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'?

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!)

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.

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.

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!

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 :)

@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 💕

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.

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

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

@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.

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?

I was prescribed progesterone (cyclogest suppositories) by a private clinic (south west) and got pregnant that cycle. This was a few months after a miscarriage. I believe the progesterone made a huge difference. I was tracking BBT and the chart looked much much better with the progesterone. Had previously had a borderline short LP of around 10 days but quite low progesterone levels in the LP.

GP had no idea or interest in potential luteal phase issues but specialists were great.

I'd definitely encourage you to pursue it with a specialist. Best of luck.

@kennetrose just wanted to jump in and say to definitely double check your local CCG policy on assisted conception as some areas definitely do medically assisted IUIs. Another lady on MN I chat to has been told to go down that route and that the NHS will fund 3 of them. In my local CCG they fund up to 12 IUIs but weirdly all unassisted!

@Juno231 oh that's interesting. I'm struggling to find my CCG's full guidance on fertility. I've only found details about IVF. Any pointers on what to search for?

We are hopefully getting our SA results tomorrow and having an appointment with our GP who should finally put our referral to the fertility clinic through. No idea what wait times are so want to get a consultation with a specialist to at least have a plan of action, even if we don't act on it yet. Just feel in limbo now and want to get moving!!

I'm in the same boat. I did suspect I had issues with my hormones in my luteal phase as my BBT took 'slow rise' to a new extreme and LP is a little on the short side. I decided to take a at home progesterone test at 6DPO and my results came back low: 27nmol/L where > 30nmol/L indicates ovulation.

Around the end of cycle 3, I too went to see a fertility specialist and got scans and bloods done. AMH was at 40.5 (I'm 28) so physically I'm fine but I just knew something wasn't right with my hormones.

So, even though I do ovulate every month, I just don't think my ovulations are "strong" enough, so I'm speaking to my fertility consultant soon to see what he suggests. Plus I'll need to consider DHs SA in all of this because although he apparently has good quality sperm his count per ml is low. We're currently on cycle 6 and taking a little break because quite frankly, I'm a bit fed up 😅

Hopefully your DPs SA results come back fine so you have a lot less to deal with 🤞

Hi @kennetrose, hope you are doing well, did you get your SA results back? I think we are heading to these tests etc now, 13 months in with not a single BFP (I'm 31 and seem to ovulate monthly with OPK's / BBT). I've just done my day 21 bloods last week.

My cycle issues are:

• 26 - 30 day cycle
• Ovulation is late, between CD 17 - CD 23
• LP has been anything from 7 days to 10 days
• Pre-AF spotting for 1 - 3 days, usually with nausea and cramping
• No temp drop when starting AF, temps remain high for a few days
• Light AF usually with maybe only one heavy day.

Sadly when I spoke to the GP he was utterly useless, didn't listen to me, had me on loud speaker and seemed busy doing some paperwork. He asked me what I wanted them to do about my short LP basically. I am at my wits end with this!!

@Kitte321 - Did you get your longer luteal phase?
@Debs726 - Your private appt sounded great, please let us know how you get on.
@LondonladyTTC - Did you get your test results back?

There is just so much information out there it is so overwhelming. I don't think my cycle is a total disaster and a least I ovulate monthly, but just feel a bit bemused by this short LP. One month I ovulated on CD 17 so was delighted by that, but I started spotting on CD24. There definitely seems to be a gang of ladies who have this issue!

Hello @Rose2108 yes I did, so I guess the cycle was kind of a success - sadly I didn’t get a BFP tho. So I did progesterone 2 dpo. I’m currently on 14dpo with no sign of AF but a BFN this am so I’ll stop taking the pessaries and wait for AF to arrive.
It’s an incredibly long slog with little certainty 😔

hey @Rose2108 sorry your GP was useless! GPs really don't know much about TTC. They parrot off just relax, have sex EOD etc and aren't interested when you educate yourself about your cycle because it contradicts what they are told to say. Not to slag off all GPs, they are a wonderful resource, but with TTC you really have to advocate for yourself! Especially when you're speaking to male GPs, I've found. I think GPs are just the gatekeepers to specialists. You just have to deal with them until the refer you onwards. Persistence helps. We got our SA results back at last - apparently normal which is good but haven't seen the breakdown.

@LondonladyTTC I booked my appointment with Dr Gudi this morning! It's not until 23 April which I expected from what you said. Did you have an ultrasound or blood tests done at your first appointment?

@Kitte321 sorry about the BFN. Guess people with short LPs never truly know what the murder zone is, which is a small blessing. I hope your period comes soon and you have better luck next cycle.

Hi @kennetrose. I have nothing of much use to add but thought I might join/watch the thread as I’m in a similar position. My last progesterone result was 10 so it seems unclear if I’m ovulating (although everything else suggests I am) but my luteal phase is a normal length. I’ve been referred based on this too, waiting for the appointment and just taking supplements and doing acupuncture in the meantime.

A private doctor did suggest cycle monitoring to me but I’ve already had my follicle count and lining scan and my AMH done so I’m not sure what additional monitoring it (at some cost) will show.

@kennetrose congrats on booking your appointment! Very exciting.

@Rose2108 , sorry your GP was a useless as mine 
Yes, I had my test results back. I thought AMh was low at 13.7 but he said it was actually perfectly fine. Progesterone was on the low side but did indicate ovulation. I had my second appointment on Friday and got my luteal phase defect confirmed after a scan of my ovaries (follicles were no way near fully developed on cycle day 10 and I only have a 24 day cycle which led to the conclusion that my luteal phase would be short). My suspicious were confirmed that any fertilised egg would have not had time to implant due to the defect. This month I am trying an ovitrelle injection (took last night) to stimulate ovulation and then will be taking progesterone suppositories for 14 days. He was very positive as ovaries looked healthy and I had a good egg supply and apparently had two maturing eggs, one in each ovary. Took all the medication home with me on the day and left feeling very positive. I feel a huge weight has been lifted from my shoulders, I knew something wasn't right. He said he is very confident I will be pregnant within a few months, so way more relaxed now and would recommend these private investigations to anyone who can afford it.

@LondonladyTTC another way we're similar - my AMH is 13.8. Almost identical! How much were all the medications if you don't mind me asking? Just wondering what I might be getting in for.

@LondonladyTTC that sounds like great news. At least you can move forward in your TTC journey with confidence that you will get pregnant! I was going to ask the same question as @kennetrose about how much it all costs via the NHS. I'm private so I expect it to be more 😱

@kennetrose The follicle count scan, 7 dpo blood test (getting next week), and medications came to £320 which is actually less than I expected to be honest.

@LondonladyTTC ah just realised you went private. I paid £550 for AMH, scans, SA and consultation. But if you got medication too, yours was probably better value for money.