Spotting pre-period
8 Replies
Slatka - July 18

HI Dr. Jacobs --

I wonder if you have an information on this:

I m/c in March of this year and have had 5 cycles since then. For two of those cycles, I have had a pink spot on the CD26 (I have a 30-31 day cycle, so I generally ovulate CD17), then nothing, then brown spotting for several days, then I get my period a day or two early. I'm concerned about the spotting, as I have heard that this is not normal and may indicate a hormonal problem. I had my progesterone tested on CD 24 and it was only a 6.

I am also unsure why I have less than 14 days from ovulation to period; often, I get my period 11 or 12 days post-ovulation. I had thought (and been told by my OB) that there are always 14 days between ov. and period.

DO you have any sense what could be happening, and how to correct it? I would appreciate any help you can offer, as I don't want to just let this go.
Thank you (and thank you for taking the time to help all of us -- I've read your compassionate and helpful replies many times; it means a lot).


B. Jacobs, M. D. - July 18

Spotting befrore a flow is common and not associated with any particular problem. Your short luteal phase is. Also, some of have observed that women who ovulate after cycle day 16 seem to have poor fertility rates, and increased miscarriage rates. I have no data to support that statement, but my patients who ovulate late, I stimulate their ovaries, and usually produce successful pregnancy.
Good luck.


Slatka - July 18

Thank you Dr. Jacobs. I have a call in to my OB/Gyn; hopefully she will finally help me and stop telling me (as she has for months, despite my descriptions of my cycles) that everything is normal.

Again, thanks -- Slatka


Aimee37 - July 19

Hi Dr. Jacobs (excuse me for jumping in here) You mentioned that women who ovulate late most likely have poor fertility rates & higher miscarraige rates? :o

Ugh...I ovulate late, that is without BCP's. Are you saying my chance of m/c would be higher than the norm? Is this because the egg quality is poor with late ovulatation?

Well..with the help of BCP's & stims (my 1st IVF) I had a m/c. I am sure I ovulated right on target with the help of the HSG shot. I am hoping that his more likely has to do with the embryo not being genetically/chromosonally normal.

Another question...why do some RE's give thier patients Heparin/Dexamethasone/Viagra suppositories to help implantation and help avoid miscarriage when woman have never had a m/c? I wish my RE would play it conservative with me because I do not want to have another m/c. Do you think I should ask her if I can go this route? I am pretty sure she would tell me it is not necessary. I guess some RE's want to play it safe and cover all grounds? Do you treat your patients simularly?

What is your take on this?
Thanks for all your help!! :)



B. Jacobs, M. D. - July 19

I have no scientific data that late ovulation increases the risk of miscarriage. Several of us have the impression that it may be the case. We have no information about possible mechanism. I do not know whythe cocktail you mentioned is used. I have seen no data to support the use of that combination. The only reason I know to heparin is for antibody problems as a cause of recurrent pregnancy loss.
Good luck.


Aimee37 - July 20

Ok thanks Dr. Jacobs. :)

But...from your experience, when you have patients who ovulate late and treat them with BCP's/stims, etc... is the m/c is about the same as with others who ovulate on time? Do I have something to worry (regarding m/c rates) about because I ovulate late without BCP's/Stims?

Thanks!! :)


B. Jacobs, M. D. - July 20

For my patients for whom I do ovulation induction, I do not use birth control pills. I just use one of the FSH products. We do seem to improve the successful pregnancy rates, but I do not have adequate data to prove my observations.
Good luck.


Aimee37 - July 20

That makes sense. My RE used BCP's with my IUI's for me because I ovulated late and thought it would be better to time my cycles. For IVF's, do you have your patient's start off with BCP's? I hear it calms the ovaries down before all the stims and they actually produce more follicles after BCP's. Have you found this not to be the case?

Thanx, I hope I am not irritating you with too many Q's? :)


B. Jacobs, M. D. - July 21

We fell we get better quality eggs and embryos if our patients are on birth control pills for a pack, or more, before we start the stimulation.



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