TTC with long cycles, no PCOS, chemical pregnancy

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Hi all!

I'm a long time reader but this is my first post.

I'm 32 and TTC for the first time. DH 28. Bit of background - my periods started aged 14 and back then I think were about every 8 weeks. Had blood tests back then - all fine except slightly high prolactin. Then went on the pill for 12 or so years.

Came off just over a year ago and my cycle length has ranged from 31-55 days with no consistency each month. To my surprise, I conceived in early December (even though I didn't ovulate until approx CD40) although sadly lost the pregnancy I think at 4 + 5. I've always suspected PCOS so had had some blood tests with the GP which were all "normal" although I know LH/FSH are supposed to be around the same:

Testosterone - 0.4
LH - 3.1
FSH - 5.8
Prolactin - 352
TSH - 2.29

I think my TSH is a bit high (and this test wasn't fasted) as I've seen other posts on here which say it should be under 2 - could this level have caused the chemical?! Should I be pushing to go on medication (although I also saw a private gynae this week and she said not). She also referred me for a scan which confirmed that my ovaries were not polycystic or enlarged.

So it's a bit of a mystery to me why my cycles are long. I'm a tiny bit overweight (BMI 26.5) but otherwise no health problems and exercise, maybe drink too much alcohol (but I'm really going to cut down now for TTC).

Would be nice to hear if anyone's had success stories with similar set of circumstances! It's just a bit stressful not knowing when ovulation is going to come post period! I haven't been temping or doing ovulation tests - I get loads of EWCM (and tracking that worked for conceiving in Dec!)

Oh and when I had my progesterone blood test it was 51 which both GP and private doc said very good.

There’s a few missing elements here, namely estriadol levels, and timing. Without knowing precisely where you were in your cycle when bloods were done and without the E2 levels, your results can’t be fully interpreted. That LH might be normal, and it might not. Your FSH might be normal or be suppressed by estriadol.

If the lab reference ranges for TSH are standard and in mIU/L, then yes, that’s a normal, middle range result which wouldn’t need medication.

Thanks for your reply, I was on day 5 of cycle. They didn't test estriadol!

Those numbers should be ok for CD 5 but without estriadol and possibly additional context with AMH and an antral follicle count it’s impossible to say.
You also don’t say when the progesterone draw was done. Was that during pregnancy?

There are a few possibilities as to why you could have these bloodwork results and still have long cycles and difficulty TTC. Have you had a vitamin D test done recently?

Hi! Your LH:FSH ratio does look indicative of PCOS - normally it is 1:1 but in PCOS women it is 2:1 or 3:1 or higher. You can also have PCOS without having polycystic ovaries - for diagnosis you need to have two of the three - polycystic ovaries on a scan, irregular cycles, and/or blood test results suggesting hormone imbalance/physical symptoms of hormone imbalance even if blood work is normal - ie acne, weight gain around middle, hirsutism or male pattern hair loss! PCOS can be caused by several things and manifests differently in people. Hope that helps!

Was it an internal ultrasound? Sometimes polycystic ovaries can be missed on a regular abdominal ultrasound, you need an internal one.

@gwenneh thanks I will ask for these tests! Yes the progesterone was done on CD47 when I was unknowingly pregnant. Not had a vitamin D test but I've been taking Vit D supplements consistently for years (and they're now included in the Pregnacare pre-conception supplements that I'm taking)

@magnoliasinbloom Hi there - for PCOS it's usually the LH that is higher for the 2:1 or 3:1 ratio, rather than the other way round where FSH is higher! Also never had acne, hair loss etc.

@Whyisitdarkalready Yes it was an internal ultrasound done by a doctor (rather than technician).

Thanks all!

I have never had acne, hair loss, weight gain etc. but yet I got a surprise diagnosis of PCOS. Depending on when I get scanned my ovaries may or may not be Polycystic. I had regular 30 day cycles also.

You will need to ask for your serum testosterone levels to be checked as well as your sex hormone binding globulin levels, that's what got me my diagnosis. My first results were not dissimilar to yours. My high testosterone and low SHBG was interfering with ovulation and also any potential implantation.

Oh and also, my GP told me my bloods were 'normal' lol a fertility consultant explained they were certainly not normal.

Sorry again 🤣 meant to add testosterone/SHBG at CD21

I don’t know much about the hormone levels but I do have one piece of advice in case you haven’t come across it before: stay away from ibuprofen or other anti inflammatory drugs while ttc (unless your doctor recommends them). The uterus wall needs to inflame for implantation to take place. It needs to swell around and engulf the little blastocyst so ibuprofen or other NSAIDS could prevent that!! Good luck to all you ladies!! FX

Thank you @Mamacita9 !