From CANFP
More Complete Hormonal Workup Needed
By Dr. Davenport
Feb 12, 2009, 15:07
Question
Hi, I'm a physician. I'm 27, married a year ago & trying for a baby since then. I had a very regular cycle,27-29 days. After 7 month I started investigations, my 21st day progestrone was 16 & prolactin 11. My husband had seminal analysis (53 million & more than 57% normal sperms). I visited a dr. who said my progestrone should be at least 20 & therefore gave me clomide for 3 months & gave me a post coital test on day 12 of each cycle, I had viable sperms. My 21st day progestrone was 18.5, 25 & 35 respectively during the 3 months, I didn't get pregnant though. I had a hystersalpingogram showing normal tubas except for some perifembrial adhesions on the left & they told me that it's not a problem. Then my dr. gave menogon (menopausal gonadotrophin) from the 5th day of the cycle 2 shots for 5 days. He examined me on 9th & 11th day & gave me pregnyl (HCG) on the 12th day. He told me to have intercourse on the 12th & 13th days. Actually I had unprotected intercourse from day 10 until 14. I took baby asprin & mucolytic a few days prior to ovulation & for 10 days. I had progestrone 32 on day 21. On the 24th day I started spotting, 25th changed to bleeding, 26th also bleeding. It almost stopped on the 27th day but I spotted light pink for 6 more days!! I called him but he said it may be immature menstruation due to high progestrone & artificial cycle. He told me to take a break for a few months.
I'm so frustrated & depressed!! Could you please tell me what's wrong with me?!
Answer
I would suggest you needed a bit more complete hormonal workup. It would be good to know both progesterone and estradiol 5,7, and 9 days after the peak. Estradiol should be 100-120 pg. Thyroid should be optimal with TSH less than 2.5 and Free T3 in the upper 3rd of normal. I presume you were placed on mucolytics due to poor cervical mucus? If this is the case, correcting cervical inflammation and optimizing estogen with low dose estradiol supplements might help. You do not state your weight, but opitmizing this is important. You might see if fasting insulin is elevated and check DHEAS, testosterone and LH/FSH ratio 7 days after the peak for a possible subtle PCOS like effect. Was your husband's sperm motility good? Do you have dysmenorrhea?
Also, I wouldn't be casual about pertubal adhesions; they can prevent pregnancy by impairing tubal motility and might be a sign of another abnormality such as endometriosis. Since it has been a year, you might benefit from a laparoscopy with an expert surgeon who could clear your peritubal adhesions and any possible endometriosis.
Mary L. Davenport, M.D.
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