Progesterone deficiency - can you help?

[WantaBaby4Xmas]

Hello ladies,
I've been reading Mumsnet for over a year but this is my first post. My husband and I have been trying to conceive for 11 months without success. I'm 27 and he's 28. I was diagnosed with PCO when I was 16 and had been on the pill since (with breaks) up until when we started TTC.
After blood tests (on cd 3 and 18), my GP told me I had Progesterone deficiency but my levels of all the other hormones are normal. She gave me first a vaginal gel (Crinone 8%) for two months and now duphaston (tablets), 10mg, twice a day for 2 weeks, starting cd 12. If I don?t get pregnant in two months she?ll put me on Clomid.
I really need more info and don't know where to start.
What is luteal phase defect?
Has anyone here ever been on progesterone replacement tablets or gel? How does it work?
Is Clomid really recommended for progesterone deficiency?
Thank you very much and good luck to all of us.

many years ago i went to a gynae due to irregular cycle. he told me i had low progesterone levels and would very likely need assistance if i were to start trying for a family.

I then became pregnant twice by accident

so no advice but i guess its not completely out of hte question

If you have been previously diagnosed with PCO then I would suggest you get a referral to a gynae.

Its the polycystic ovaries that are the main cause of your problems and this affects ovulation. The causes of PCO are not fully understood and whilst symptoms can be controlled, there is no one therapy or treatment that will completely eradicate it.

The general consensus is that if you have been trying for a year without success then you should be referred anyway to a subfertility unit at hospital. PCO is not a condition to be messed with by GPs. I would not actually think your other hormone levels are quite, were both your levels of LH and FSH tested?. With PCO there is often an imbalance between these two hormones (the level of LH is higher than that of FSH).
If the levels of LH and FSH are awry to start with then this will affect progesterone as well.

I would be very wary about this GP putting you on clomid without any form of monitoring - you should be monitored whilst on it as it can affect hormone levels particularly with PCO. Also if you are not monitored there is no way of telling whether clomid is doing its job or not. It is also not suitable for all cases of PCO.

Also without having an internal ultrasound scan done there is no way of knowing exactly how polycystic the ovaries are.

For the above reasons I would suggest that you ask about a referral.

Thank you very much, Jampots and Attila.

In my home country I used to go to the gyneco yearly for check ups since my periods became erratic at the age of 16 and I?ve found out I had PCO through internal scans as my blood tests were always normal (or so the gyneco said). The scans show that I have larger than normal ovaries with lots of tiny cysts.

Last month I had a blood test (cd3) and the results of my LH and FSH were 7 and 6 mUI/ml respectively. I guess from what you said, Attila, this shows an imbalance since my LH is higher than my FSH. Strange that my GP didn?t spot that and told me everything other than the progesterone was normal

I didn?t want to go through fertility treatment without proper monitoring and I?m scared I might be doing my body more harm than good. To be honest, I?m thinking of stopping the progesterone altogether and not taking the clomid until my GP refers me to a specialist but this might take a while. I?ve asked her to refer me twice but I feel she gets a bit upset as if I didn?t trust her advice. She told me Clomid is no big deal and the only side effect I could have is multiple pregnancy. Do you think I should tell her I?m not taking it unless monitored? What sort of monitoring should I ask her to do? Scan, blood test?

Unfortunately, even though I have a couple of good friends here, I don?t discuss the fact that I?m trying to conceive with anyone except dh (not even my parents back home). I just don?t want people to feel sorry for me nor do I want people asking me every month if I've had my period.

Thanks once again.

Hi,

Unfortunately some GPs only look at the results of tests individually but with PCO the results need to be compared. If they were not then the test itself is meaningless. Your LH and FSH are indeed awry which is indicative of PCO anyway although when looked at individually the levels are "okay". I would think that your progesterone is not of normal levels either (a level of at least 30 should be seen). There is a standard blood test called a Day 21 that measures progesterone later on in the cycle. Mine used to be done according to calendar days as my cycle was very irregular (due to PCOS).

As you have both a PCO diagnosis and have been ttc for a year without success you should be referred anyway. I would therefore speak to your GP again and insist that you are referred to a gynae. You basically need someone who knows more about this than your GP supposedly does. She will probably end up referring you anyway but you asking again should hopefully shorten this process. Clomid is not suitable for all cases of PCO and you should in any case be monitored whilst on it (with blood tests and ultrasounds to see if any eggs are leaving the ovaries). If you are not monitored then there's no way of knowing whether its doing its job properly.

Some polycystic ovaries contain hormones, others are dormant and a few have an egg in them. The causes of same are not fully understood.

I certainly relate to what you mean by not telling anyone about your ttc problems, I was the same.

I wish you well, let us know how you get on.

Larger than normal (walnut) sized ovaries are also indicative of this condition.

Verity's website which is www.verity-pcos.org.uk may be of use to you as well.

Hi Wanta (sorry if this a bit long winded)
I have a similar, but not identical problem. (I had suspected PCO but my consultant is pretty sure I don't after further tests). As you can see from Jampots response this issue is far from clear cut.
Atilla's advice sounds pretty spot on to me, so all I wanted to add was:

My consultant advised me the Jury is Out on the importance of luteal phase (the time between ovulation and af). You may read LP is 'supposed' to be 14 days, however it is generally accepted 10 -16 is 'normal'. Furthermore fertility experts are unsure whether a shorter than 10 days is really a problem too. Opinion seems to vary from country to country.

I understand in S.America & USA it is quite common to treat LP with porgesterone creams or suppositories. This sort of tricks the body into having a longer LP - the theory being this gives the body longer to nuture a viable pregnacy before the onset of af. In the Uk it seems to be thought this gives false hope rather than proven success.

I discussed this with my consultant and, while I wait for IVF approval, I have said I accept it may be false hope but I am willing to try. He actually suggested I should try clomid WITH monitoring (internal scans and blood test) as this can result in improved egg quality and can, in turn, correct LP. After a couple of months of monitoring we'll discuss using progesterone too if needed.

I wish you lots of love and luck with ttc - feel free to ask more if you need ... but I've probably rambled on enough for now!

Hi,

I can't thank you all enough. I think you've given me the information I needed and my plan now is to go to my GP in January to tell her once again that I want a referral. I definitely won't start taking Clomid unless monitored. In the meantime I'll check verity-pcos.org.uk as suggested by Attila.

I'll let you know how it goes.

Lots of love

Wanta

Hi - do you fancy joining the TTC chatty thread?

• You'd be welcomed

Thanks snowy, I'm going out now but when I'm back tonight I'll introduce myself to the girls on the TTC thread.