Fertility referral questions..

[MildredH]

Hi,

Our ( apologies-long!) story is the I had a MMC at ten weeks at Christmas. We had fortunately conceived very quickly- 2nd cycle of trying ( and first cycle was using KY jelly which we later discovered was not sperm friendly!). Following that, I had irreg cycles. Previously 25 days spot on and now anything up to 32/33 days. Also periods just not quite the same as before..

I knew something must be up and asked for day 21 bloods. My progesterone was 27 - should be over 30 so possibly not ovulating. A gynae I knew suggested a month of progesterone tablets to try and "reset" things.

Last week I repeated the day 21 bloods to see if this had worked and progesterone now 10.7.

Obviously pretty upset. Have appt to see gp Monday and ask for referral which she has agreed to already. I am guessing I may need clomid?

I'm a bit anxious about how long I might wait in the NHS system.. I'm guessing this will vary from area to area but does anyone have a rough idea on timescales to actual treatment?

Secondly- we would consider seeing someone privately. Does anyone know approx how much money we'd need set by for this? I don't want to embark on it unless I know we can afford it..

Thanks in advance!
Xx

I'm surprised they said a reading of 30 was low. When I was on Clomid (didn't work for me) they said anything over 11 indicated ovulation had happened. The thing with a Day 21 blood test is that it assumes you ovulate on Day 14, whereas most women don't.

Progesterone increases after ovulation, peaking 7 days later before falling over the next 7 days. A blood test cannot tell whether it has detected the surge on the way up or on the way down. A low reading does not mean you are not ovulating, it just means you are ovulating later in your cycle.

My experience of getting a fertility referral was as follows:
Jan 2011 Saw GP and had blood tests and ultrasound, referred on to fertility specialist
Feb 2011 saw specialist
Apr 2011 had HSG (dye injected into tubes)
July 2011 had laparoscopy (operation to inspect ovaries and tubes)
Oct 2011 prescribed Clomid
Jun 2012 Clomid withdrawn
Aug 2012 referred on for ovulation induction

We're now waiting for a gap in the treatment programme so that we can start.

Good luck in your journey.

Hi, I also had a MMC in Nov 2011 at 11 weeks. I had only been trying for 2 cycles also. I had a period in Dec but then had no more. I was diagnosed with POS when I was 19 (27 now) but I had a little girl who is now 2 1/2 with no problems at all. Becasue I had already been diagnosed, I got referred to Gyno straight away - waited 3 wks for app (north east) and then they gave me Chlomid. 1st lot of 50gm hasnt worked - day 21 bloods came back as not ovulating. I didnt get a period so had to take pills to force one and now on 2nd cycle of Chlomid 100gm (fingers crossed). I know how you are feeling and my heart goes out to you. I would say you should get an app letter through in 3 wks xxx good luck xxx

It's very tricky to get an accurate 'day 21' blood test when you have irregular cycles because ideally it needs to be 7 days after ovulation/7 days before AF - very difficult when you can't predict when AF arrived. My first couple were pretty low so when I went to the fertility clinic they gave me two forms - one to be done 7 days before my shortest cycle and one 7 days before my longest. My highest reading was 28 and the consultant was quite happy with that!

My time scale was;
January - start blood tests for progesterone - over 3 cycles.
March - GP did referral because progesterone looked low
June - saw gynae endocrinology specialist who repeated bloods and ordered HSG and pelvic ultrasound. DH had sperm analysis.
July - had tests done. All looked ok for me after that.
December - DH saw endocrinology specialist because of his sperm analysis and bloods looked unusual. Got a diagnosis for him and he started treatment.
August - BFP!

I wouldn't jump the gun in assuming what treatment they'll offer you. If they think you have PCOS then they may well offer you clomid but that diagnosis wont be made off two blood tests results. It's a syndrome so they look at other factors including cycle history, hairiness (!) and look at your ovaries to see if they are covered in cysts. Have they checked your OH's swimmers yet?

Hi all,

Thank you so much for the advice- and especially the timelines- that's exactly the info I wanted..

Sorry for not replying sooner- our virginmedia has been down all weekend..

We have been to the GP this morning and had a referral. I was very impresed as she did a choose and book one which meant she pulled up all the available appt's on the screen in front of her and we chose! Will be late Oct- just over 5 weeks.

I feel so much better now we're in the system. I think the most stressful time is when you're in limbo knowing something may not be right but not making any progress.

Frankel are you in the UK? I've been told 30 is the benchmark for ovulation but I know there are two different units for measuring progesterone and therefore two sets of reference ranges.. always get confused reading anything from the USA as they must use the other scale..

Everhopeful I really hope the higher dose Clomid works for you.

Havealittlefaith DH is having the swimmers checked tomorrow- he can't wait ! You're right- I don't know that it's clomid I need- I just guess ( and hope!) it's a hormonal issue rather than structural as I conceived so easily last time but something seems to have gone askew since then!
Many congrats on your BFP- hope it is all going well so far!

Thanks again,
Mildred x