What would you do next?

[hopelesslydevotedtottc]

Hi all, looking for some advice. Background:

• DH and I have been ttc baby number 1 for 14 months. Never been pregnant.
• I’m 31, DH is 32
• Semen analysis normal
• Semen DNA fragmentation normal
• Ultrasound normal - have PCO but not PCOS
• Regular(ish) cycles (between 27-34 days)
• Day 21 progesterone normal but on the low side (25) - OPKs and BBT show I’m ovulating
• AMH is good
• Hycosy is normal
• Only red flag is spotting before period, sometimes for 7 days

We fall into the infruriating ‘unexplained’ category and I don’t know what to do next. Feel like I have tried everything: acupuncture, preseed, fertilily cup, reflexology, you name it.

Would you:

a) keep trying naturally and hope we have just got unlucky so far?

b) push for more tests, and if so which ones?

c) ask for Letrozole and / or progesterone (just to try something?!)

d) cry into some white wine and galaxy chocolate?!?!

I'd have a private fertility assessment (assuming all assessments have been under the NHS). I'd probably DTD every other during fertile window, and try to avoid overtracking as I'm sure you've exhausted all tracking options by now.

I'd speak to doctor to explore post-ovulation progresterone supplementation, considering it's on slightly low side, just to see if it helps. Spotting early may indicate earlier shedding of endometrial lining. So you never know, worth a shot. Caveat being that it may result in late periods, which some find more tortuous for obvious reasons.

I'd try another year at least natural.

Hi @Outliers thanks for the reply. I actually had all the tests done privately as waiting times where I live are pretty ridiculous. My region also has very strict IVF criteria (only one NHS-funded round, must be between 30-34, if unexplained must have been trying for two years) and very long waiting times so wanted to get the ball rolling as quickly as possible just in case.

My doctor has been pretty dismissive of BBT and says just to use OPKs so I’m trying to step back on the tracking. We already DTD at least every other day over fertile window so I’m sure we aren’t getting the timing wrong.

That’s what I’m worried about with the spotting too. My doctor just dismissed it and said lots of women spot before their period, but looking at my BBT my temps do seem to drop from about 8 or 9DPO / a week before my period which I’m worried is affecting implantation…

I second the post ovulation progesterone... I'm sure I've read about that somewhere for people with spotting pre period. I think maybe it was the PROOV testing kits that had some blog articles about that. I wonder if pco without pcos would still be positively impacted by treatments with either or both metformin / inositol. I only ask because I was shown to have PCO on scan and with no further testing my specialist just said it is likely PCOS (I do have some symptoms) and put me on both of those. It may be worth looking into. I wouldn't suggest waiting further purely because the longer it takes it may impact of future plans if you were hoping to have more than one little one. If you wait another year and then progress with other testing / treatments you might wish you'd started earlier. Wishing you all the luck.

@hopelesslydevotedtottc I (personally) think doc is right in that OPKs are a more scientific way of establishing ovulation. BBT, while it works for many, is a very flawed metric system, as there are a host of factors that can affect basal temp.

Doc is right regarding spotting as well, I think it depends how early. if it's circa days before period is due, I don't think it's much to worry about.

The unscientific suggestion would be to ensure your orgasms and keep legs raised afterwards😅

A good friend of mine experienced unexplained issues for a long time, over 2years trying. Eventually they randomly had a son. They didn't both with contraception given their issues, and 6 months later conceived another even though they weren't TTC. From what I've seen can be quite frustrating as there's no obvious remedy. But a positive is that there's physiological barrier, it's just about chance and luck facilitating. I hope though, you don't have to wait much longer.

@thehurtingheart thats interesting you mention Proov as I have literally just ordered some Proov progesterone urine tests so I can test out my theory that my progesterone is just about okay 7dpo but then goes down!

I don’t understand why doctors are so reluctant to prescribe progesterone. I had a friend who had 2 miscarriages and she practically had to beg her doctor to give her it - first month with progesterone she conceived and carried to term her DD!

Also interesting you were told is likely PCOS. I don’t really have any symptoms of pcos other than hormonal acne but I’ve never had day 3 bloods or my testosterone tested so I’ve always wondered if they were too quick to rule it out? Were you given anything for it?

@Outliers yes I’ve heard the same about BBT and I find it quite stressful waking up at the same time each day and being the first thing I do each morning - makes it very hard not to obsess!

I hope you’re right that there’s no physiological barrier and you definitely do hear stories of people taking ages with their first and then falling unexpectedly pregnant with their second (as well as the other way around!) I think I’m just nervous that we are not actually unexplained and there is something wrong and we just haven’t found it yet and that if we keep trying naturally we might just be wasting precious time…

what a minefield hey 😂

What does the private doctor suggest you do/investigate next?

I would recommend you take a month off trying. It's such a long road when trouble TTC, it would be great to take the pressure off yourselves for a cycle, dont track anything, enjoy each other's company, see friends, eat and drink what you like, and have as much or as little sex in whatever ways you feel like.

Then by all means get back on the horse, so to speak, but feel a bit recharged.

@Whataretheodds so rather confusingly I have actually seen two doctors. The first doctor (who I ran the majority of the tests with) told me to just keep trying naturally until I feel ready for IVF. I asked her if there was anything I could try first and she said if I really wanted to I could try Letrozole but she wouldn’t necessarily recommend it as already ovulating. Then I saw a second doctor because I listened to this podcast which really advocated getting men properly tested and getting a sperm dna fragmentation test and my original clinic didn’t offer it; in the follow up consultation the second doctor basically contradicted the first and was like don’t accept unexplained as a diagnosis, there are so many other tests we can do, go for further investigation eg a semen culture test, monitored cycle, vaginal microbiome etc. So now my head is completely spinning! Hence have turned to good old wise Mumsnet 😂

Taking a month off sounds great! The problem is my DH thinks we should go all in on the lifestyle front - quit alcohol, eat super healthily, give it all we’ve got - but we are already relatively healthy so I feel like it’s just putting unnecessary pressure on ourselves 🤷‍♀️ I’m definitely going to cut back on the OPKs and BBT and just try to DTD when we feel like it. For a couple of months we followed the sperm meets egg plan or DTD every day throughout the fertile cycle and whilst that was fine for DH I felt really pressured by it!

You can 💯 take a month off and then throw yourselves into it. Imagine a month of not waking up with a beeping thermometer!

So confused - just started spotting again and I’m only 7DPO - period not due for another 8 days or so! The more I think about it the more this can’t be normal / can’t be good for ttc?!

Just so you know, everyone's progesterone peaks around 7dpo then goes down (it's why your period starts, putting it very very simply - sorry to any medical professionals for my dumbing down 😂). Your progesterone only stays high after that peak if you are pregnant. It would be worth getting the day 21 progesterone re-done, my GP had it done for 3 months for me as she said one on its own could be an anomaly. There's some online finger prick blood tests you can do which are a little cheaper than full blood tests.

I have PCOS the single most effective thing for me in regulating my cycles and ovulating was losing weight.

What is your BMI?

It took us 3 years to conceive and it happened almost as soon as I'd lost 10% body weight which is the number often cited as being a good success rate.

Mayo-inosotol is also good if you have PCOS, I've been taken it for a couple of months now to help me regulate my glucose levels as I have the insulin resistant form of PCOS. If you haven't already then I'd recommend asking the GP for a diabetes test to see if you may be in that range too.

@moosey89 yes I might look into doing an at home test to check - I thought ideally your progesterone stayed relatively high for a few more days in order to allow for implantation (which can happen as late as 10dpo) and then drops (causing a period) but maybe I’m wrong / need to ask my doctor. The Proov urine tests make you test on 7, 8, 9 and 10dpo and say you want ideally at least 3 of those days to be ‘positive’ (ie relatively high progesterone).

@FlabMonsterIsDietingAgain my BMI is normal - 20/21 - so I don’t think weight is the issue. DH is also a healthy weight as well. My doctor is adamant I don’t have pcos even though I have polycystic ovaries as I have regular periods and I don’t have high testosterone / androgens, but I have wondered if trying more of an anti-inflammatory low-GI diet would help.

Have you had a Day 4 test, which checks thyroid function amongst other things? That ended up being the answer for me when TTC DD1, although I had wonky annovulatory cycles, which doesn't sound the case with you.

Preface: no medical expertise of any sort here

I agree given the PCO, opk strips might be useful... generally I am not a fan as I think they create more stress than they solve sometimes

Are you taking CoQ10 it may help if only because you feel you are "doing something"

The other thing to look into is IUI - you are young ish so a good candidate...apparently it only has a 15% success rate BUT that varies by clinician and it's cheaper and a lot less intense/ invasive than IVF. Also anecdotally it's how LOTS of people in my office had their kids.
I work in tech and we have a fertility "benefit' I haven't needed to use it myself so not sure if therrs a reason my office is "skewed" ie. it's to do with the approach of the provider (ie.they push it pre ivf) or the clincs they use are just awesome at IUI or what...

@curliegirlie I’ve had my thyroid tested before although a while ago now (T4 was 15 and TSH was 1.15) but I didn’t have it on day 4? Not sure if that’s needed? I’ve never had a day 3 test which I think tests FSH, LH, estrogen etc so I could look into that.

@GreatGateauxsby I haven’t taken CoQ10 but I might start now as who knows maybe egg quality is the issue. I have strangely found that multivitamins seem to delay my ovulation and so I have just been taking folic acid and vitamin D, but maybe I need something more comprehensive.

Yes I wondered about IUI. My doctor said success rates were very low for heterosexual couples and so just to go straight to IVF, but I am definitely intrigued by the lower cost / less invasive. It’s so hard when you don’t know what the problem is because you don’t know what to target / focus on - I’m just worried that if the problem is with implantation then IUI won’t help. But then a lot of our parameters are good but not great (eg sperm motility and morphology) so maybe IUI could give us the extra boost we need!

@hopelesslydevotedtottc definitely check with your doctor - I was told by mine that they do the test 7 days prior to your period being due as this is the peak. Who knows 🤔😂

@moosey89 will do! Tbh I want to get my progesterone checked again anyway - they insisted on me doing the test on day 21 (even though I very rarely have a 28 day cycle) and the month I had the test I think I ovulated later than usual (maybe as late as day 18/19) so that would explain why my result was on the lower side. My cycles are just never the exact same length so quite hard to pinpoint 7 days before af!

@hopelesslydevotedtottc ah yes that might be it! Hopefully the Proov test helps give some more insight. Irregular cycles make testing and checking things that much harder!

@moosey89 absolutely!

Thank you all - ttc is such a minefield and everyone I know in person either doesn’t have kids or has got pregnant in the last 3 months - DH has been very supportive but I feel like I put everything on him so it’s nice to hear from people who have been through it and can relate!

@hopelesslydevotedtottc I’ve had the spotting problem too and wondered about my progesterone. I started taking a vitamin C and Zinc supplement as I’d read Vit C can help with lengthening the luteal phase. Also started eating a banana everyday for the Vitmain B6 (tried to avoid taking even more supplements!) which is also supposed to help. In my case I did find the spotting stopped/reduced massively and I did manage to get pregnant in November. Unfortunately it’s just ended in miscarriage but I have wondered if the vitamin C and B6 increase helped me lengthen my cycle enough.

Obviously there’s no way to know if this actually helped and it could be a massive coincidence but it was an easy change to make. I did jump in with high strength Vitamin C to begin with and it sent my ovulation off so I recommend just a regular strength!

@Wish23 I’m so so sorry to hear about your miscarriage. I didn’t know about the vitamin c and luteal phase link so that’s really interesting and I’m glad it made a difference to your spotting. Fingers crossed 2024 will be your year too 🤞🤞🤞

Hey OP, I had similar test results to you and was TTC for 15 months before falling pregnant.

My private consultant, however, did suggest trying clomid for a few months. He equated it to having "more darts to throw at the dart board". I fell pregnant my 2nd month of clomid, so certainly worked for me and I felt it was worth pursuing before going down the IVF route.

Hi @Alloveragain3 thanks for sharing your story and glad it was successful for you! Did you have extra progesterone with the clomid out of interest?

I'd start fertility reflexology/acupuncture . I'd also buy a natural progesterone cream off Amazon. I think it's called something like Auntie Annie's Yam progesterone cream though I could be way off

Also have a look at vitex and see if it's a good fit for you - it might not be though, it might make PCOS worse so definitely research first