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 Everyone I can see the thread hasn’t been active since last year but im struggling with luteal phase defect TTC number 2. I had a second trimester miscarriage in Feb 2021 and have been trying since and no luck’ so around 17 months. I finally decided to seek private back in January but I was still declined progesterone. I was getting brown spotting for 7 days before my period flow so anything from 5 dpo or 7dpo etc. Anyway I’ve had a hyterscopy to check for polyps and nothing so I’m now on. Clomid days 2-6. Estrogen days 7-11 and progesterone from 3 DPO. I’ve just finished my second medicated cycle of this and no pregnancy :( I conceived my 3 year old first time and then our miscarriage was a try first time and now we’ve had 17 months of this is just heartbreaking. I’m just worried if it’s egg quality and I don’t stand a chance! I had the spotting still when just On a clomid cycle but since the progesterone also I’ve had no spotting and I stop them and then my period starts in full flow 3/4 days later and a much better period. Does anyone have any success to give me some hope as it’s affecting me so much. Xxx

Hi @Loz2467, so sorry to hear what you are going through and about your heartbreaking second trimester miscarriage.

I ended up having ICSI which was (so luckily) successful first round and now 30 weeks. That being said, I actually think my partners sperm was a large part of our problem in the end so not sure how much my short luteal phase contributed to our inability to conceive naturally. His count was pretty low which is why we needed ICSI.

I really hope things work out for you in the end, it is such a stressful journey so completely stressful empathise with how you must be feeling.

@LondonladyTTC congrats on your pregnancy! Thanks so much for getting back to me! I’ve been wracked with anxiety since the spotting started last July! I’ve spent a whole year TTC with spotting starting from 7 dpo because 2 of my prog reads were 61 and 37 p mol but I think they were dropping literally that day / day after. Then it was only in June on my first clomid cycle I had a prog read of 21 n mol which he said is low for a clomid cycle and would expect higher. I had that done the day I started spotting - 7 DPO. Because my bbt always stayed high too I almost felt in denial about the progesterone and was sure it was a polyp. I’m just worried if my lining isn’t right but I’ve had the camera done - and the progesterone pessary has stopped the spotting so does that mean my lining is reacting in a good way to the meds? I’m just so worried about egg quality. I’m 36. The spotting only started last July when I turned 35 and got my covid vaccine. I literally can’t find any reason for it hence why I’m worried to start IVF if it’s egg quality but your story is reasurring that it was nothing to do with egg quality for you xxx

@Loz2467 that sounds really stressful but glad the progesterone is helping. It definitely wasn't an egg quality issue for me as all the mature eggs they collected fertilised and they all made it to day 3, which is meant to be the part of the IVF process egg quality is important for.

Before I started IVF, the clinic did a few tests to check if anything could hinder the processes. This included. Thyroid test (I found out my TSH was a bit too high, no idea if it was connected my my luteal phase though), pelvic scan including follicle count, AMH so if you are considering IVF it may make sense to start going through the motions and seeing what they say. Even if you want to wait for a few months (we ended up doing this), it gets the ball rolling and gives you piece of mind that there isn't anything obvious which could interfere with a cycle. Well it did for me anyway.

I'm sorry you're dealing with that @Loz2467, it's so tough. I hope this treatment is successful for you. That's could progesterone pessaries have stopped the spotting. Could you have fibroids? Hysteroscopy wouldn't necessarily show those.

My story is similar to London's, we ended up doing IVF with ICSI, our first transfer worked and I'm now 19 weeks pregnant. I did six medicated cycles treating my luteal phase defect and never had success. I still have no idea why we couldn't conceive before. We were truly unexplained as all tests were normal.

@LondonladyTTC that’s great to hear that all your eggs fertilised! Shows the quality was good for sure!

Yeah my initial consultation covered those. So my AMH was 8.4 (was 35) which he said was low end of average but my follicle count was 21 so they said it didn’t really match and sometimes trickier to work out IVF meds. I don’t have PCOS or anything. I had my TSH done twice last year which was 1.5 and 1.4 but last month is was 2.9 but that was a full medicated cycle so I’m wondering if that changed it? Because even at the 1.5 and 1.4 I still had the spotting: just such a minefield just trying to work out why / how it started but maybe I just need to leave it to the professionals now. I have 3 more medicated cycles left which takes us to November ish then I’ll do IVF in the new year and I can always say I tried everything then. I just worry about the financial costs but I don’t want to get to 45 and regret not even trying.

@kennetrose congrats to you also! What great news! Yeah I’m relieved the prog has stopped the spotting but still panicking over the eggs and the follicle And my lining. Literally just so much anxiety which probably doesn’t help either. I do have a small fibroid but not in a place to affect conceiving. I guess like I said above I’ll ride the rest of the year out on these medicated cycles and see but I don’t feel very hopeful. I was hoping that it would work but after month 2 failing I’m just not hopeful. Was the only thing for you guys low prog? The luteal phase defect? I knew something wasn’t right when we couldn’t concieve again but it’s just crazy how it comes from no where! Xx

my progesterone was really low and my LP was only 7 days. I'd ovulate then get my period a week later. I just wasn't producing much progesterone or for long enough. Medication fixed that but I still didn't get pregnant. I'm glad I tried treating my LPD with medication, it made it easier to accept we needed IVF.

@kennetrose I did read the thread and saw that about your periods. Mine is similar but starts with a week of spotting. Just upset it’s taken over 12 months to get some medication for it because I was told “progesterone doesn’t create a pregnancy” which I knew but I wanted to stop the spotting as it’s been driving me insane! I need to think the same - try these medicated cycles then if not move onto IVF and hope we get some embryos and it works. Because I lost our girl due to an infection I was worried it had damaged my lining but I’ve had a hysteroscopy and he said it all looked fine. Surely that wouldn’t affect my ovaries. Your mind can wander everywhere through infertility can’t it!

@LondonladyTTC did you get anything to help your thyroid? What was your TSH? Like I said I don’t know if my higher one was because of all the meds that cycle or not. Xx

@Loz2467 my TSH was only marginally higher than the advised limit (it was 2.7) so they said it would not have delayed our IVF cycle even if we had decided not to wait a few months. I am on a low dose of levothyroxine now and it needs to be rechecked in each pregnancy trimester Xx

@LondonladyTTC that’s what mine is like but not sure if the medication changed it. I can see online that it can but google just opens cans of worms. I can’t keep away from the thing 🙈 last month I stopped my prog on the Wednesday evening and got my period on the Sunday with no spotting. This month if stopped the prog on Wednesday and started brown spotting today. Drives me insane. I was expecting to go to full flow on Sunday! Or tomorrow without spotting. Because I had no blood tests this cycle I feel anxious that I didn’t have a good read for some reason. I’ve just got to ride this out and hope IVF is a success for me next year. Feeling so sad! Xx

Hey Ellen please can you confirm where you went ? X