QuestionHello Dr. Ramirez-
Thank you for reading my question. I am 41 years old, healthy and active. My husband and I have been trying to conceive for 3 cycles. The first 2 months my cycle was normal-ish (26 days, ovulation on day 11 as detected by both OPK and temping). However, I had spotting starting CD 22-23 that lasted until my period. This past cycle I ovulated normally on CD 11, but I then began spotting on CD 18 and got my period on CD 23, which is extremely frustrating. My temps stay high until my period comes, so I'm not sure that progesterone levels are my problem with the spotting? Although we've only been trying to conceive for 3 cycles, it seems futile to continue trying with my cycles being all crazy. My OB/GYN didn't seem concerned, but I'm not sure she fully appreciates the difficulty of getting pregnant at my advanced age.....time's-a-wastin'! At my age I don't feel like I have a lot of time to wait and see what happens, especially if no amount of trying will result in pregnancy if something is amiss. Are my cycles too short? Am I ovulating too early? Is the spotting problem? At what point should I see an RE? Is it OK to do so now, or will I be turned away if I haven't waited the requisite 6 months of trying?
AnswerHello Becky from the U.S.,
First, I would strongly recommend that you seek out and start seeing an RE or comparable infertility specialist. You are completely correct on the age factor, and I am saddened to hear that your Gynecologist, who should know better, does not think more seriously about that aspect. At this point, if you were my patient, I certainly would give you the option of a natural treatment option, but I would want to enhance the chances by using controlled ovarian hyperstimulation (also called super-ovulation) to increase the number of eggs you ovulate per month. But, my recommendation would be to consider aggressive therapy because time is critical and I'd hate to see you not be able to achieve pregnancy using your own eggs even with IVF. There are some tests that can be does to give us a gauge of how close you are to that point.
I'm a little concerned that you don't have 14 day luteal phases. Usually the luteal phase should be 14 days by definition. This could be part of the problem, but would most likely be an additional problem, in addition to the age factor (reduced egg quality). The spotting is probably an indication of inadequate luteal phase or some type of hormonal disorder as well.
I would strongly recommend that you go see a specialist as soon as possible.
Good Luck,
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
