Clomid vs. progesterone for luteal phase defect

[Sleepymama]

Hi, I am new to this infertility stuff...we will have been trying for a year next month (with one miscarriage at 11 weeks and another chemical pregnancy last month, and possibly many more...) and I am getting the runaround from my obstetrician about luteal phase defects.

I have 22-24 day cycles, 10-11 day luteal phases, low BBT, and so basically demanded a progesterone test (she poo-pooed the existence of luteal phase defects). My serum prog. level at 5dpo was 4.5, which my OB claimed was "normal." Yeah, for a living breathing woman, not for someone trying to get pregnant. I don't think she has a clue.

Anyway, I have given up on her, and no one else will give me an appointment except the fertility clinic. My research says that progesterone supplementation isn't always the best course for LPD, but rather clomid? Anyone with experience/advice? I just want to go armed with info.

Obviously I'd love to avoid clomid...but am ready to do what is best. We don't know what caused my miscarriage in September (missed miscarriage, no heartbeat at 9.5 weeks). I also have a son with a congenital heart defect, which might be related, or might not. No one knows. I'm feeling very low and let down by the medical community right now. I've also been taking vitex for 4 cycles, which has extended my luteal phase a bit, and who knows how low my progesterone was before that! I am positive I am ovulating--all signs are there. Just not ovulating well, obviously. I am 30, if that helps at all.

[jeniferm]

Hi sleepymama - sounds like we have some similarities! I can only tell you what my RE has said, but it makes sense to me. He generally doesn't test for progesterone until you become pregnant, because he doesn't feel it tells you anything. There's a wide range of normal. Plus, he doesn't really feel progesterone supplementation helps anyway, though he would do it if a progesterone test in early pregnancy seemed low.

He feels that any LPD issues are entirely due to what happens pre-ovulation. Generally, that would be egg quality issues, and clomid is often the first line of treatment there. My RE diagnoses such a problem with mid-cycle (cd12-14) transvaginal ultrasound to look at follicle development, rather than with progesterone tests post-ovulation.

I would definitely recommend seeing the RE and asking about this kind of testing. There may be things you can do naturally to boost your own follicle development if you have the patience to try. Natural options tend to take longer to work. I haven't done a lot of research here, but am doing acupuncture right now and beginning to read some more about options. I have done 6 clomid cycles (with excellent follicle development, but no pregnancies) and 4 injectibles/IUI cycles (with a pregnancy on the last one which ended in m/c with development stopping at 9 weeks). I'm now going back for one more injectibles cycle before another short break to let acupuncture work some more. Hopefully my reading will shed some light on other good natural options, but I can't offer any other suggestions at the moment. You're not alone though! Good luck.

[Mommy StormRaven]

I've been where you are. I saw one of the best RE's in teh country. I had repeat losses (7) and irregular cycles with secondary IF.

My RE ran every possible test on me at my first visit. So he could get baseline levels of everything so he knew what to monitor from. My first P4 was at 5DPO and it measured a measly 3. However my ovarian u/s showed that I had ovulated as did my other hormone levels. At that point he recommened Clomid - which did help, a little it took my 7DPO P4 levels from 4 to 6.5. Clomid should put your Post-O P4 levels at 15+, it takes at least 10 to maintian a pregnancy. Thru another month of moniroting we discoverd that my P4 levels were chronicly low - so we upped my clomid dose, did a trigger shot AND supplemented with progesterone and monitored my P4 levels from 3DPO on. That is what worked for me, my P4 levels stayed where they needed to be until the placenta kicked in and started producing the progesterone necessary to sustain PG.

I think it depends on what the problem is and just how low your progesterone level and other hormone levels are whether clomid alone or progesterone alone works. Mine has always been low even now when we test it for my semi annual bloodwork it is low. I know that if I should ever choose to get PG again that I will require Progesterone AND clomid to get that way. that is just how it is for some people.

If you are in the Cincinnati, Norther KY area see the UC physicians group - Dr. Michael Thomas - he is in the top 1% success rate in the country for single births in assisted reproduction. I hate docs - I even had a home water birth but he was a Godsend and I will recommend him until the day I die.

[mamaadelheid]

Is Clomid safe while nursing? Can nursing contribute to luteal phase issues?

Wow, I am so glad this thread is out there. I am just coming out of a miscarriage that I suspect is from a low progesterone level. I thought I was pregnant but then got a period and didn't think anything was up until I had spotting around when I should have been ovulating again. Turns out the miscarriage is what finally triggered a pregnancy test but it was already too late.

The reason I think it's a luteal issue is that I was concerned about it before my son was born. Generally my luteal phase is 10-11 days but there was no problem the first time. After doing some research I was thinking that progesterone and vitamin B6 might be the best way to start. And I'm kind of afraid to take Clomid. My son is still nursing - 6 times during the day but not at night - and I really don't want to wean because we both still enjoy it. Is Clomid safe while nursing? Also, I heard an offhand remark that nursing might have prevented implantation of the embryo but can't find any research that supports this - does anybody have any insight or resources?

I'm going to see my midwife on Monday. I plan to bring up my concerns and see where we should go from there. I'm 36 and can't dilly dally around waiting for more miscarriages. So, if anybody has any advice or info, I'd be most grateful

Thanks!

[Sleepymama]

Thank you both! I am nowhere near cincinnati (southern california) but am seeing an RE in a couple of weeks. (there is only one practice nearby, so I hope they are OK!!)

Mommystorm did they give you any idea why this was only a factor after your first pregnancy? I had a very normal pregnancy with my son, but he does have a rather severe cardiovascular defect and I am wondering if there is any connection between that and possible low prog. in the first trimester last time (which I wouldn't have known about). Or ovulatory defects. I am so sure I am ovulating because I have so many symptoms and all other signs point to it--in fact, I have such obvious O pain that I know which side I'm ovulating on each month. The right side is gearing up this time I also ovulate really early, like CD 11 or 12, so it would seem that those hormones are working OK.

All of this is off our insurance now so I hope it doesn't take too long to figure it out. I doubt I need any more specialized tests than bloodwork because it seems conceiving isn't the issue, just keeping them around. And making them healthy--I'll do anything to get a healthy one.

I'm glad you could have a homebirth too! I had planned HB with my miscarriage (if my specialized prenatal testing showed the heart was OK) and would still like to. I really, really like my lay midwife but she isn't a "fertility specialist" (her words). She does want to know if I find anyone humane who does fertility stuff (so she can recommend them, I'm sure!)

[Mommy StormRaven]

Originally Posted by Sleepymama

Thank you both! I am nowhere near cincinnati (southern california) but am seeing an RE in a couple of weeks. (there is only one practice nearby, so I hope they are OK!!)

Mommystorm did they give you any idea why this was only a factor after your first pregnancy? I had a very normal pregnancy with my son, but he does have a rather severe cardiovascular defect and I am wondering if there is any connection between that and possible low prog. in the first trimester last time (which I wouldn't have known about). Or ovulatory defects. I am so sure I am ovulating because I have so many symptoms and all other signs point to it--in fact, I have such obvious O pain that I know which side I'm ovulating on each month. The right side is gearing up this time I also ovulate really early, like CD 11 or 12, so it would seem that those hormones are working OK.

All of this is off our insurance now so I hope it doesn't take too long to figure it out. I doubt I need any more specialized tests than bloodwork because it seems conceiving isn't the issue, just keeping them around. And making them healthy--I'll do anything to get a healthy one.

I'm glad you could have a homebirth too! I had planned HB with my miscarriage (if my specialized prenatal testing showed the heart was OK) and would still like to. I really, really like my lay midwife but she isn't a "fertility specialist" (her words). She does want to know if I find anyone humane who does fertility stuff (so she can recommend them, I'm sure!)

My first PG was an m/c, my second PG was no where near normal - I had a "period" thu my 6th month of PG but Bobby is a perfectly normal 15 year old (if ther is such a thing )

My RE was HB friendly in that when he did release me he said to go on and have a great waterbirth at home - no pressure to see one of the docs in his practice - abslutely respectful of what I wanted.

I had the same kind of cycles you describe too all of my life but still I had and still ahve low progesterone. Feel free to send me a message if you want more detail - gotta go get teh littel one down for her nap - she is gettign whiney....

[Amoreena]

Originally Posted by Sleepymama

Thank you both! I am nowhere near cincinnati (southern california) but am seeing an RE in a couple of weeks. (there is only one practice nearby, so I hope they are OK!!)

Hi Sleepy...we are "neighbors"...I'm in southern California too (AP group links in sig below). I am 46 and have recently been posting a bit on the 40-something boards and pre/menopause boards, although as far as I know, I'm not yet premenopausal...

Which brings me to the more on-topic part of my post. A couple have mentioned low progesterone being involved in miscarriage. We (dh and I) are 99.999999% I recently was pg and had a miscarriage. My cycles had been regular for quite a while, then I missed a period, got sore breasts, took a pg test but it was neg, then just when I was deciding the test was wrong, I started a period which I'm pretty sure was a miscarriage, then exactly two weeks after that had another period! I visited my ND (naturopathic doctor) last week with all this information, and she's having me go for bloodwork in a couple weeks when I should be about midcycle based on thsi latest period. She suspects that I'm low on progesterone and iron (have been so on both, before; this was discovered last year at my first appts with her), and she mentioned low iron as being a suspect in not holding an implant. I honestly can't remember if she mentioned progesterone as being responsible too, but now I'm reading the posts here and seeing that it apparently is.

I have never charted, temped, etc. I have only just kept track of my starting period dates and roughly when I detected ovulation symptoms (I too often felt I could tell which side I was ovulating on, though not always). I usually have had ovulations that were more uncomfortable than periods, or at least uncomfortable in a different way.

Sleepy, I've heard good things about these RE folk in socal:

Fertility and Surgical Associates Clinic
www.fertilityassociates.com in Thousand Oaks
Dr. Buyalos
and
Dr. Gary Hubert
Both in that office in TO.

I wonder if these are the folks you're seeing. Not that I need to know, but curious, and always interested in sharing good information. This is how we all find our best resources.

[Sleepymama]

amoreena, good to know about the iron. I have also suspected thyroid issues for a long time. I've had it tested twice and it came back normal, but I'm not sure what exactly they tested and what their definition of "normal" is.

Low thyroid can lead to birth defects (my son has one), BF problems (I had mega supply issues from day 1), miscarriage--have had 2, dry skin (I have atopic dermatitis), depression (I have had for years + bad PPD this time), low energy, low BBT (didn't know this until I charted and it's way low--high 96 and low 97s yikes!), excessive weight gain even while eating healthy and exercising. I have had these symptoms since I was about 14 (the first time I had my thyroid checked, the second time was after my son was born).

So that's the first thing I'm going to ask about other than the fertility bloodwork. I've been taking vitex, evening primrose oil, essential fatty acids (fish/flax/borage), kelp, and a b-complex. Hadn't considered iron, but what the heck, what's one more pill?

I am nowhere near thousand oaks...in fact about as far away from there as you can get and still be in southern california :LOL (east, east inland empire, I'm going to Loma Linda Fertility Center) But if I hate them...what's a 2 hour drive several times a month for a :

How long have you been TTC? You probably want to get a move on considering your age. I'm already getting the "perimenopausal" comments and I'm only 30...can't imagine how awful they are to you! You might consider charting a couple of cycles so you know exactly when you O--the prog. test needs to be 7dpo not "CD21" b/c that can throw the results. I had to do 5dpo because 7dpo was a sunday :

[May-lily]

Herbal suggestions: maybe upping the vitex a bit + red raspberry leaf, red clover. all those have helped me normalize my cycle (and acupuncture and lunaception= lights on to bring o)

Good luck

M

[Sleepymama]

Hi Maylily! So...how much should I be taking? I am currently taking 2 600mg capsules 2x a day (the nature's way variety).

Is tincture better? How much of that?

I read all of your comments about the lights and am not sure that would help. My son's room has tinfoil on the windows to keep him asleep :LOL and I have very regular sleep habits so I'm not sure what else I can do in that regard.

[May-lily]

Hey sleepymama...I have not taken vitex for a while so I dont remember the dosage. Do a little interent surfing and see what's recommended and then if you're below the recs, up your dose (that's just an idea, mind, not medical advice).

Lights on thing: it's called lunaception. It's great if you have a tendency to ovulate late(r). start leaving a small light on (like in the hallway or next room) and door to your bedroom open around cd11 or 12. The idea is to recreate a moonlight while you sleep. 3 nights in a row is recommended. For me it works, sometimes even in just two nights. It's something to do with melatonin production, which changes when there's light and triggers o. For more info, do searches on lunaception.

good luck

M

[Sleepymama]

That's the thing--I O insanely early, like CD 11 or 12. My cycles are only 22-23 days.

Interesting though. I sleep in a different bed each night as DH and I switch nights sleeping with DS. It made my temping fun, that's for sure, but I hadn't considered that it might be throwing off the O.

[Amoreena]

Originally Posted by Sleepymama

amoreena, good to know about the iron. I have also suspected thyroid issues for a long time. I've had it tested twice and it came back normal, but I'm not sure what exactly they tested and what their definition of "normal" is.

you reminded me that i had low thyroid too! showed up in the same bloodwork as the low iron and low calcium and low progesterone.
i've heard more than once that thyroid issues are one of the least detected conditions around, as so many of the symptoms (which you mentioned) are factors in *other* conditions, therefore hard to spot. i've also heard that your typical doctor doesn't read the bloodwork results well enough, that it takes someone very familiar with the signs...a specialist. and even then, things get missed.

Originally Posted by Sleepymama

I am nowhere near thousand oaks...in fact about as far away from there as you can get and still be in southern california :LOL (east, east inland empire, I'm going to Loma Linda Fertility Center) But if I hate them...what's a 2 hour drive several times a month for a :

lol
we could plan a park date
but i hope it goes GREAT at loma linda!
tell me (not a socal native), just exactly what area does the inland empire cover? does it go all the way to the state border? where does it start, i mean how far east?
there's at least one person in SoCalAPFamilies in that area. hopefully more eventually

Originally Posted by Sleepymama

How long have you been TTC? You probably want to get a move on considering your age. I'm already getting the "perimenopausal" comments and I'm only 30...can't imagine how awful they are to you!

yeah, i've been getting that from my mother for *years*. she had early menopause and thinks every time i have an emotional moment or feel tired or crabby or whatever that it MUST be menopause. :

honestly, though, we're not really TTC. but afaic, we're not exactly being rigorous in trying not to, either. this last conception was an "accident" (i don't really believe in those) in a way, although we hadn't totally closed the door. we've had many talks about whether we're done, and the pros and cons of all the angles we can think of. i was very happy to be pg, and when the test was neg, i wasn't able to detect one iota of relief within my being, only disappointment. dh was more relieved than disappointed, although he admitted to an iota of disappointment. then i finally got back to the point where i felt and believed i was pg despite the neg test (and had a midwife friend tell me she once had two negs before getting a pos on one of her pgs), and then had that period in which i'm pretty sure i miscarried.

i'm at a point in my life, and dh and i are at a point in our relationship and family life, where i can't quite bring myself to say "okay, let's intentionally work on making a baby." yet, i'm also not at the point personally (and may never be) where i can say "okay, i'm done, let's make sure we don't have another." i'm just not that kind of person, methinks. i'm more the kind to just let nature take its course, and what will be will be.

not to say i'm not going to work with my ND on making sure I do all I can to keep any little sprites who manage to get started! seems i need to up progesterone/iron/thyroid... although she and i talked about the fact that i probably shouldn't up progesterone while nursing, so there's that.