My H and I (both just turned 32) have been TTC for 11 months with no success so far, prior to that I took the OCP (Cilest for 15years). Since stopping the Pill my cycles have been moderately long and irregular. I am currently CD33 of my 9th cycle. My average cycle length is 38 days but has varied between 28 and 52 days. I always have at least 2 days of spotting (rusty/altered blood) prior to my AF arriving and have had 4-5 days of spottingin a few cycles. Due to my irregular cycles, I found charting difficult but I have found myself to have a temperature shift mid cycle/positive OPK's and appear to have a luteal phase of 12-14 days.
I have normal CD2 LH, FSH & prolactin as well as noram tyroid function. My BMI is 21 and my transvaginal ultrasound was normal (no PCOS, no fibroids & corpus luteum seen).
My 1st CD21 progesterone was 0.2 nmol/l, taken 4 days before I believe I ovulated.
I have had my progesterone repeated twice this cycle on CD24 and 25. The first was 29.5nmol/l and the second was 28nmol/l. I have had spotting (rusty/altered blood) for the last 5 days but no sign of a true AF.
Due to all this I suspect I am having occassional anovulatory cycles as well as an issue with the amount of progesterone my corpus luteum produces, making implantation a problem.
My H's semen analysis showed 88% abnormal morphology but with a count of 270million. All other values were withing normal range.
We have been referred to a fertility specialist for further investigations and possibly treatment if appropriate but was wondering if you thought my concerns/suspician regarding my LP was justified and what you think my treatment options may be?
Many many thanks in advance,
Lee
p.s. I am a physician but work in Paediatrics therefore have limited knowledge of infertility!!!!
Please be sure your "fertility expert" s a Reproductive Endocrinologist. if you are in the U. S. From your spelling of your specialty, I assume you not. Too many OB-GYN generalist describe themselves as fertility experts, but have no special training beyond the basic residency program. I assume you are not ovulating regularly, based on your description of irregular menses. As far as your husband's semen analysis, if the morphology evaluation was performed usnig Kruger's strict criteria for morphology, that is essentially normal. If the WHO classification was used, you probably have a problem and may require ICSI. Good luck.
Many thanks for your reply, it is very much appreciated.
I am based in the UK and therefore my referral has been made by my General Practitioner and I believe it is to a Consultant in Obstetrics & Gynaecology who has a special interest in Infertility, minimal access surgery, endometrial ablation. As an NHS patient, I have little say in to whom I am referred unfortunatly. My husband and I will go for initial investigation but may consider transferring to Private care a little further down the line.
If we do use private services it would be to the Assisted Reproduction Gynaecology and Conception Unit in London under Dr Taranissi
I do not know by which criteria my husband's semen analysis was evaluated but my own doctor descrived the result as only just outside of normal limits.
I know I have given you limited information and that you obviously could not make a diagnosis over the internet but would you be concerned I do not ovulate at all or that i do not ovulate every cycle. If I was to ovulate 9and on the assumption my husband's result is normal) , would my progesterone level and pre-AF spotting cause a problem for implantation, and if so, what would the treatment be for this?
Are you certain that the second progesterone level was only 29.5 nm/l and not 29.5 nm/ml? If it were the latter, you either ovulated that cycle or had a luteinized unruptured follicle. You do have an ovulation dysfunction. I do not know what other problems you have, as a couple.
I do not know Dr. Taranisi. I do know Peter Brinsen, the director of the Bourne Hall Clinic. I do know that institution and Peter both have an excallent reputation.
The only other suggestion I have is to see the information I have provided on our web site, <www.texasfertility.com>.
Yes, my progesterone was definately measured in nmol/L.
AF arrived overnight so the 2 values of my progesterone were measured 9 days (29.5nmol/L) before AF and 8 days (28nmol/L) before AF.
I will look at the website you suggested. I am based in London so Cambridge is to far to attend for care unfortunaltely. Are there any London based experts you could recommend?
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