QuestionI am 31 years old and have a 3.5 year old that was conceived naturally after 2 months of trying. I had a natural unmedicated delivery but he was induced using pitocin due to being postdate. I exclusively breastfed for 4 months or so and then weaned off completelt by 6 months due to returning back to work. My period started a couple of months later and was normal except for i had some light spotting 1-2 days prior. over the next two years it gradually turned into 4 days prior. I have a 5 day period every 28 days like clockwork and the 4 days of premestrual spotting. we have now been trying to conceive #2 for 18 months and have had the complete fertility work up with no avail. I did try progesterone supplements which lessened the spotting and shortened the days from 4 to 2. We then tried clomid with the progesterone and the spotting went away completely but no pregnancy yet (2 rounds so far). I have positive OPk's every month around day 14 of my cycle. I am healthy, work out, eat a balanced diet and am not overweight by any means. My doctor seems to think it is either endometriosis, a progesterone issue or i may be ovulating immature eggs. I dont have any symptoms of endo except the premenstrual spotting but that went away on the meds. My progesterone levels have always tested normal. Any insight in this?
AnswerHello Jonica from the U.S.,
If you have had a full infertility evaluation and nothing was found, and you have not responded to treatment with Clomid thus far, then I would suspect endometriosis as the culprit. That seems to be the case in the majority of young patients that were fertile previously. I do not agree with the conclusions that it could be a progesterone issue (since you have been getting progesterone) or an immature egg issue (which does not make any sense at all). My recommendation would be to have a laparoscoy done before proceeding any further with treatment. Certainly there are other possibilities but this would be the first step. Again, this assumes you have had ALL the basic infertility testing done.
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
