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Last Updated:
Jan 12th, 2008 - 00:02:48
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Question
I delivered identical twin boys stillborn at 30 weeks in July 2007. I had post partum bleeding for 13 weeks. My first actual period was 3 weeks later. The next period was 9 ½ weeks later. Blood work done on 11/27/07 and don't remember exact number of times, but estrodial and progesterone where both under 2. The doctor stated very low numbers and probably not ovulating. Normal period started on 11/28/07. Started testing LH on day 10. Tested twice a day 10:30 a.m. and 5 p.m. On day 14 am and pm and day 15 am only, the line was darker than usual. Cervical mucus was stretching, but not clear through day 17. On day 22 had progesterone test and level was 4.4. Cervical mucus has been dry. Cervix closed and low. The doctor states he wants me to come back on day 1 of next cycle since blood work is still low.
Does this mean that I am still having ovulating problems? Could it have been too early to check blood? We are trying to conceive my 4th pregnancy and with others had no problems and pregnant within 2 months. Do you think clomid would be an option for my next cycle, since this cycle sounds hopeless? The doctor states with the multiple pregnancies it could take up to a year for hormones to get back on track. I am 33 yrs old and don't want to sit and wait for something I have never had a problem with.
Thanks for your help.
Dawn
Answer
Dear Dawn,
It sounds as though you are ovulating irregularly. The progesterone levels that have been drawn are not targeted very well to your ovulation. The first progesterone level was done the day before your period started—we would expect it to be low, even if you did have a normal ovulation. The subsequent level of 4.4 is low, but it is difficult to say whether this was abnormal or not—it could have been on its way up, or on its way down…
The best way to assess the health of the luteal phase (the phase after ovulation) is with a targeted progesterone panel. That is, a series of progesterone (and estrogen levels) drawn on days 3, 5, 7, 9, and 11 after ovulation. The most reliable way to target these tests, is to chart your cycle using the Creighton Model charting system, and using your peak-mucus day as the assumed day of ovulation. You can then determine not only if you have had an ovulatory event, but also whether it resulted in normal levels of progesterone or not.
Clomid is a very useful medication to induce ovulation in women who are not ovulating, and also to enhance the quality of the ovulation. You may be a good candidate for this drug. Your doctor should discuss with you the potential risks of ovarian cysts.
Cervical mucus is essential for conception—without it the sperm cannot gain access to your egg, even if you have a perfectly normal ovulation. There are some medications that may enhance your cervical mucus. Use of these falls under the new science called “NaPro Technology”, developed by Dr Thomas Hilgers at the Pope Paul VI Institute. You could visit their web site for more information. There is a link to their website under the links page of this website.
The length of time it can take for your hormones to “get back on track” can vary, and is affected by many factors, including your level of stress, as well as diet and exercise.
Good luck! John Gisla, MD
John Gisla, MD, NFPMC is Board Certified by the American Academy of Family Physicians,
and Certified as a Medical Consultant for Natural Family Planning and NaPro Technology
by the Pope Paul VI Institute. He is on staff at Mercy of Folson Hospital and on the NFP Advisory
Board for the Diocese of Sacramento. He has been married ten years and has two daughters and a son.
© Copyright 2005 by CANFP
The information on this page and web site is for informational purposes only,
and is not a substitute for medical diagnosis and treatment by a physician.
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