Day 21 test - not ovulating and cried myself to sleep

[stopthepain]

I’m nearly 26. Since tracking my cycle since I stopped the pill (over 2 years ago) my periods have been irregular. Started bbt charting and despite a dramatic temp shift (and fertile cervical fluid) it would soon go back down to the cover line 36.4C and then rise later. My day 21 blood test confirmed I’m not ovulating. Internal ultrasound apparently doesn’t show any cysts.

I’m distraught. I keep crying. Doctor told me I’ll probably never conceive.

Is there any hope for me?

Yes. There definitely is hope. Your doctor is awful. Even if you aren't ovulating, there are medications you can take to induce ovulation, or ivf is also an option.

Has your GP referred you to a fertility clinic? If not, go back (maybe see a different GP as that one sounds crap) and request a referral. You'll likely have additional tests at the hospital.

But there is definitely hope.

Wow, yeah, I have to second pp, your doctor is showing a shocking lack of knowledge and/or care !

If the issue is not ovulating then your first step is more likely going to be clomid, but you might want to check everything else first so that you have the full picture.

Actually your first step before that first step is to get rid of your doctor and find another one. Dear god.

@Marty13 @VenusStarr thank you for reassuring me❤️ The doctor said she’d refer me but hasn’t yet. Such a shit doctor with zero compassion! I can’t get over her wording. I couldn’t stop crying. I told my mum and she went mental. She never struggled but she told me her friends had used fertility drugs and Ivf. You know what? The dr also mentioned egg donation but not clomid etc! What the hell??

Wow that is awful! Even mentioning egg collection is too far until you've had a scan to check your egg reserve. You might have some cycles where you do ovulate and some where you don't. You also might not have ovulated yet in the cycle when you had your day 21 bloods, especially with irregular cycles. There are lots of possibilities including PCOS, which you can conceive with but may need help as mentioned above. Have you had a blood test for AMH? That can help to show your egg reserve

@ChristmasJumpers thank you. You know so much more than the GP. She didn’t even mention AMH. Just egg donation and harvesting my eggs to check the quality! I was already reeling from the idea of not ovulating. I didn’t need that too

I only know as I have been through testing for irregular cycles myself. I did ovulate when I had my blood test but my AMH level is high which suggests I don't often ovulate as my egg reserve is really high.
Definitely push for more testing, it sounds like your GP has jumped to some extreme conclusions

@ChristmasJumpers I'm sorry that you had issues too :( I’m going to chase up the fertility doctor referral and ask for my AMH to be checked. I just never thought I’d struggle at the age of 25.

@ChristmasJumpers not sure if you have experience with charting but my bbt is higher than it was after my period (usually 36-36.3C) and I get egg white or watery discharge. I could understand if I was always dry and had low bbt but that’s not the case. My body is playing tricks on me :(

This GP is full of nonsense @stopthepain . They should refer you to the fertility clinic - guidance actually states that should have been done a year ago. Then I reckon for you it will be:

Assessments
Repeated day 3 and 21 bloods
AMH
Hycosy
(Has your partner has his semen tested? If not, he should request it)
Most of these GP can't request btw, needs to be fertility clinic

Interventions

1. ovulation induction medication eg letrozole or clomid. If one doesn't work they will try the other
2. IVF if that fails.

Read all the NICE guidelines etc, be informed about how things SHOULD go.

How's your overall health, weight etc? Do either of you have living children?

If your GP is as rubbish as they seem I wonder if you just had the day 21 test at the wrong time? If your BBT goes down and then back up later on and stays up then until your period comes, then you are ovulating, you're just ovulating late?
I have PCOS so long cycles and my GP told me to treat the day 21 progesterone test as a "7 days before my period" test rather than CD21. As otherwise all the day 21 test will do is prove you've not ovulated at that point in time. It really annoys me because it's not actually that uncommon to not ovulate until CD20.
I hope the messages you've had on here have helped. We've got other fertility problems but if it's just not ovulating (or potentially late which I guess might impact quality but don't know) then it's possible you'll conceive with some help ovulating. Try not to let it destroy your hopes of conceiving.

@TheDaydreamBelievers thank you - I have screenshot that! My progesterone was less than 1nmol/l but my oestradiol was normal (200 something). My DP requested a semen analysis so he’s waiting for his doctor to get back to him. I had a quick look at the NICE guidelines. Neither of us have dc.

My bmi is 18 but I think that’s down to my ethnicity (we’re tinier than women in other countries). For example, my mum, grandma and great grandma were around the same size as me when they conceived. They never struggled. I have a normal healthy diet, no skipping meals or surviving on salad (that’s a side dish, not a main meal!) However, I’m worried the doctor will use my weight against me. I have cervical fluid but it’s like my body tries to ovulate and fail. I have periods, but I can’t predict them since I came off the pill over 2 years ago (didn’t track prior to that).

I've not had my AMH checked. I’ve never heard of a Hycosy. Which is better, letrozole or clomid? I’m going to contact my GP again tomorrow.

@stopthepain all of these things come via the fertility clinic not GP. Honestly at this point id give up on the GP if I were you, apart from getting a referral to assisted conception. Check the criteria for assisted conception referral in your healthboard/trust but sounds like you meet it. Letrozole Vs clomid depends on your personal physical numbers etc so I wouldn't want to guess at which they will give

Just to add to what @TheDaydreamBelievers has said, try to start tracking your cycle lengths now from day one of AF through to the last day before next AF. I did this for a few cycles to get an everage which helped to determine when my "day21" blood test should actually be. 7 days before AF is the advice I got too and I managed by some miracle to get it spot on!
I also have all the physical signs of ovulation each cycle but don't always actually ovulate. I've never taken my temp as my GP said it could rise when my body attempts to ovulate so wouldn't indicated actual ovulation. No idea if that's true as we know GPs don't always get these thing right...

@ChristmasJumpers it will rise after attempts but won't stay up. 3 elevated temps isn't enough to indicate ovulation for people who's bodies try a few times. I'd say 7 days where 6 or more are elevated probably is a better bet

I hope you get the answers you need. I was diagnosed with unexplained infertility by the infertility clinic at my local hospital which means straight to IVF.
When I had my first consultation at the IVF clinic (my local hospital did all the testing but don't do IVF in house), they said I definitely have PCOS.
Due to all the delays in getting referred, we stuck with the IVF route and currently going through it now. I always wonder if I should have been offered Clomid first 🤔

@TheDaydreamBelievers nobody ever told me that so I never tried that or ovulation kits 😣 we're in the middle of an IVF cycle now

@ChristmasJumpers yours is an unusual tale - if you often have long irregular cycles then this suggests that your body ovulating on time is an issue, which means egg quality often an issue, so it's weird it would go down as unexplained infertility?

Clomid/letrozole/any ovulation drug don't have a good evidence base for unexplained but they do for missing or late, weak ovulation.

That said, IVF may be much more invasive but it's also more successful (depending on age etc). When at the correct dose, ovulation induction drugs work for 38% after 6 months. That's not a great return!

Sorry, meant to also add to my comment to @stopthepain .

My history: 33yrs old, 2yrs 2mo TTC, massively irregular cycles (30-161 days), usually no ovulation at all. Overweight but not obese (within NHS fertility criteria)

My path so far:
Assessments
Repeated day 3 and 21 bloods
Full hormone and androgen bloods
Thyroid, iron, blood sugar bloods
Scan of all pelvic organs, ovaries to see if cysts or ay structural issues etc
AMH
Hycosy - checks fallopian tubes are open
2 x semen analysis for DH

Results:
Ovulation disorder (not PCOS). Hugely high AMH value (suggests eggs all being kept). DH totally fine.

Interventions offered:
ovulation induction using letrozole. Currently building up the dose to hopefully find an effective one.
IVF if that fails.
Even if IVF with my eggs fails, then we can look at egg donation.

@TheDaydreamBelievers I do feel a bit put out when I think about it. I originally went to the GP before TTC as I suspected we'd struggle with my irregular cycles (between 35-70 days). I have other signs of PCOS such as excessive body hair and weight distribution is all in my middle. I had a the blood tests and a scan and was told all is normal and to go off and try for a year. I waited 2 years due to covid and then went back for all the other tests, still told all is normal but then my consultant at the IVF clinic took one look at the same blood results and said its clearly PCOS with how high my AMH is 🤦‍♀️ I didn't want to start clomid at that point because by then we were 3 years into TTC but in a few years if we want to try again I might ask about it

@ChristmasJumpers I dont to be too blamey as GPs have to be generalists but I have found their knowledge about fertility to be v poor, meaning the patient (us) has to be v well informed. Then the fancy level professionals (gynaecology and reproductive medicine) have often needed me to be quite straight with them to get a full explanation of why they are saying yes/no or recommending specific things.

For anyone else reading PCOS is based on presenting with at least 2 of 3 symptoms which are 1) irregular cycles 2) androgen and hormone levels off or indicators of this eg excess or thinning hair, spots, weight gain and 3) cysts on ovaries in scans.

I didn't meet this criteria when assessed as I didn't have odd hormone levels and I didn't have enough ovarian cysts. But now I've been off the pill two years I definitely have loads of the soft signs, most notably thinning greasy hair

Hi. My last cycle was ridiculously long and the first time I’d ever charted my temps. As in my period was in December and nothing until April. Prior to that I had 2 periods in October (that was horrific) and then obviously my period in December. It was the same in August. I had been skipping a month for a year or so until the ridiculous Dec-April cycle. I’ve attached my latest chart.

Thank you everyone for sharing your stories and experiences with different treatments. My GP is shit! She made me cry!

@TheDaydreamBelievers blood tests show my oestradiol, androgen, thyroid and full blood count are within normal levels. Internal ultrasound didn’t show anything sinister. Day 21 progesterone was very low but I probably haven’t ovulated yet. FSH was higher than it should be for my age but it wasn’t taken on day 3 of my cycle. This is all I’ve had so far.