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'?

That is a reasonable cost @LondonladyTTC when I think how much I have probably spent on OPK's, supplements, etc! I enquired about a private clinic locally and the first session is £190, they recommend you get the basic day 3 / 21 bloods and the SA done in advance with NHS if you can, to save doing it through them, but I know that isn't an option for everyone. That also all makes so much sense and sounds really positive, hopefully just a matter of time for you :)

@Kitte321 Pleased to hear it worked for your LP, steps in the right direction hopefully. Hopefully this is what I can start taking to lengthen mine!

@kennetrose Glad the SA results were as expected. Agree re GP's - I understand they cannot be experts in all fields but it is really upsetting when they make you feel stupid and ask you questions like "What would you like me to do for you" - I felt like crying! I said I want you to help me.... And he just sent me for the bloods.

Do you all get pre-AF spotting too?

I've found this post quite interesting. My LP isn't short but I've spotted through it every single month since I came off the pill in 2018.
My day 21 tests (had 2 now) were 45 and 48 - so not low. The fertility clinic have given me cyclogest to trial. I have mixed feelings as to whether this will work, because of the thought that a poor ovulation is the cause of a LP defect. But being my day 21 results aren't low- does that indicate a poor ovulation or literally just something strange happening in the LP? The first day 21 test i had i was spotting from several days before the blood test even was done (mine really does vary by month) yet the result wasn't low.
None of it makes any sense to me!

I don't get spotting usually. For me it's more like a tap just turns on at 8DPO exactly. Have you asked your fertility clinic that question @paintfairy? If your progesterone is normal I'd say your ovulation is fine and it's something else happening.

I had my fertility consult last week, had a scan this week, and am having another progesterone test at 5DPO next week. Super interested to see what my progesterone is doing now. If it doesn't indicate ovulation I'll have a consultation with the doctor, if it does then they'll do a tubal check and I guess I'll be on my way for who knows how long. A little nervous - it's not that I want a problem, but I am convinced there is and if my progesterone test is normal at 5DPO then I'll be on my own again.

@kennetrose I did ask if something else can be causing the spotting. I've already had all the tests now (normal) and I've got a HSG next cycle. She seemed to think it would be progesterone and I suppose the proof relies on whether it works. If it does work then it must be that, but it still makes no sense. I often spot on and off through my LP and so far I've had none. But really tomorrow onwards will be the real test.....

none of this makes any sense...unfortunately. Things that look like problems are sometimes not problems at all, other times there are problems with no causes.

Progesterone is released in pulses which is why testing it is tricky. Maybe it rises and drops quickly in you @paintfairy, causing the spotting?

@kennetrose who knows. But one of the months they did the progesterone test i spotted every day for the whole 2 weeks! So it was happening before the test and yet the test came back at 48? Which did shock me. I did ask though and she said the progesterone test only shows you ovulated. It doesn't really tell them much more than that.

I need to vent. I have now gone through the NHS assessment. They did an ultrasound, saw a follicle, and predicted I'd ovulate on CD14 and should come in for a progesterone test at 5dpo. Well I didn't ovulate until CD17, so went for my progesterone test later. Called for the result yesterday and was told it was good news, I ovulated! My result was 19.8 nmol/L and although they look for 20 nmol/L it was high enough.

I got my period yesterday, after the call, at 8DPO. My LP was SEVEN days! That's short even for me. The nurse just didn't care - she said it was 'potentially' enough time for an embryo to implant. Potentially isn't good enough!! But that's it - the NHS won't do anything now. They want me to come in for a HyFoSy so I think at that point I'll push the point again and try to get a consultation with the doctor, but I'm not hopeful.

So glad I have my appointment at Fertility Plus a month today but I'm sick of medical staff not believing me. I wish I was lying about my 8 day LP. The nurse yesterday even tried to argue with me 'well the scan said you'd ovulate on day 14, so that was 11 days ago, that's plenty of time'. Did she not hear me say I didn't ovulate until day 17? It doesn't matter what the scan says when OPKs, CM and temping all pinpoint ovulation to day 17.

Anyway rant over. 23 April cannot come soon enough.

@kennetrose sorry to hear about your experience, sounds so frustrating!!! Also, that progesterone result seems quite low from what I understand (but I am obviously not a medical professional!) mine was 27 at 7dpo and I was told it was a slightly low so got given the cyclogest. I was told if it was under 5 it would indicate no ovulation, but over 30 would be normal. I am also not sure how they could have accurately pinpointed when ovulation would be without controlling it with a trigger shot or something...
I suspect that you will have your progesterone retested as part of your fertility plus treatment (I have had mind checked twice now, before and after starting the cyclogest). It really is such a weight off having the defect recognised and getting treatment so I am sure you won't be disappointed.
Sadly didn't work for me last month but today is ovulation day after a trigger shot on Sunday, so will be onto the next two week wait- it feels never ending! Cycle 13 for me now!

@kennetrose I can feel your frustration! I just don't think the NHS recognise this as an issue do they, my GP actually said to me that the day you ovulate is irrelevant, as long as you ovulate (?!). It's great news you're ovulating but just seems so unfair they won't give you more support. Sorry you're going through this.

Good luck @LondonladyTTC

In Feb, I ovulated on CD19 and was due AF on CD 27, so just 8 days. Amazingly at 7dpo, I felt a twinge and had some spotting, assuming it was early AF which is quite normal for me, but unbelievable it was implantation and I got my bfp a few days later. We had been TTC for nine months and my luteal phase varied from 5 days - 12 days. I suppose I just got lucky that it happened within just a week. I just wanted to share this to give you hope! I'm 8 weeks now, so still have a few weeks to go before I can get confirmation everything is okay but it's my first BFP. I was taking Agnus Castus to regulate my cycle, vitamin C and a Vitamin B complex.

thanks @LondonladyTTC and sorry it didn't work the first time - fingers crossed next time. Did the doctor say how many cycles he'd give it with progesterone? Are you doing Clomid or something now too, with the trigger shot? They said I'd ovulate in three days based on the size - it was 13mm, you ovulate when it's about 18mm, and it grows just over a mm a day. But every follicle is different and they grow at different rates, otherwise we'd all have identical clockwork cycles.

It's weird how the bar for ovulation varies depending on who you ask. The nurse told me 20 but I've seen 30 written down elsewhere. I know it's easy to miss the peak so it makes sense there isn't a set number, but 20 and 30 seems like a big difference.

@Rose2108 thanks - it does give me some hope! NHS just don't care that can track our cycles accurately and assume we're wrong even though I know I'm right!

Short LPs....I get why doctors won't treat it outright, unless you have failed to conceive, because people do get pregnant with them (Rose2108 for example!). We haven't reached the year point but because my cycles are so short we have a lot of them under our belt! Given we have so many unsuccessful cycles, even though short LP isn't always a problem, in me I think it is a problem. Just need someone to take me seriously. I'm just so mad at my body and the universe for not being pregnant yet.

Congratulations @Rose2108 ! What an encouraging story  wishing you a happy and healthy pregnancy.

@kennetrose we plan to give it three cycles with trigger injection and progesterone and he said he is very confident it will work (but feeling a little more disheartened after it didn't work last cycle). Not on clomid at the moment, he said he wanted to refrain from stimulating my ovaries until we see if this works as think it is a luteal phase issue (progesterone related) rather than something that's going on at the start of my cycle which happens to impact my luteal phase. Being honest, I am not sure what the next steps will be- whether it will be clomid or straight to iui but will keep you updated on my progress in case it helps you.

I had two maturing eggs again at my scan on CD10, one 16mm and one 14mm, oddly both in the left ovary (not sure why I expected if two, one would be in each ovary) so hoping they have both fully matured and released in case having two ups my chances for a bfp this month (no idea if it does!)

So happy to have found this thread! I'm only on cycle 4 but have consistently had 8 day LP. First two cycles I ovulated on day 21 but last cycle I took soya isoflavones and ovulated day 16 but still 8 day LP. I use opks and track bbt to confirm O, but my bbt doesn't drop before AF. It's cd4 for me and it's still 36.74!

I went to the gp because I'm fed up and impatient. To my surprise he was great and did day 3 bloods yday and I'll be back then for day 21.

I bought agnus castus but I'm holding off this month to see what my bloods are like. Did anyone else find it at all helpful?

@Fifi1086 I haven't tried agnus castus, soy isoflavones or vitex yet. I've heard they work for some people, but I've heard they can really mess up your cycles. You don't know which camp you fall into until you try! Your doctor may also check you're not taking anything like that before ordering blood tests as they can affect your hormones. They'll ask you to stop before doing blood tests and that can delay any treatment you might get.

Those products, along with progesterone cream, I'm holding off on as they're my very last resort. Once the NHS have totally wiped their hands of me (probably after HyFoSy) and if I don't get anywhere with Dr Gudi (which seems unlikely based on @LondonladyTTC's experience but you never know) and there is absolutely no other option and I won't be having blood tests any time soon, then I will give those a chance...

Hi ladies
I just stumbled across this thread, and I'm hoping someone can give me some advice.
we've been TTC #2 for 7 months. I've only been tracking ovulation for two cycles using cheap opks, both cycles get peak opk on Cd 16, but both cycles Af has arrived cd 22 which means I have a crazily short luteal phase of about 6 days. Before tracking cycles did seem to vary in length 21-26 days.
Started taking pregnacare conception about two months ago not sure if I should try some other vitamins (in addition or instead), try something else or just make an appointment with the gp. Although from reading this also considering getting a home progesterone test done.

6 day luteal phase is just really getting me down, and I don't know what to do.

@Cantthinkofaname99 sorry to hear that you are going through this too. It is so frustrating. You can book an appointment at the GP but work of warning, some aren't that helpful unless you have been trying for a year and you might come away feeling frustrated, but I don't think there is any harm in trying through! The GP will actually probably be more interested in your irregular cycle length so I would mention that too as often short luteal phases are discounted as being a non issue. I have tried taking all sorts of supplements over the past 13 cycles and none of them made a difference to me until I got prescribed progesterone suppositories, but your short luteal phase could be caused be an entirely different problem which is helped by natural remedies. I would try speaking to the doc before taking and, and home test is a good idea. I got mine at 7dpo which is half way through a normal luteal phase but I am not sure when you would get yours since your AF will have arrived by then, needs a little research or you could ask the doc for advice on this when you see them. Another thing I have heard can work well is acupuncture if you can afford it. I did try for a month and that was the month I had a chemical pregnancy (might be a coincidence) but didn't enjoy it or find it relaxing like some people do and it was expensive (mine was almost as expensive as my private fertility treatment is costing) so stopped.

Good luck, and hope this stress ends soon🤞🏻

@LondonladyTTC thank you for the reply.
Had a good chat with DP last night and came up with a bit of a plan which I think does help with the stress.
Going to stop taking pregnacare and see what my cycle does this month, just because the only time I'm tracked ovulation properly is when I've been on them and my cycle seems to be shorter when taking them.
If I still have a short luteal phase next cycle then I'll see if I can get an appointment with a gp, there is a certain one at our practice that specialises more in women's health and I've seen her before and she seemed nice so🤞 might have to wait a few weeks for an appointment with her though!! I'll be 35 in July and I think at that point they will be more helpful if you've been TTC for 6 months, so that might help my case!
Do like the idea of the home test too, but like you said no idea what day I would take it on, 21 days would be pretty useless as AF would be about due then!

@Cantthinkofaname99 as @LondonladyTTC said, it’s best just to tell your GP that your cycles are short and irregular. They don’t really believe in luteal phase defect and if you sound too informed they just dismiss you as anxious and tell you to stop tracking! It does really suck. As my earlier posts said, once they confirmed I did actually ovulate (just) they didn’t care anymore. I wouldn’t have thought Pregnacare impacts your cycle that much - most supplements take some time to build up in your system so if you stop taking it one cycle it’ll still have some effect. But can’t hurt to try without. Vitamin C and B6 have helped some people lengthen their LP but has had zero effect on mine. Going through the NHS system can take some time so I’d recommend going to your GP now for testing and try no Pregnacare at the same time but of course entirely up to you!

The progesterone tests are either 7 days before your next period or mid-LP so in your case 3dpo would be the ideal time to take it. It isn’t an exact science though as progesterone has a short half life and is released in pulses so it’s easy to miss the peak so don’t worry too much about being precise. GPs always insist you do it in cd21 regardless of your cycle so if you tell you GP your cycles are too short to do that I’m sure they’ll tell you when to go.

@kennetrose thank you for the reply.
I know there is no reason the pregnacare should affect my cycle in this way but just seems really strange that I've took them for 2 months and both cycles were dead on 22 days, previous to that most of my cycles were 24/25 days, so I think it's worth a shot, although I know ovulation may have been later on those cycles too. At least with a 3 week cycle I haven't got as long to see if it works!
I'll take you advice and just say to the gp about short irregular cycles, I might have a look and see how long the wait is to see the particular gp I want to see, if it's a while I'll just book an appointment now.

So a little update, I had 21 day bloods taken on day 20 a couple of weeks ago, chased up drs yesterday and only spoke to receptionist who will chase dr, I asked her what result was and she said 15 although she didn't seem very sure. I did have a really weird cycle last month (the month I have the test!) spotting from day 22 but AF didn't start till day 30 and was really heavy. I will wait to see what the dr says but I'm hoping they at least redo the test. Guessing these results aren't great?

When I spoke to her before she didn't think my short luteal phase was an issue and seemed to think because I was getting peaks on opks everything should be ok. I did push her a bit and managed to get the tests done. I do get 'peaks' on opks but the lines never seem that dark, although maybe due to when I test?

@Cantthinkofaname99 15 is ok. The progesterone test is tricky - so hard to get your peak as progesterone is released in pulses and has a short half life. That’s why the number varies. I’ve seen the NHS variably use 20 and 30 as the number which indicates ovulation, but last time mine was tested it was 19.8 at 5dpo and they were happy with that because it was a rise. If you hadn’t ovulated it would have been under 5. So it’s not high but probably means you ovulated but of course that’s a question for your doctor or nurse.

Positive OPKs are all that matter. Again it can be hard to catch your true peak. Also if your LH doesn’t have a massive surge that’s not a bad thing - it means your ovaries don’t have to work too hard to release an egg and that’s a good thing!

Keeping pushing your doctor but sadly they really don’t care much about short LP once they confirm you ovulate. I guess if you’re over 35 and it’s been six months they might be more helpful for you though. It’s why I’ve gone private although I do have an appointment with an NHS fertility doctor on 8 June and am going to push really hard to get her to explain why a 7 day LP isn’t a problem even if I am ovulating. Will report back!

@kennetrose thank you for your reply. So it sounds like it's pure luck what level is considered normal, as I've read so many stories of GPs and others saying different things! I suppose I will wait and see what mine says. It was taken at only about 3dpo as my luteal phase is so short and I seem to ovulate late in my cycle.

Thanks for info on opks, that helps.

Let us know what they say when you push the dr.

I've ordered some folic acid and vit D for this cycle as that's all the nhs seem to recommend, I may then add vit C in a few cycles time. I just want to add things gradually as I don't want to screw my cycle up.

So I chased the drs again and have a telephone appointment booked to discuss my blood test results but not until 21st June. I couldn't get out of the receptionist if the dr reviewed my results and wants to discuss them with me or if receptionist didn't know so just made me an appointment. So frustrating having to wait so long!

So I've gone as far with the NHS fertility clinic as I can go for now. They tried to do a HyFoSy last week but it failed so they've referred me for a lap in December, but I already know my tubes are clear so I might cancel as I don't know of any other benefits a lap would give.

They made me an appointment with a doctor because I kept asking the nurse for reassurance on my luteal phase. I spoke to the doctor yesterday. She said that the NHS won't treat this, they can't do anything, she can't even advise on progesterone supplementation as the NHS won't do it. She said she's not a fertility doctor, then corrected herself to say "well I am a doctor that works in fertility, but I'm not an IVF doctor so not familiar with the kinds of drugs that are used". So what's even the point in the NHS fertility clinic? If you're not on the waiting list for IVF, they do nothing. She tried to reassure me that my short LP isn't a problem - she said if an embryo starts implanting then hormones turn around very quickly. I can see this with a 9, 10, 11 day LP. But 7 days!!! Come on. It has to be a very early implanting embryo to stand a chance.

And the best bit of all, she said I should look into going private. And literally said "I would do that if I were you".

So basically I got the impression she thinks a 7 day LP could be an issue but can't advise on it because it's against NHS protocol, and encouraged me to go private. I'm so glad I already am and did not wait for the NHS to do something, because honestly I kind of expected this outcome.

How do I get a refund on my taxes???

Hello op, I can't see that anyone has mentioned acupuncture for a short LP, but I had it before my son for this issue, and whilst I cannot of course definitively say it led to a successful pregnancy, I can say it took my ovulation day from day 18/19 weeks in a 27/28 day cycle to day 14, over the course of 3 months.

I had been monitoring it for over a year, so very confident in the timings.

I also took a mega dose of vitamin D, as it transpired I was extremely deficient.

Hope this is of some use.

@kennetrose that must be so frustrating for you, sounds like it's a good job you were going private anyway. Please keep us updated as to how you get on.

So my update... I spoke to the dr on Monday and she's booked me in for another 21day bloods on Friday, as last lot didn't show I ovulated but was borderline. She says they like to do 3 sets as we can all have the odd off month where we don't ovulate. Booked in with her to get results on Monday too so I'm not waiting around for weeks again! She did suggest that if tests show I'm not ovulating then they can prescribe Clomid or something similar so that's positive news, I was wondering if it might take ages if I have to see a specialist. Although if I need a 3rd lot of tests I may put if off a month as I have my 2nd Covid jab and I don't want that to affect the results.

Anyone know if short luteal phase could just be because I'm not ovulating? Or are my levels just dropping off to quickly? Would the Clomid even help if I am actually ovulating? It's all so confusing!!