Low progesterone/Anovulation

[MimiArm]

Sorry if this had been asked many times before but hoping someone can offer anything positive and feeling so down today.

Background: I just turned 39 (DP36) and TTC baby 1 for over 6 months.

Had been on progesterone only minipill for years and stopped it last December.

I've been tracking ovulation with OPKs and been getting the static smiley face each month.

So far my cycles have been 26 days (except one month is was 30 days). In all cycles, my "luteal phase" is 9/10 days and periods are very light and last 2.5/3 days.

I usually "ovulate" on day 16/17 but this month I was happy to see the static smiley on day 14, so stupidly got my hopes up.

GP did the CD3 blood test last cycle and everything was normal. (Note though that the previous month I paid for a private test online as it showed low Estrogen - not sure of that was a scam or not since GP one came back normal the next month!)

Had the CD21 test last Friday and phoned for results and got the dreaded "the doctor needs to speak to you". Got the call back today and Dr said progesterone was low and therefore I didn't ovulate. He said that he suspects I might ovulate some months but not on others and he would like me to retake the test on CD21 and CD25 this cycle.

I asked if there is anything I can take and he said no and that he is happy to refer me for fertility treatment. I asked about waiting list and he said to expect it to be at least 12 months. The only treatment he mentioned was IVF.

I should also add that my usual GP (who instructed the tests) specialises in fertility and the callback today was from a locum doctor.

I feel so deflated, hopeless, useless and a whole bag of general shitness today and haven't stopped crying.

Since this news I've Googled frantically in between work and learned that Clomid is usually prescribed to help ovulation.

I guess I'm wondering why this wasn't mentioned as it seems to be the first step and is able to be prescribed by GPs.

Anyone able to shed any hope? Is it worthwhile in me calling back again and requesting a callback from my usual GP as she seemed much more proactive. I don't wanna be a pest but I can't afford to be on a waiting list for at least a year either and it was just make me feel even more shit.

I also asked my pharmacist friend and she said she was shocked they didn't mention that. She suggested paying for a private consultation with a view to the consulting making a referral to the GP for Clomid.

Sorry, I'm rambling now. I feel like such a fool for getting excited each month for nothing when there wasn't even an egg there to be fertilised 😢

Did he say what level your progesterone test was?

And yes, I often see that clomid is prescribed for help with ovulating so I’m surprised that he suggested IVF straight away. But this is also good news in that there are options if you aren’t ovulating!
I personally would call your usual GP and see what they say, and don’t worry about being a pest! I’m sure my doctors and consultants have been absolutely sick of me and my questions but fertility issues can be so so stressful and I think if anything helps to put your mind at rest then it’s worth it

Also, if you only came off your pill in December it can take up to 2 years (albeit I think it’s unusual to take this long) for your fertility to return to normal

@Wishingforamiracle19

Thank you for your reply. He actually didn't tell me what level it was and, in my shock, I didn't ask.

I am definitely going to call back on Monday and ask to speak to my normal GP and ask about the result, and also the Clomid.

The general consensus seems to be that Clomid could be perhaps be a solution.

Also, in NI to qualify under the NHS, the government website says that you have to be referred before your 39th birthday! I turned 39 last week!

Yes I think that sounds like a good plan! Yeah as far as i’m aware you would usually try something like that to encourage ovulation before going down the IVF route. I also think that anovulatory cycles are quite common, obviously not every month but the odd one. It could also be that you’ve ovulated earlier/later than expected and therefore your test wouldn’t show a true reflection. I remember my progesterone test was low too on day 21 and the doctor seemed to think I’d ovulated earlier in that month (actually I had as my period was earlier than usual).

Also with everything that’s been going on recently with the pandemic I would hope that they wouldn’t hold it against you for the sake of a couple of weeks! NHS funding is such a lottery though, we were lucky to get one round on the NHS as some places don’t fund it all. Then again in others, 3 rounds are funded!

It's all such a minefield! It's weird as each month two days after I get the static smiley on the OPK to say I'm about to ovulate, I get really sore boobs. I know when I period is going to arrive as the boob pain then stops two days before period starts. Like clockwork every cycle.

That's always backed up my theory that I ovulated when the OPK said I would.

I also get the EWCM a day or so before the static smiley so this confirmed to me even more that the OPK is correct.

I suppose I'll be able to gauge if i don't ovulate at all of this cycles blood test is also low as maybe, as you say, it's just an anovulation cycle.

Was your IVF round successful? Had you tried Clomid prior to IVF (hope you don't mind me asking).

Yes I also know from EWCM too. It sounds like all the signs are there for ovulation so that’s positive.

No unfortunately not. We have MFI so we had ICSI and unfortunately none of my eggs fertilised. Kind of at a loss at the minute as to what to do next, whether to go ahead with ICSI and do a long protocol again or reduce the drugs to concentrate on egg quality. It’s so hard so I really hope you’re able to sort things without going down the IVF route!

Sorry - I’ve never tried clomid but a girl I worked with did and she conceived. I think from what I’ve read it’s quite successful!

Clomid is generally only prescribed by a fertility clinic. You need to be monitored when taking it. This involves repeated scans and usually bloods. Obviously, there are exceptions and every once in a blue moon I hear about a gp prescribing it. But be warned, it is powerful stuff. Often there are side effects.

I've got long term consequences of taking clomid: I reasonably sized fibroid I didn't have before.

I'd really suggest having the 'day 21' (obvs on the suitable day) taken for more than one month before doing something like clomid.

But if anovulation is your issue, there are loads of things they can (and often do) try before ivf.

Hey, sounds like your GP was really flippant just throwing in IVF!! Anovulation is my issue (currently ttc number 2 - so if you're anovulatory it's very possible to conceive!) and I've been told that I will first be put on letrozole, which I'm trying for the first time this cycle. If that doesn't work then clomid and after that maybe gonadotropin shots.
IVF is brilliant and has worked for a few of my friends but it's usually something that you go for having tried other ovulation induction treatments first.
I would definitely give your normal GP a call. It doesn't sound like the locum was helpful plus it can be hard to ask all the right questions and gather your thoughts when you've just been told some upsetting news.
Best of luck xx

Hi @MimiArm
I would definitely give a call to your gp and ask about your blood results. If it's not too low that is because your blood test was taken on the wrong day. They call it day 21 test but in reality it is not day 21 for all of us. Like you said you might ovulate day 17 so the test should be taken later.
Gp should never prescribe clomid/letrozole as previously said you have to be monitored at least for couple of cycles.
If I was you I would definitely go private and wouldn't waste any time being on a wait list. If you can get some blood work done on Nhs but keep your options open. Unfortunately age is our enemy and we shouldn't ignore that.

@Chicasimona - thanks for the advice. I had my blood test on my CD19, since my cycles have been 26 days so that compensated for the shorter cycle. Turns out though that I only had a 24 day cycle this month but the doctor said as long as the test was later, rather than earlier than the "21 days" then it would be accurate. Not sure why they want to do day 21 and day 25 next month though. Any idea?

@RG1987 Thanks also for the comments and the reassurance. Good to know it's not insurmountable. I have been panicking so much today as I had no idea I had this problem so it's good to hear others experiences.

@physicskate thanks for the comments and sorry to hear of your experience with Clomid. Also good to highlight the risks. I'll be educating myself as much as possible on all of these meds over the coming months. I'll be definitely having the tests again this month and am anxious to see the results again.

@Wishingforamiracle19 - Ah, so sorry to hear of your hurdles. I'm not sure what those procedures are as I'm completely new to this side of TTC but I hope you're able to decide what the best way forward is. Thanks also for the words of positivity - sending back positivity your way!

Hi @MimiArm
Our cycles are very similar in length with 9/10 days LP. The test for progesterone needs to be done one week after ovulation not one week before AF starts. I did opk to pinpoint ovulation and had the test done accordingly a week later and came back with the right numbers.
Also don't be anxious if you haven't ovulated it can be an easy fix with meds. X

Hi @Chicasimona

That's so strange because my GP said it should be 7 days before AF due and to adjust down accordingly since my cycles are shorter. But if you're correct, my test was done 5 DPO per the OPKs. Maybe then when I get tests done this month I should wait until I get the positive OPK and then book the test! X

The pill actually leaves your system very quickly after taking the last tablet so that is not a factor here.

You need a diagnosis first and foremost and both of you should be tested in tandem.

The day 21 test is a standard test but this is only part of it.
You also need a day 2 test done to check and compare your LH levels against that of FSH. If these are awry then ovulation will be affected.
I cannot understand why a day 25 test has been suggested at all and the person who did phone you sounds useless actually not to say frighten you re IVF. I would put in a complaint.

You should be monitored on Clomid but I was given 6 months supply by the NHS clinic and told if it didn't work then I'd move on to IVF.

I had day 21 tests on two cycles, one showed ovulation and one didn't.
I always have spotting before AF starts.
The consultant thought the Clomid would stop the spotting. It didn't so they upped my dose.
I had to push for another day 21 test while taking Clomid to see if my progesterone level was higher (it was).
I paid for a private scan as the NHS did not do any monitoring.
Other people I know had scans and blood tests.

Anyway @MimiArm you definitely have less invasive options before trying IVF.
Good luck.

@AttilaTheMeerkat Thanks for your comments. I had the test on CD3 (they said had to be done in day 3) in May and it checked all that you mentioned and everything was "normal".

I'm geared up for speaking to the "good" GP this week and am going to relay what the "bad" locum told me. To be honest, he sounded uncomfortable even taking about periods and whatnot.

He said I need day 21, 25 and 28 tests done this month - until I pointed out again that my cycles only usually last 26 days.

I'll report back after my call this week but yes, I felt really distraught after the phone call!

@JeNeBaguetteRien thanks also for your comments. They, and the others, have completely calmed me down since yesterday so I'm really grateful 😊

Update: I spoke to GP again. Said I have to go to clinic and the referral has already been sent off.

She mentioned that the clinic will need to run more tests and that they, as GPs, can only do the start off work (bloods, semen check etc). She then mentioned that the clinic could prescribe Clomid/injection (?) depending on outcome of tests.

I've to go back anyways on day 21 & 25 for more blood tests for the re-test/

My progesterone level was 1 in the last test.

@MimiArm did they say what unit of measurement they did the test in?

@Wishingforamiracle19 No, and I didn't ask

@MimiArm i wish everywhere worked with the same ones! I think if your cycle length is 26 days then a 21 day test may not show high levels of ovulation as it most probably occurred earlier in the month. Good thing is you’ve been referred and can have additional tests so I’m sure you’ll get to the bottom of it :)

Clomid is a tablet. Letrozole is often the next step and is also a tablet. Some clinics skip clomid and go straight to letrozole. Depends on your clinical presentation and consultant preference.

The injections for ovulation induction are often gonal f.

Generally you'd start with tablets to induce ovulation. If the tablets don't help you to ovulate, then you might move into injectables. This would generally be after several cycles of tablets first, seeing if increasing doses make you ovulate. It's part of the reason you need to be monitored.

The tests that each clinic decides to perform depends on the tests you (both) have already had, the results of those tests and consultant preference.

Thanks @Wishingforamiracle19 and @physicskate

I actually think the original blood test was mistimed. The GP told me to adjust the date to take account of a short cycle. From what I've read, and another comment here, it should be 7 days post ovulation rather than 7 days before AF. My test was done 5 days post ovulation, and (of course) my cycle was shorter than normal at 24 days, so it was 5 days before AF.

I think I'll book in the test for 7 days post ovulation this month. They are also doing it at day 25 as well, so that would correlate to 11 DPO for me.

Does that sound right?

@Wishingforamiracle19 @physicskate

Hey! How are you both doing. Just an update - we've went ahead and booked the private fertility clinic and I have my AMH blood test and ultrasound scan tomorrow. OH has his SA test booked in for Friday and then we have our results/plan of action consultation next Thursday.

Managed to get a copy of my results from GP to bring with me tomorrow as well (and had progesterone test redone and the result was even lower than the first time so still apparently no ovulation.

Are either of you glued up on results? Here's mine but I've no idea what they mean!

*clued up (not glued up 😳🙈)

@MimiArm hi! I’ll be honest I have no idea...FSH should be below 10 so that ones ok. I’ve just dug out an old blood test and it states that your serum progesterone needs to be above 30 nmol/L to suggest ovulation. Did you have it done on day 21? How long are your cycles? X