Unexplained infertility or problem with ovulation?

[Lightofday21]

Hello I'm new to this so please bear with me. Been ttc number 2 for 12 months. My son was conceived naturally and very quickly (very lucky I know) at aged 31. Husband and I are now 35

I've recently had some bloods on the NHS.

I haven't had an appointment yet to consider the results as on the waiting list for Hycosy and NHS said they won't discuss any results until after that test so likely not to speak to a consultant until the new year

I got a copy of my results and had them interpreted by a private clinic as after 12 months and no success I was keen to know if I am ovulating. A progesterone test by my GP in march had showed no ovulation but I don't actually know what the number was. I've suspected for a while that I have pcos due to acne and weight gain after having my son so I was assuming this was stopping ovulation

However my test in August on day 21 progesterone was 20 nmol/l

This was taken 7 days before my period but I got a positive opk on day 17

The private clinic said this result was normal and shows I am ovulating. The consultant said he can't see why we haven't conceived yet and told us to carry on trying for another 6months. He said he wouldn't recommend ovulation induction as I don't need it

I've seen a lot of conflicting information though and that a result of 30 nmol or over is confirmation of ovulation so I'm not sure what to believe?

My ultrasound showed high AFC and polycystic ovaries. Amh was 52. The consultant said pcos isn't a problem if I'm ovulating so not to worry and keep ttc

My husband's semen analysis was good but morphology was 3 %. We were told it shouldn't be a problem though because of numbers overall

I'm not sure if I should get a second opinion. Does anyone know what level is considered to be too low for progesterone? Can you ovulate but have low levels and at what kind of levels are people being prescribed clomid?

Hi @Lightofday21

So to meet the diagnostic criteria for PCOS you generally need 2 out of 3 of these:

• Clinical Hyperandrogenism (Ferriman-Gallwey Score >8) or Biochemical Hyperandrogenism (Elevated Total/Free Testosterone)

-Oligomenorrhea (Less Than 6-9 Menses per Year) or Oligo-Ovulation -Polycystic Ovaries on Ultrasound (>= 12 Antral Follicles in One Ovary or Ovarian Volume >= 10 cm3)

You haven't mentioned your cycle length but you may meet the criteria with the 1st and 3rd points.

In relation to confirming ovulation, the lab where I had my test have these cut offs:
30 ovulation confirmed
This would need to be the equivalent of day 21 in the cycle to be interpreted, 7 days prior to menstruation in irregular cycles.

So I guess it's difficult to say if you are ovulating, we can only interpret whether you ovulated in the cycles where you had the blood test done. The first you say came back saying you hadn't ovulated and the next seems to be equivocal.

I am not an expert in infertility treatment in PCOS but I agree that seeking a second opinion would be useful. In particular the go away and keep trying stance is not particular helpful. I was initially told this after TTC for a year, they actually missed that my lining was too thin for me to conceive naturally and I'm now one year into IVF with no success as yet. So I'm glad I didn't put it off for several months as all that would have done is wasted more time.

Your August test would not have confirmed ovulation with such a result, a level of 30 or over should be seen. If an ultrasound showed polycystic ovaries you are not unexplained. Unexplained is no diagnosis, all that means is that they have failed to find out what is wrong.

As you have a child the NHS may not be able to help a lot further going forward.

You certainly need a second opinion from another clinic. Do you researches carefully before you part with any more cash, some private treatment is poor as well as expensive. I would not return to the place you went to previously. A level of 30 or over for progesterone would need to be seen on a day 21 test to confirm ovulation.

One semen analysis is not sufficient to determine if there is a male factor problem and therefore should be repeated.

Would suggest you refrain from using Opks as these are not recommended if polycystic ovaries or PCOS is an issue. These kits can give false positive results if your LH level is out of sync with FSH, the kit reads the increased level of LH.

I would also suggest you seek a second opinion from another clinic as soon as possible. Do your researches carefully before parting with any more money re clinics.