LPD, Endometrial biopsies - what does it all mean? Any CAM suggestions?

[Rachelette]

This is my first thread, and I'm posting because I feel overwhelmed by all the information and I am also finding that my ob-gyn tends to dismiss complementary/alternative medicine. 

We have been TTC for almost 2.5 years.  I have been diagnosed with PCOS and am overweight, so my ob put me on metformin to cause ovulation and a regular cycle, which worked. I conceived once in October 2010, but it was a chemical pregnancy, sadly.  My progesterone levels were too low to cause implantation.

My ob then put me on Chlomid, with an HCG trigger, IUI and Prometrium.  Sadly I heard yesterday that it didn't work (the 2 mature follicles didn't produce eggs which were fertilized).  So they did an endometrial biopsy today, in hopes of seeing whether I have a luteal phase defect (which I understand to be a shortened window of implantation). 

While the doctor (not my ob) was giving me the endometrial biopsy she wasn't very helpful.  I asked if they would see why the eggs didn't fertilize and she said "Chlomid is only between 20 and 30 pc effective, so its not unusual"  when I asked what I could do with respect to CAM she said it can't hurt, but I doubt it will help.  In addition she said not all MDs believe in LPD, which I found interesting. Perhaps because of that, she wasn't all that helpful in explaining to me what they were hoping to find.  Since this is all out of pocket, I am frustrated by the very expensive (and pretty uncomfortable) procedure with little information.  Can someone provide some context for me?  From Dr. Google I've seen that LPD can be remedied by using extra progesterone, so I assume they would up my dose of prometrium or switch to a cream/suppository.

I also have seen CAM references here and elsewhere that says Angus Castus is good for PCOS (a friend conceived using only AC after TTC for over a year), that you can help LPD by using B6/biotin, Vitex, chaste berry tea, red raspberry leaf tea to add progesterone via your diet. I also got a good reference for an accupuncturist I am hoping to see.  

We're going to try another Chlomid/HCG/IUI cycle though, so hopefully this will be the charm. But at over $1000 out of pocket per cycle, I would like to increase the efficacy any way I can.  It really is a brand new world, and I find myself so challenged by all the new language and concepts .

Thank you in advance for any help you can offer. 

[dot1]

Pub Med is a great resource for researching what has actually been studied.  Google doctor is hit and miss....but I do find that it gives a great starting point of where to begin researching - and can also help clarify some of the medical terminology out there.  The best source of info, I've found is the library - good books on infertility is a good first step.  Sign out all of them and read them all!

The problem with most CAM treatments is that they haven't been studied well enough with rigourous scientific standards that control for biases and other variables that can influence study outcome.  As a result, most physicians (who are required to have evidence to back up their recommendations) are hesitant to recommend it and tend to give the non-committal response you've just heard.  I've read that acupuncture, meditation, yoga seem to show promising results but I don't know references off hand.  My OB said that acupuncture can be helpful for some.  She also said that there's insufficient evidence supporting progesterone creams to support the luteal phase; however superovulation (wtih clomid, femera, etc.) does result in lengthening of the luteal phase and increased progesterone levels (affecting LPD).  It certainly had a positive effect on mine - unfortunately the clomid thinned my lining and decreased cm production.

My understanding of metformin is that it regulates the body's insulin production (and problems with insulin regulation seem to be result in anovulation or too much testosterone).  Are you still taking metformin?  If not, are you trying other ways to regulate your insulin levels naturally (e.g. low glycemic index and high fibre diet choices, regular aerobic exercise, etc.)?  It sounds like you could be at risk for type II diabetes (given the positive impact metformin had)...and infertility might just be a red flag.  Sometimes the best longterm solutions for overall health and fertility are not necessarily the easiest ones.  However, perhaps you're already getting regular aerobic exercise and eating foods that don't cause spikes (and drops) in blood sugar...

Best wishes on your journey.