp originally did day 21 and day 2 blood tests, my cycle co-operated more or less that time but I did say when the results came back they were about a day out. I actually dont know what the day 28 test is for, my consultant just said it was for progesterone levels. She thinks I'm having anovulatory cycles, but I am 99% certain she's wrong, I can tell when I'm ovulating (or I think I can!) and if I'm having a period every month surely that can't be the case?

Hi, my best guess is that the philosophy behind asking for a day 21and 28 blood test us to attempt to catch the progesterone, you don't need to worry persay when you ovulated, just go by cycle day (is days from the first day of your last period)...

As far as the consultant appointment goes, You may have had your day 21 test a bit early, but who knows what it will show? I would still go.

Have you thought about taking your basal temperature? You don't have to get stuck into the full in charting stuff, but just temping might give you enough of a clue about ovulation to hit the nail bang on the head with choosing a day for the progesterone tests... With taking your temp you would find out 3 days after ovulation which day and then be able to pick a day 4 days after that....

Sorry that should have read, you may have taken the test late this month... But who knows your progesterone level might still be high enough to show you ovulated

Gah! Damn smarphone, didn't mean to submit...and I'd not consultant might be able to make an educated guess. And it might be enough to deduce something else (luteal phase length etc)

Atilla, I would expect guven she is at a fertility clinic that they might ready have the other blood test covered? ;)

beam at your smartphone posting abilities, you do better than me, I have a smartphone but have no idea how to use it, so you're doing well!

Thanks for your advice, I'm going to call and ask in the morning, like you I thought it may still show something even if on the wrong day, and maybe she'll ask me to go and get another day 2 blood test for comparison which I could theoretically do tomorrow if I could get an appointment with the nurse for bloods.

I have thought about temping, I keep hoping I wont need to, but looks like I'm here for the long haul, so it may be another thing to seriously look into.

I found temping very helpful actually. We've been ttc for 18 months. I had two progesterone levels come back low but since temping I was able to get an idea of when I ovulated. Also now have some idea of my length of luteal phase so I know (ish) when af is due based in ky ovulation date and luteal phase combined. Not saying

*oops that's me with a smart phone error!
...temping is an exact science but I feel it takes some of the element if surprise put of my cycles.

Hi Bluemoon

Re your comment:-

"My gp originally did day 21 and day 2 blood tests, my cycle co-operated more or less that time but I did say when the results came back they were about a day out."

What results were about a day out, what did the day 2 tests show?.

"I actually dont know what the day 28 test is for, my consultant just said it was for progesterone levels".

Ask her to clarify, you should always be clear as to the exact purpose of these tests. If your initial day 2 test showed a difference between the LH and FSH levels then your progesterone level may be awry as well.

"She thinks I'm having anovulatory cycles, but I am 99% certain she's wrong, I can tell when I'm ovulating (or I think I can!) and if I'm having a period every month surely that can't be the case?"

But what if she is right, you need to actively consider that possibility now.
You can have periods without actually ovulating. Signs can be misleading. Generally speaking if cycles are consistently irregular then a person is less likely to be ovulating regularly.

TBH BlueMoon you are now well beyond the stage of temping and such like now. They need to determine exactly why your progesterone levels are "low normal".

Given your gynae history as well, you certainly warrant further investigation from a gynaecologist and I am glad you are under the care of such a person.

It is vitally important that the three of you can work as a team. If you are not sure of anything , for goodness sake ask.

Make a list of questions you want to ask well ahead of time and do not leave there thinking, "oh I should have asked about...". You will need to be persistant in order to get answers.

atilla sorry I wasnt very clear there, I meant that my cycle was a day out for the blood tests, so I mentioned that to my gp in case it made a difference to the progesterone levels - she seemed to think it didnt.

I know I've been previously tested for fsh and lh an was told this was all ok.

I will ask the consultant next time, if I'm honest I was such a nervous wreck last time, I had to re-tell my story of the miscarriages in detail, how long we'd been trying etc and by the time we got to the plan of action I felt sick and wanted to run out of the door.

I know you can have periods without ovulating and that most women at some point do have anovulatory cycles, but I can feel when I ovulate, if its not that then what is it?

Thanks for your encouragement, you sound very knowledgable and very confident :)