Not sure what to do next -- Low LH/ FSH/ Progesterone

[anonymouspink]

29, TTC for 8 cycles with 2 missed cycles in there (partner was unavailable to BD). BFN every time.

No known health issues. No alcohol/ caffeine/ smoking at all, but I did consume 300MG of caffeine for 10+ years ,daily, until 5 months ago. Not sure if this matters. Also used to smoke weed socially, about once a week, until age 27.

I have a regular cycle, 28-30 days for the last 5+ years that I've been tracking.Using the simple qualitative OPKs (LH surge or not), my LH surge comes CD19-21, with my period starting 10 days later. No spotting in-between during Luteal Phase, however. I recognize this is a short LP, which is what led me to consider that I have a problem.

When I tried Maca Root, it messed up my cycle -- it delayed my ovulation to CD22-23, but it did stretch my LP by a couple days. But then, it would be CD23 ovulation, with cycle lasting up to CD35, which is so uncharacteristically long for me, it freaked me out so i stopped Maca after 2 months.

I am taking a Prenatal, Vitamin C, and Vitamin D. I was taking a B complex as well, but that also pushed my ovulation to CD22 that cycle, some internet research said too much Vit B can delay or prevent ovulation if you overdo it, so I got scared and stopped the extra B complex too.

As for blood tests:

CD3: FSH: 1.9.

7DPO: FSH 1.3 , LH 1, Progesterone 4.3 ng/mL.

This low progesterone would imply either weak ovulation, or no ovulation? I'm not sure.

How can I confirm if I am ovulating or not without going to a specialist? If I do go to a specialist, what can they do that I can't do at home? Ultrasound?

A RE is not covered by my insurance and the out of pocket costs are so high, I''m hoping to exhaust all my at-home or OTC options before taking the plunge. Please help.

 

[sesan]

@anonymouspink You can confirm ovulation by tracking basal body temperature. You should get a sustained temperature increase post ovulation. Don’t worry about the history of caffeine consumption. There’s a fairly substantial body of research on caffeine and fertility and it doesn’t seem to be linked at moderate consumption.

 

[anonymouspink]

@sesan Let's say the temping shows I DID ovulate, what's next? A progesterone that low implies there is ovulation, but it's very weak. I guess I'm confused what are the next steps if I confirm I am ovulating. How do I fix "weak" ovulation?

Let's say the temping shows I did NOT ovulate, now what?

I guess I'm just frustrated because IDK why this would happen or what the solution would be. I'm guessing weak or NO ovulation would be the same.

My OB is refusing to order the progesterone test so I can re-test at 7DPO next month, she keeps telling me I need to see a Reproductive Endocrinologist (again, not covered by insurance). Sigh.

 

[sesan]

@anonymouspink I’m not totally sure what you mean by a weak ovulation. Progesterone levels very significantly in the course of a day. My understanding is anything over 3 typically suggests you ovulated. Lower progesterone levels have not been shown definitively to be linked to higher risk for early miscarriages. The Texas Fertility Center has a reassuring article (had trouble making it a link but you can cut and paste). I’m 8 cycles into trying. All my testing looks perfect but I’m not pregnant yet. At this point I’m just continuing to try. At your age it’s reasonable to keep trying for a year as long as you don’t have really clear signs that something is wrong like anovulatory cycles. For women under 30 ~85-90% get pregnant within a year.

https://www.fertilitysanantonio.com/female-infertility/progesterone-level/#:~:text=Once%20ovulation%20occurs%2C%20the%20ovary,to%20above%203%20ng%2Fm.

 

[sesan]

I forgot to add that if there’s blood work you want you can self order at labcorp or quest. I believe it’s around 50 dollars to run a progesterone level. I order all my own labs since my insurance doesn’t cover fertility either.

 

[anonymouspink]

@sesan Thank you. I don't know what "weak" ovulation means either, I guess it's something I read while researching. Many doctors disagree about Progesterone and treating low progesterone/ short LPs.

I realize Progesterone fluctuates so maybe I need to re-test next month at 7DPO? to see if this is a consistent problem. Tho my FSH has been consistently low twice now so I'm willing to bet this is a recurring thing. I know I'm not exactly old but I just hate having yet another month go by.

 

[sesan]

@anonymouspink There is a little evidence for supplementing progesterone for women with recurrent miscarriages. There are two fairly large well controlled studies that found a 3% reduction in miscarriages.

I know what you mean about the stress of trying. I’m turning 37 this year and to add to it we’re using donor sperm so my TTC journey involves more logistics than typical. That’s the only reason I’ve done any work up because of the added stress of using donor sperm.

 

[ruky]

@anonymouspink It definitely sounds like there are ovulation issues. I wonder if your OBGYN can have you try medicated cycles to help ovulation rather than going through a fertility clinic just yet? I know some do but not all.

 

[anonymouspink]

@ruky Would that be Clomid or something of the sort? I want to ask but all of the OBGYNs here under my Kaiser insurance are so stubborn, they keep repeating that i need a specialist.

Also, is it too early to try Clomid? IDK

 

[ruky]

@anonymouspink Yes clomid or letrozole usually. Did you do your blood test through them? That's unfortunate if they can't do medicated cycles in their office. Based off of your abnormal day 21 labs, I'd say no it's not too early. I went to an RE at 9 months TTC bc I did an at home test that indicated issues. The kind of trumps the waiting for a year mark IMO.

 

[anonymouspink]

@ruky I agree. What at-home test did you get? i just ordered a quantitative LH at home test and a Progesterone Metabolite PdG test. hoping to get more intel with those.

 

[ruky]

@anonymouspink I used modern fertility which told me I had an ovarian reserve issue (and it was accurate) lol. Also just a side note to another comment of yours, those meds can help "weak" ovulation as well. I definitely had that issue most likely due to my ovarian reserve.

 

[anonymouspink]

@ruky I'm concerned about Clomid as I read that after 6 momths of Clomid, once you're off it, it ruins fertility by ruining CM?

I was looking into Modern Fertility or Inito. thanks.

 

[queenie4o]

@anonymouspink I have inito and love it! Currently on cycle 3 of TTC for #1 and enjoy the data inito provides

 

[shadow316]

@anonymouspink Honestly it does sound like you might need a hormone test. Ask your OB about a day 3 blood test. On day 3 or your cycle they’ll test all your levels with one blood test. Based on those results they can tell you how things are looking. They usually go through Quest labs so you can get a price estimate.

 

[anonymouspink]

@shadow316 I got CD3 testing done. FSH was 1.9. TSH was 2.7. They weren't able to do AMH as that falls under fertility. Testosterone / Estradiol normal, cant remember values right now.

 

[jangja]

@anonymouspink Are you charting your temps to ensure you’re ovulating when you think you are?

 

[anonymouspink]

@jangja i already bought a BBT thermometer off amazon but have not tried temping yet as I read its not a reliable method. should i try?

"it has been predicted in some studies to be only approximately 22% accurate in detecting ovulation." --> https://www.ncbi.nlm.nih.gov/books/NBK546686/#:\~:text=%5B11%5D%5B12%5D%20It,by%20women%20to%20this%20day.

 

[jangja]

@anonymouspink I would say it’s fairly accurate but it’s accurate AFTER the fact. You won’t be able to tell when you will ovulate but you’ll be able to see that you did ovulate. I recommend The book Taking Charge of your Fertility. Lots of helpful info on tracking ovulation.

 

[anonymouspink]

@jangja i'll look into it, thank you!