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

[kennetrose]

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'?

Hi @kennetrose I'm sorry I can't offer any advice but I'm really interested in your post as I too have just had an 8 day LP, I haven't been off the pill that long so I don't know if it's going to be consistent but I am a little worried.
Sending hugs 💜.

@glow92 I know that LPs can be wonky for a few cycles after BC and gradually lengthen. I hope yours sorts itself out!

There are a few historic threads on the topic but it seems very mixed. I read some experiences of posters in 2004 (!) but I imagine the NHS protocol has changed a lot since then.

Hello @kennetrose
I have a short luteal phase (8days as well) and have my first appointment with a specialist on Saturday so will let you know how that goes and what he says.

You are very lucky your GP referred you on before the year, I am going private as my GP basically said not to worry about the short luteal phase at all! cycle 11 and now taking things into my own hands! I havnt had any tests yet though so will expect they will want to do those before telling me treatment options.

@LondonladyTTC hope the appointment goes well! Please do share what they say.

I feel really lucky for getting seen before a year. I think what helped is that I'd called a few months earlier because I had one random long period that freaked me out, and the doctor saw that as a history of irregular periods. I also didn't describe it as short luteal phase as I know some doctors are quite dismissive of that. I just said that I track ovulation and there wasn't much time between ovulation and my period.

Also the doctor is just a nice person (some GPs really need to work on their bedside manner) and she herself is a woman in her early 30s - so maybe she knows exactly what I'm going through.

@kennetrose hi! I’ve no answers but I’m also in a similar position. This is my 10th cycle ttc and my lp is anything from 7-12 days so really short. (That 12 day one was a once off!) I’m getting my day 21 blood test this month but I feel the same as you. That I’m ovulating (using OPKs and tracking BBT) but I’m guessing my progesterone doesn’t seem to be high enough? I’ve tried lots of different supplements but nothing seems to really be working. We’ve been referred for the SA for DH but think there’s a wait because of covid. I’d be interested if clomid would be recommended in this type of situation or not. I hope you get your appointment and some answers quickly!

thanks @Cams50. It really sucks doesn't it?

Hope you don't have too much of a delay with the SA. Is your GP going to refer you to the fertility clinic if the results of these tests aren't good?

I've seen Americans get Clomid for similar issues but I really don't know what the UK approach is. My sense is that UK doctors just prefer to 'wait and see'. Luteal phase defect is a controversial area. I found posts on here from 2004 where people got prescribed Clomid but I feel like the NHS protocol has probably changed a lot since then as more research has been done (and funding has been cut!).

Following this thread - I'm on cycle 3 TTC#2 and this time round I seem to have a 9 day luteal phase. Really interested to hear what you're told.

I know very little about it but was considering a private fertility check because I don't think I'll get referred on the NHS until 6 months at the earliest (I'm almost 35).

@larrythelizard I had a private fertility MOT which was reassuring but they only look at the first half of the cycle. Have you approached your GP? Can't hurt to ask - worst they can say is no.

My understanding (not a doctor, just my own reading) is that a short luteal period can make it take longer to conceive (as you have said) and the concern with low progestorone is that it can be more difficult to hold a pregnancy in the early months? eg associated with first trimester miscarriage

I had a short LP of about 10-11 days when I was ttc #1, although I never sought medical help for it. I was ttc nearly a year. I have no idea if this actually helped but I looked into Chinese medicine for 'cold' and 'stagnant' types, ate a lot of chicken broth and followed advice about looking after myself and keeping warm. I got a few books on it and researched. I had 1 acupuncture session too (tho the needles in my ear freaked me out and i didn't go back).

Maybe it was nonsense, but 3 cycles later, (the cycle before I concieved) I had no spotting before af and a longer LP, the cycle after that I concieved.

It might not help everyone, and I definitely think you should see your fertility clinic, maybe it was a fluke or a placebo... but my cycles lengthened out and I have a 14 month dd now xxx

Hello. Defo not an expert but have had a short luteal phase since TTC #2 and have been seeing a private consultant.
Having looked at your day 21 results - not sure re the results. Mine have always been in pmol I think and the consultant insists it should be 30 or over (mine were 27 and 41).
My LP is consistently 8 days which he suggests indicates a weak ovulation (certainly the first result). He also believes if you get a good ovulation the body will produce the progesterone required. So far treatment has been;
Clomid - first go led to pregnancy but a miscarriage. Was monitored and suggested the lining was on the thin side.
Letrozole - now on first cycle. They are hoping this will strengthen ovulation without impacting lining.
Progesterone - if I am lucky enough to get a BFP.
Also - I tried so many supplements- nothing worked thou I think it does for others.
Hope this helps!! good luck x

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

@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.

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 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!

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

@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.

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.

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

@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 @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!

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.

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.

@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!

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!

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