"unexplained infertility" and LP spotting

[daurelia]

Hello everyone... I don't have kids yet, I miscarried 14 months ago (and that time I was preg on my first cycle trying), and have been trying to get pregnant ever since with no luck. I am only 30 years old. 

I have now had the day 3 hormone panel, came back fine. I had the HSG exam, which was traumatizing and painful, and it came back with my fallopian tubes fine too.

I always have a 28 or 29 day cycle. I know I ovulate every cycle through cystal clear ovulatory signals (lots of EWCM and a temp spike), and I also have started using those OPKs and I clearly am ovulating.

My husband's sperm results are very high across the board.

So I've been diagnosed with "unexplained infertility". Not knowing what is wrong with me or if I will ever become a mother is just killing me. 

The only thing that I sense is wrong: Starting a few months ago I've had brown spotting during my luteal phase. Starting around 8 or 9 DPO and until I get my period on 14 DPO.

So could this be impacting implantation? My theory (that my doc shrugs off) is sperm meets egg every month but implantation isn't happening because of this spotting

Here is my question: any tips for stopping the spotting during the LP?

I have tried raspberry leaf tea, and will keep drinking it because I've noticed cycles when I drink it more I have less spotting. Should I try progesterone cream? I want to try acupuncture but I'm scared because it's SO expensive. 

Also, any book recommendations on the anxiety and depression I am experiencing would be appreciated as well... this is by far the hardest experience of my whole life and I just don't know what to do anymore. I am so deeply unhappy and hopeless feeling lately. I've started psychotherapy but I don't know if it is helping.

Thanks so much in advance, ladies...

[laura-belle]

You have just described me and my diagnosis and symptoms (no miscarriage though) although we have male factor issues as well. It sucks--I started to hope for something to be wrong so that they could just fix it, but it wasn't that easy. I wish I had more advice for you--for me what helped with the depression and anxiety about it all was time (and avoiding baby stuff--I give gift cards at baby showers. Or checks.) *hugs*

You might want to ask your RE about trying supplemental progesterone during your luteal phase. Do you know what your post-ovulatory progesterone levels are? I am asking because mine are low and it is my understanding that the spotting is related to that. (And honestly, I would try the cream on my own in your position.) Sadly, once you get into paying for infertility treatments, acupuncture looks cheap--I haven't done it because I am needle-phobic (yes, great for someone currently doing IVF ) but my RE is very enthusiastic about it. I think it is worth looking into.

[daurelia]

I actually don't have an RE yet, I've been doing my testing through my regular OB/GYN. My doc has referred me to an RE, but I'm apprehensive about it because I imagine she'll just push IUI or IVF on me. I don't feel I've exhausted my natural options at this point.

Thank you so much for commiserating with me :)  I'm sorry you are needle-phobic!! I did acupuncture once before, and it's not really needles, you don't even feel anything, I promise!

Thanks for the tip about progesterone. I haven't had those levels tested, BUT, when I miscarried, they said my progesterone levels were low, so maybe that's something I should do? I am now looking into taking B6, Vitex (pre-O), and then progesterone cream (post-O). I haven't tried any herbs or supplements yet so that's something new to try...

[pokeyAC]

Spotting can be caused by low progesterone.  Some women take B6 or Vitex to support the luteal phase.  I don't have experience with progesterone cream but I have taken progesterone my doctor prescribed.  It's a little pill that can be taken orally but is usually used vaginally.  It definitely helps with the spotting.  Would your Dr prescribe it for you?  The generic is pretty cheap.  You said you had CD 3 testing, have you had testing after you ovulate for progesterone?  Progesterone is definitely necessary for implantation and staying pregnant.  Your theory sounds good to me.

I would look to see if there is a community acupuncture clinic where you live.  I live in an expensive area and the community places charge $15-$30 sliding scale.  It's helpful, natural and very relaxing.  Any way you can find to manage your stress is very helpful during this process.  I like yoga also.  I really like this meditation.  It's not too woo-wooey, and it's very relaxing.http://www.amazon.com/gp/product/B002B2GD6U/ref=docs-os-doi_0 

I read the book Making Babies.  It combines Western and Traditional Chinese Medicine treatments so that might be helpful if you are interested in acupuncture. 

I'm sorry you are feeling hopeless and sad.  I feel that way sometimes too.  But I am trying to keep the faith.  It will happen.

[daurelia]

Thank you so much,  pokeyAC, I really appreciate your comment. 

So, there is a community acupuncture place near me that is exactly as you described, 20-40 per session sliding scale. But they don't specialize in fertility. There is a fertility acupuncture place near me that is $85/session. Do you think the fertility specialization really matters?

I'm gonna take B6 and Vitex next cycle. Thank you thank you, both of you.

[Stevi]

Be careful with Vitex. I found that if you're ovulating it can mess up your cycle. I would recommend that you try the B first, see what it does over 2-3 cycles. Then maybe look into Vitex and other things.

The progesterone cream is also a good thing to try. That stuff held onto a definite failed pregnancy with me for weeks!

[pokeyAC]

I think that working with someone with fertility experience is important, someone who can look at your charts and such.  But I think that working with someone who doesn't specialize could be helpful still.  There might be someone at the clinic who is more experienced than the others with fertility.  They should still be able to help increase blood flow to the reproductive organs, and it will still be relaxing, and I think that is beneficial.  I had a friend who went to one of these places, and they gave her herbs to support the different phases of her cycle, and she noticed a difference.  Sometimes it's hard to find someone who has fertility experience.  You have to do a little digging.  They may be really good but not part of a fertility practice.  Maybe someone in the Chicago area could give us a reference.

[SKJ2011]

Daurelia- I'm not sure where in Chicago you live, but I've been very happy with people's community acupuncture on diversey and pine grove. I've gone to the nest and Lincoln square acupuncture and I've been the happiest with people's. Kinga is awesome and actually requested to see my bbt charts and took a thorough history. It's $20-$35 for a session.

Good luck!

[indie1976]

daurelia, i am so sorry you (and the rest of us) are going through this.  it really is a depressing and anxiety provoking experience. i would really encourage you to not accept the unexplained infertility diagnosis. many reproductive endocrinologists are now saying that "unexplained" typically means either undiagnosed endometriosis and/or diminished ovarian reserve (usually caused by endo). you can still get pregnant with both, so i don't want that to add to your anxiety, but a proper diagnosis will help you determine your best course of treatment. low progesterone can also be a factor, and definitely one you want to look into. have you had a day 21 progesterone test? that will give you more information. and the ladies who posted above all gave great advice for helping with low progesterone. 

personally, i also got pregnant on my first cycle trying and miscarried. that was two years ago this month. i've always had normal cycles and never any indication that i had endometriosis until a few symptoms started showing up after miscarrying. for a year i had three different doctors tell me that they did not think there was anything wrong and when i brought up my concerns about endometriosis, they said i would have many more symptoms. finally i went to a reproductive endocrinologist who specializes in endometriosis and he diagnosed me right away. i had surgery, where it was determined that i had stage II endo (mild/moderate) and it absolutely affected my fertility. i am now looking into IVF but have hopes that I will conceive on my own before then. you might find this information helpful. 

[SilaMarila]

Just wanted to chime in and say I agree with Indie1976. My first immediate thought after reading your post was endometriosis.

You are also invited to join us on the IF thread. Many of us a "unexplained" there as well :)

[Sourire]

daurelia, luteal phase spotting is a symptom of endometriosis. I would suggest reading up on endo to see if you have any other symptoms and talking to a doctor about it. I have LP spotting caused by endo and I tried all kinds of of stuff for the spotting: vitex, B6, acupuncture, progesterone cream, herbs, homeopathy. None of those things ever helped me. The only thing that reduces my spotting is taking prescription progesterone. However if your spotting is NOT caused by endometriosis, I think B6/acupuncture/progesterone cream are very likely to help you.

I would recommend going to see an RE. Obgyn's are not specialized in infertility, mine once prescribed me a medication intended to bring on AF when I was actually trying to extend my LP. If you don't want to jump into IUI or IVF right away, you don't have to. It's your choice. When my RE wanted me to start IUI, I wasn't mentally ready for that so I ended up waiting 6 more months then starting. I don't regret waiting at all.

I think any acupuncturist you go to can help with stress and improve your cycles a bit, but having tried both a general acupuncturist and one specializing in infertility, I think there is a real difference. My recommendation would be to go to the most convenient (cheap/nearby) acupuncturist for 6 months, and if you aren't pregnant by then switching to someone who is specialized.

Also I think that the exact point where you are right now was the hardest part of infertility for me. I had just finished my testing and was starting to feel like it wasn't going to happen naturally for me, but at the same time I had a really hard time accepting that I would need medical help to get pregnant. I ended up needing a 2-month leave of absence from work due to depression and anxiety. It was really difficult. I got through it by doing a lot of yoga (I highly recommend this DVD: http://www.amazon.com/Yoga-Stress-Relief-Barbara-Benagh/dp/B000ICLRKW), seeing a psychologist who specializes in infertility, and just letting my emotions run their course. I eventually got to the other side of that dark time and things have been much easier in the one year since then.

[daurelia]

Hey everyone, getting caught up now. Somehow I didn't get any notifications that all these people had replied to this post. Thank you so much- wow, I am humbled by all your insights and generosity to share your stories and your perspectives.

@SKJ2011, thank you SO MUCH-- I believe we've messaged with each other before. Thank you so much for all your advice. I just can't afford the nest right now, I mean, I COULD but I'd have to give up so much stuff that makes me happy. I actually have an appointment at Lincoln Sq tomorrow. I had never even heard of this other place in Lakeview. I'm in Logan Sq but live right off Diversey and that's pretty convenient for me via bus. I may go there next. You also recommended the RE Dr. Mary Molo to me, she's right by my office so I will give her office a call and make an appointment for a few cycles from now (as I explain below I'm going to try this thing first before I see an RE).

As for endometriosis... that isn't something I'd considered before. I thought there were a LOT more symptoms to endometriosis? I have 2 friends with it and they have noticeable endo symptoms. Me, I have normal cycles (except for the LP spotting, and that's recent), normal PMS and cramps, I ovulate at the exact same time every month, etc. I am going to make an appointment with an RE in a few cycles and pursue that possibility, but I am skeptical.

For now, I am going to try acupuncture and some supplements, because I really think the problem might be low progesterone, since I had low progesterone when I miscarried, and I think I can fix that on my own. My OBGYN has told me with the *utmost conviction* that progesterone has no bearing on conception and only on early pregnancy loss. I mentioned my spotting during luteal phase to her and she totally shrugged it off. So I'm feeling a little mad and misled right now, now that I am doing all this research and learning from very reputable sources. So to answer your question, @indie1976, no I have not had the day 21 progesterone test, because my doc would not suggest it.

My plan for the next 3 cycles until I get a BFP:

-- B100 complex once a day, 100mg

-- B6 complex twice a day, 100mg

-- Vitex twice a day, 250mg

-- Red Raspberry Leaf Tea, once a day

-- acupuncture once a week.

-- progesterone cream post-O (still looking up the dosage on that, but I have a week to learn, because I'm only on CD7 right now).

I actually have not been able to find anything reputable on correct dosages, so I'm cobbling that together from various sources. It also seems to vary person to person. I actually work in health science research (this isn't my area though) so I feel like I have a good handle on what is reputable and what isn't, what's a good source and a good study, etc, and I have seen a lot of good information about B6 and vitex for low progesterone and luteal spotting but not on dosage. This study on fertilityblend is well done and has promising results.

As for my mental health... It's Rosh Hashanah this weekend, which is Jewish new year, and I've been doing a lot of contemplation about what I want to change for the new year. I want to have a better attitude about this whole TTC thing. I've been so blue, every time I get AF I am sent down this horrible depressed spiral... I'm just sick of it. I want to have a new attitude going forward. I want to enjoy my life with my husband, fill it with things I can't do when I have a child (like travel, concerts, etc) and just generally have a more peaceful attitude about this stuff. I know, easier said than done, but it's my goal.

Thanks again for all the support, everyone. Big hugs. 

[Gryphonn]

Hi, I know you have a ton of information here.  Not getting pregnant when you planned on it is terribly painful and disappointing, we all want to "fix" it for you :)

I just wanted to chime in that I had LP spotting and absolutely did not have endometriosis or low ovarian reserve (I was working with a RE so both were checked).  My RE put me on a dose of 200 mg progesterone to be taken every day vaginally starting 3 days post ovulation and I got pregnant on the very first cycle; coincidence maybe since we were also doing IUI, but previous IUI cycles WITHOUT progesterone had not been successful.  I had also been supplementing (for several months) with vitex and B6 with no luck.

[daurelia]

Oh, Gryphonn, thank you, that is SO heartening. I really hope something simple like that could fix my problem. I just am SO ready for this, you know? It's been over a year now, and I want so badly to move on with my life into the new chapter of motherhood. My husband too.

Actually, I forgot to mention: for a few months after I miscarried, I spotted during my LP, so someone told me to drink RRL tea then and that cycle I didn't spot. We weren't trying then (long story but after I miscarried I was offered a new job so we stopped trying for a few months), but now when I look back on that, I wonder if that's a good indication that this kind of treatment (natural progesterone-enhancing things) might help me.

[Gryphonn]

Originally Posted by daurelia 

Actually, I forgot to mention: for a few months after I miscarried, I spotted during my LP, so someone told me to drink RRL tea then and that cycle I didn't spot. We weren't trying then (long story but after I miscarried I was offered a new job so we stopped trying for a few months), but now when I look back on that, I wonder if that's a good indication that this kind of treatment (natural progesterone-enhancing things) might help me.

Ooh, I wonder about that too for you since the RRL tea worked.  I wish I had heard about RRL tea when I was trying to conceive.  I am a big, big fan of it now.  I make a strong mixture of RRL, nettle, oatstraw, alfalfa, rose hips and spearmint and drink about half a quart a day, and have had a very smooth and spotting-free pregnancy, perhaps because of it.  

I very much understand how hard it is.  You're being careful, pursuing your career (putting off a baby for the right job!), getting married, doing everything "right" then just hit this wall with that AF showing up every month...  I had cancer about 5 years ago and honestly, not getting pregnant was tougher to deal with and more of a disappointment.  I love your plan of enjoying your time with your husband and doing things you won't be able to do in the future, because you WILL get pregnant, from what you've said it's not IF, it's just WHEN.

[daurelia]

Gryphonn, thank you so much, would you believe your comment just made tears spring to my eyes-- happy, understood tears because you totally get it. I DID do everything right. I married the right man, I went to grad school so I could get a better job to help support our future family, I thought 30 would be the perfect time-- the right balance of maturity but young enough biologically-- man, I had it ALL planned out. And here I am, just as you said-- coming up against a wall. Meanwhile, literally everyone I know in real life has gotten pregnant on the 1st, 2nd or 3rd cycle.  I am just so resentful sometimes that this is happening to me when I've been so "good". 

I am totally in awe of what you said about having cancer was easier to deal with than this. That is just amazing. I often say that this infertility business is the hardest thing I've had to deal with in my life, but then I usually take a moment to reflect on how good my life has been and how little hardship I've had. So hearing you say that, with your experience, is humbling.

saying "when" is a good thing to say. I need to get back to saying "when". I used to say it, then I switched to "if", and I think "when" is better for my mental health.

Thanks again. I am really grateful for this boost today. 

@Stevi makes a good point that maybe I should hold off on vitex and just try b6 & RRL & progesterone without it? I'm not sure. I have heard really good things about vitex and luteal spotting.

[Gryphonn]

Daurelia, it's lovely to be able to help :) One of the better feelings in the world, so thank you!

[Lindz]

Daurelia....I have unexplained fertility as well for 2 years.  :(  I know that depressed/anxiety feeling all to well.  

I recently read the books "Every cheerleader why not me?" and "Silent Sorority."  I enjoyed both.  The first has a twist with some humor.  I am a believer in laughing through pain sometimes.  Both helped me out.  It was just good to read about other women's feelings and know that it's ok to  freak out and hide in the custodial closet at work every time someone announces their pregnant.  Stay strong.  We are here for you too!

[daurelia]

Thanks so much @Lindz. I'm really grateful to have the support here. I've heard of the 1st book you mention but not the second, I"ll have to check it out. I just bought a book called "conquering infertility", it's a mind/body book about using meditation & mindfulness etc to cope with infertility.  I'm working on that.

So, an update. Based on all I've read about what I suspect is my problem (low progesterone leading to a luteal phase deficiency), I've been doing the following since the 4th day of my cycle, 11 days now:

 

-- 100mg of B-100 complex timed release capsule, once a day

-- 100mg of B6 twice a day 

-- 200 mg of vitex, twice a day

-- Red Raspberry Leaf tea, once a day

-- starting progesterone cream after I ovulate (I got a positive OPK yesterday, and today was my first day of high temp, day 15 of my cycle, when should I start the cream??)

-- Acupuncture

 

And the usual healthy lifestyle stuff, medium-impact exercise 5 days a week, lots of green veggies and whole grains, almost no alcohol or coffee (I am down to 1-2 glasses of wine a week and 1-2 cups of decaf coffee a week). I'm trying to reduce sugar but that's really hard for me. I LOVE sweets. 

 

I'm going to do all this for 2-3 cycles and hopefully get some good results. It feels a little crazy to be doing all these things, because I'm generally of the philosophy that if you take care of yourself with good food and sleep and exercise you should be fine... I'm a minimalist when it comes to health interventions. But a year of trying to get pregnant means something is not quite right. And  I really do suspect the spotting between ovulation and menstruation is my problem, and these are all things that have been reported by reputable sources and rigorous scientific studies to fix the problem.

 

I went to acupuncture last week and it was a good experience. He asked me so many specific questions. He asked to see the last 6 months of my charts! I felt like he knew more about fertility and cycles than my OB/GYN. I'm going to go back 1x a week except during my luteal phase when I will go 2x a week. 

 

So far I have experienced some interesting effects of all this. I've had the most vivid, intense dreams every night for the last 4 nights, and the last 2 nights they've been totally X-rated. I wondered if this was related to all the stuff I'm taking?? I read a study that implies B6 is to blame for the dreams. Also, my sex drive is through the roof right now. It usually is around ovulation but this time it's like WHOA.

 

I ovulated a day or two late this cycle, I wonder if Vitex has something to do with that? I also had less EWCM this cycle, but I still had enough to tell me when I was fertile.

 

So now I'm at the very beginning of the 2ww since I ovulated presumably yesterday. I'm more hopeful this cycle than I've been, which could be bad when I get crushed again in 2 weeks...

[ahligamma]

Have you looked into wet cupping? I have had alot of success with alot of my clients with wet cupping. Also alot of people do not know there is certain spiritual things that block and cause infertility. You may want to check into this. You may also want to cut out all forms of alcohol in general as this produces black bile in arab/greek medicine. When there is an abundance of black bile this is one of the main causes of infertility.