LPD but normal progestrone levels - ideas?


#1

This is a long shot but I am getting no help from Dr. Google on this issue. I have a short luteal phase, usually 9/10 days at best with plenty of spotting in days prior. During my last IVF attempt I got my AF 11DPO even on PIO and two days of spotting before hand. When I had my progestrone levels checked on beta day it was normal. Can anyone present some ideas on what could be the issue and how it could possibly be fixed. My RE will be doing a hysterscopy in December and endometrial biopsy but I suspect this is going to come out normal. I will be crushed if we do a FET and I start my period so quickly and waste these good embryos.

I just had ER for IVF#2 recently and today is 8DPO. We froze everything and are doing FET later so I’m not on PIO shots. The spotting fairy has visited me and I think my AF will hit either tomorrow or for sure by Monday. So PIO haven’t done anything for me to help my problem.

One thought I seemed to gather from my online research was to use HcG a few days after ovulation to prevent my period from happening and lining shedding.

My fear is that my problem is unfixable and it a pituatary issue and we will never be able to get pregnant.


#2

Hi chefgal- I doubt your problem is unfixable… A couple of questions- When you say your progesterone was “normal” on beta day, what was it? You already had already had AF, right? So, I’m not sure that would actually tell you much. You get your period when your progesterone falls low enough (natural cycle or IVF, doesn’t matter) so getting your period while on progesterone seems to indicate that you’re just not getting enough. Did they check a level while you were on it? I got my period before my beta (I was on Crinone, but still…) I will do PIO next time and make sure to have my level checked between ET and beta so it can be titrated up if need be. I’ve seen some people that need PIO + suppositories. Wishing you luck!


#3

Hi Boston - I’m about 95% certain that on beta day my progesterone was 23 which is in the range of normal/acceptable according to my RE. He did not do progestrone level checks in my TWW. I had been and continued to take PIO shots nightly up to and including the night before my beta. I’m told it is rare but not impossible to get your period on PIO shots…that this won’t prevent you from getting your period but something about your lining not shedding? I would notice that I had bits of ‘tissue’ floating during this bleed before beta…so to me, I just assume this is my lining because what else could it be. My RE says this would be incredibly rare.

It’s a few hours from my original post and it didn’t take long…got my period so this time my LP was a whopping 7 days in an unsupported LP. Pretty pathetic. I hope beyond hope my RE find something wrong with me when he does the hysterscopy/biopy/mock IVF because it would be better to be diagnosed and have a plan than nothing at all.

Anyhow, if you have any other thoughts/ideas all are welcome.


#4

I’d say you might need your levels checked more often. I personally have a severe LPD. My progesterone was 20 on the day of ER. Our doc felt certain that our levels would plummet and placed us on 100mg PIO and 3 Endometrin inserts per day. One week after ER (on this much progesterone), my level was 23…which he felt was too close to the borderline! So…then I was placed on 4 Prometrium tablets per day on top of the PIO and Endometrin. My levels on these HUGE amounts stayed around 40. Once our beta was negative, I stopped. It took me 7 days to have a period…no spotting in between.

This past round, I did a little experiment. Our beta was scheduled for Oct. 20, though I KNEW I wasn’t pregnant by Oct. 16. Just to note, my progesterone level on October 13 was 100 (on boatloads of PIO, Prometrium, and Endometrin). In just 4 days without any PIO (I was still taking the pills and using 2 inserts a day.), my levels dropped to 13! So…I decided that our RE was right! With my LPD, the numbers WOULD plummet without supplementation!

BTW My sister miscarried twice before her LPD was discovered… So, it IS important!

All of this to say that levels should probably be watched rather closely, especially if you do have a BFP in order to prevent miscarriage! Our doc says that the younger docs are not checking levels as much and using Endometrin/Crinone. He says that when he adopted this in his practice, his miscarriage rates increased. For women with no LPD, it’s probably fine. For those of us with it, not checking levels can become a recipe for disaster!


#5

Thanks for posting this. I also have a lpd and my period came 10 days after the trigger or 6dpt. Sucks. I was on inserts and shots. I have not had my consultation with my re yet but I do plan on telling not asking him to test my progesterone levels during the 2ww to make sure it is high enough. I also read online that vit b6 helps to extend the lp so I just ordered a bottle. Clomid is also proven to be effective. Don’t be discouraged though I have always had a short lp and got pregnant with my son naturally but was 33 then. The good thing is you will be doing a FET so you won’t have that 3-5 days between er and et so I think implantation will have a chance.

Keep us posted.

Alicia


#6

lucydr - Thank you for your input…much appreciated. I will request to have extra monitoring during the TWW to check progesterone levels this go around. If my progesterone was 23 on beta day would it stand to reason that it would not have ever been lower than that during the TWW when I was not being monitored? I was on 1ml of PIO but maybe I can convince him to let me take 1.5 or 2 ml? I would hate to do this without his consent. May I ask what your normal LP is without meds? While charting I never made it past 9 days. With the PIO in IVF#1 I made it a full 11 days but that last day is questionable because the spotting got pretty heavy on day 10. My RE requires strict 5 days of bedrest post transfer so maybe I can go in on day 6 for progesterone check then. When/how often during TWW did you get checked? One last question - are you aware of any negative side effects/dangers to know about if you do have higher than usual levels of progesterone. Your 100 level seems awfully high but is there any harm to having it this high temporarily that your RE may have mentioned or you found in your own research?

Sunrise - Please feel free to chime in on any ideas or solutions your RE came up with to help support your progesterone or prevent your period in the TWW. This is an extremely frustrating topic and source of major tears and heartburn for me because nothing has worked and yet it doesn’t seem to be a source of concern for those in the medical community. But I like Lucy’s idea of upping my PIO and seeing if this helps stay off the AF.


#7

[quote=chefgal]lucydr - Thank you for your input…much appreciated. I will request to have extra monitoring during the TWW to check progesterone levels this go around. If my progesterone was 23 on beta day would it stand to reason that it would not have ever been lower than that during the TWW when I was not being monitored? I was on 1ml of PIO but maybe I can convince him to let me take 1.5 or 2 ml? I would hate to do this without his consent. May I ask what your normal LP is without meds? While charting I never made it past 9 days. With the PIO in IVF#1 I made it a full 11 days but that last day is questionable because the spotting got pretty heavy on day 10. My RE requires strict 5 days of bedrest post transfer so maybe I can go in on day 6 for progesterone check then. When/how often during TWW did you get checked? One last question - are you aware of any negative side effects/dangers to know about if you do have higher than usual levels of progesterone. Your 100 level seems awfully high but is there any harm to having it this high temporarily that your RE may have mentioned or you found in your own research?
[/quote]

I don’t remember what my LP was before infertility treatments (that was almost a year ago now), but my progesterone levels were like 3 on day 21 and my endometrial biopsy confirmed that I had a big discrepancy. It was really long after my IVF cycles, which was about 8 days after stopping the massive doses of progesterone.

As for checking it, my doc is a 4 day bed-rester as well. When my transfer was on Sunday, I went in on the next Thursday for labs. I totally agree that 100 was too high…but when we decreased the doses, I plummeted! (It was likely only at this level for 4 days…so no harm in it.) He basically checked it again with my beta (2 weeks post ER/IUI).

BTW… I take Folbic, which has B6 and it’s in my PNV. So, I agree with Alicia that it’s probably something worth taking! (I also have some abnormal clotting studies, for which high dose folate is recommended…so I kill 2 birds with 1 pill!)

I’m prety sure I’m a weirdo though…so take my experience with a grain of salt! I DO think that checking levels may be of use though and am glad our doc does!

Best wishes!


#8

Thanks Lucy for your thoughts. And, if you’re a ‘wierdo’ then I am one too. Weirdos unite for hopefully a BFP soon. If anyone else has LPD issues but normal progesterone levels please chime in, I’d like to keep this thread alive on some level to either help us ‘weirdos’ or have a place to commiserate.