QuestionI am 38 years old and my partner and I have been trying for a baby for the last year. 4 months ago we started using ovulation predictor kits and they were constantly negative so I went to my GP and she sent me for blood tests on day 2 and day 21 of my cycle. My progesterone levels are showing up as low which is an indicator of no ovulation happening.
I am as I said 38 (39 next month), my periods are very regular and I am overweight most of that is around my waist. My partner has had a semen test and he is perfect. I have joined a gym to work on my weight. Can you tell me what could be causing me not to ovulate and still get a very regular period? I am due to go back to my GP in the next week or so to discuss the next steps.
AnswerHello Lisa from the U.S. (D.C.),
One of my biggest frustrations in private practice, is seeing patients held on to by their primary care or Ob/Gyn doctor when they should be referred to a specialist immediately or doing things that they are not qualified to do.
Your age is the absolute biggest factor in your fertility at this point. Next month (happy birthday) it will be a little worst. For example, a 29 year old has an 85% chance of pregnancy per year of trying, whereas a 39 year old has a 10% chance of pregnancy per year. That is because the eggs you were born with have now declined in quality and fertility. Time is against you. Despite what the blood tests may say, assuming they are correct and interpreted correctly, if you have regular and predictable menstrual cycles, then you are ovulatory. The mid-luteal phase depends on how long your cycles are. For example, I recently had a consultation with a patient whose doctor told her she was not ovulating, like you, based on the CD#21 progesterone level that was less than 10. It turns out, she has 34 day cycles, which would make her mid-luteal phase on CD#27. So, the test should have been done on CD#27 but doctors who learn to do things by rote, instead of understanding the reason, would miss that difference.
Assuming that you have had everything checked: ovarian function, uterus, endometrial cavity, pelvis, ovulation, endometrial lining formation and semen, and everything is normal, then age is the only factor that can be attributed to your inability (or more accurately your delay) in getting pregnant. It means that you may have to move to higher levels of treatment assistance to get pregnant.
I would strongly recommend that you bee-line directly to an infertility sub-specialist for consultation and treatment. There is an age limit to getting pregnant using your own eggs and once you exceed that limit, your only option will be donor eggs.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
